HIV/AIDS as a National Public Health Priority in Tanzania - Report Example

Running Head: Policy Implementation HIV/AIDS as a National Public Health Priority in Tanzania (Name) (Course) (University) Date of presentation: Lecturer: HIV/AIDS as a National Public Health Priority in Tanzania Introduction HIV infection rates in Tanzania are among the highest in the African continent. It is estimated that thousands of people contract the HIV infection each year in Tanzania, most of them in the poor and often dangerous suburb communities of crowded shacks. Of the many people who become newly infected with HIV, about half are under the age of 20 and most of those living with the infection are less than 60 years. As such, the pandemic seems to have taken a great toll on the country’s productive work force. Perhaps, it is this consideration that the Tanzanian government has made HIV AIDS a national public health priority. Accordingly, the government has stepped up numerous prevention programs such as public education in an attempt to avert this social crisis. Justification for HIV/AIDS being a National Health Priority in Tanzania About 1.2 million people were living with HIV/AIDS in Tanzania in 2010. This number was among the highest compared to neighboring countries. In the same year, it is estimated that more than 100,000 people died from HIV AIDS and related causes, indicating the huge number of lives that the country continues to lose to the scorch. Currently, prevalence rates stand at 9.4% for those in the reproductive age bracket (The Ministry of Health and Social Welfare-Tanzania Mainland, 2007). The high prevalence rate for HIV and AIDS in Tanzania presents particular challenges for the people and the government alike. Undeniably, the spread of HIV in the East African country is connected with several years of large scale labor migration, persistent severe economic, social and gender inequalities and cultural practices which evolve with time to adapt to changing circumstances. The sheer scale of this pandemic as well as its connectedness to the country’s diverse and complex cultural, social and economic structures makes it inevitable to be tackled as a national priority issue. The expressed desire of the government and positive shifts in the political climate to urgently engage with stakeholders including research institutions and the civil society create opportunities for addressing this issue (Roura, 2009). The impact of HIV AIDS on Tanzania’s social and economic structures can be seen not only through massive loss of lives but also in the widespread poverty. The pandemic has had a devastating effect on children. In 2009, there were about 60, 000 children under the age 15 years living with HIV/AIDS. The loss of parents can not only have immense emotional effects on the children but also spells severe financial hardships on the children. By making the HIV pandemic a national priority issue, public health systems and the research community in Tanzania have an imperative to make substantial and creative contribution in combating the epidemic (The Ministry of Health and Social Welfare-Tanzania Mainland, 2007). Currently, national policy practices related to HIV as well as comprehensive public health care are evolving rapidly in Tanzania. A number of government sponsored initiatives are underway, with the aim of dramatically intensifying and accelerating efforts to manage and prevent HIV. This will be achieved within the context of effective, revitalized, efficient and equitable primary health care systems (Hogan et al, 2005). As part of efforts to align with these developments, organizations and institutions in Tanzania are approaching the HIV pandemic from the public health systems perspective and also on teaching, research and practice in public health as field. To this end, the government has been coordinating consultations and reflections aimed at clarifying the strategic directions which would enable stakeholders to align their contributions through research development of policy formulation (Desapriya, 2004). Obstacles to HIV Control in Tanzania The main obstacles to effective HIV control in Tanzania include lack of capacity to do rigorous evaluations and lack of adequate access to coverage and prevention services. The two obstacles are discussed below. i. Lack of Coverage and Access to Prevention Services Effective control of HIV/AIDS pandemic requires a two-front battle, which emphasizes both prevention and cure. Generally, Tanzania has achieved less in both of these two areas. Although HIV treatment services are available in Tanzania, sufficient efforts have not been made to contain the spread of the pandemic or to extend the capability of those infected. In Tanzania as in many other developing countries, the desired level of success in fighting the spread of HIV has not been achieved for a number of reasons. First, control strategies are ineffectively implemented and as a result, most people who could benefit from these services do not have access to them. Current low levels of coverage, together with the relentless spread of the epidemic underscore the urgent need for the government to rapidly scale up preventive initiatives. This is an imperative that the government has acknowledged but which remains to be realized despite continued loss of lives (McCurdy, 2009). The Tanzania government has in the recent past taken initiatives to seek funding from donor countries to fight HIV. In particular, the government seeks to acquire a steady supply of anti-retroviral drugs for the infected people, to get funds for developing its health care systems to be able to provide adequate treatment and preventive services. This move will greatly reduce the spread of HIV in the country besides giving hope to the millions of people infected with the pandemic (Sweat, 2011). Because antiretroviral therapy has for a long time been unavailable in Tanzania (and also in many other less developed countries, particularly in sub-Saharan Africa), national programs have lacked the means to comprehensively approach the HIV/ AIDS pandemic. As a result, Tanzania as a country has not been effective in providing universal coverage for anti-retroviral therapy. Although the prospect of increased access to treatment increases the chances of integrating prevention and care, it also arise new questions about the selection of optimal treatment programs to pair with prevention programs. This is an important obstacle which that the government of Tanzania faces in its efforts to develop preventive solutions for HIV/AIDS pandemic (Roura, 2009). ii. Lack of Rigorous Evaluations Besides poor coverage and lack of access to key interventions, Tanzania also suffers from lack of evidence to guide in the selection of interventions for specific population groups or areas. In the same way that policymakers are increasingly recognizing the need for rigorous evaluation of treatments, the need for rigorous evaluation of prevention programs is also paramount for the same reasons. Generally, the government of Tanzania does not have enough resources to invest in developing these programs (McCurdy et al, 2006). Being a developing country, choices must be made about resource allocation and priorities set. As far as HIV prevention is concerned, this resource deficit is more pronounced and is a major reason for the rapid spread of the disease. Currently, the allocation of resources for HIV/AIDS prevention is not evidence based. This is particularly due to lack of data on the effectiveness as well as the cost of interventions (Hargreaves et al, 2010). In most part of the country, especially rural areas, few evaluations have collected data on HIV infection as an outcome. For this reason, success and failure in treatment and care are quite apparent, leading to likelihood of implementing ineffective preventive policies. Moreover, it is highly unlikely that any infections that occurred in the absence of preventive programs can be monitored. This has in fact reduced the meaningfulness of care and prevention programs. There is thus need for the government, researchers and other stakeholders to proactively take rigorous evaluation to differentiate success from failure in a timely manner. Solid evidence of the effectiveness of HIV prevention can be important in light of the tendency by the government to avoid programs that address drug abuse and sexual behaviours (Garbus, 2004). In addition, it is important that the government steps up prevention studies that incorporate well-defined comparison or control groups so as to identify contextual factors that are necessary for developing sound preventive strategies. Contextual data are very critical for developing effective strategies to combat HIV/AIDS as well as social and gender norms which frustrate attempts to address sexual behaviours which lead to HIV transmission (Desapriya, 2004). The apparent lack of sound evidence and contextual data regarding the effectiveness of different HIV intervention strategies is a major hindrance to efforts by policymakers as well as the abilities to tailor HIV intervention strategies as per the nature and stage of national epidemics. In the absence of such data and evidence, most of the government expenditure on HIV/AIDS intervention may incorporate a large amount of waste as well as premature death of HIV infected persons. HIV Prevention Strategies Employed in Tanzania i. Prevention of mother-to-child transmission The impact of HIV on children has been enormous in Tanzania, although the situation has improved in the last few years. In 2002, around 30% of pregnant were thought to be HIV positive, an indication of the urgent need for the government to implement guidelines to guard against mother to child transmission. Accordingly, the government has initiated a national program that advocates use of various antiretroviral drugs by pregnant mothers. In these guidelines, HIV positive mothers are advised too seek antiretroviral therapy treatments when their CD4 count drops below certain levels. This program has greatly helped reduce chances of mother to child transmission (Desapriya, 2004). ii. AIDS awareness There are numerous large scale communications campaigns aimed at raising awareness about HIV AIDS. These campaigns are being sponsored by the government in collaboration with NGOs and other stakeholders. A principal aspect of the government’s HIV counseling and testing initiative is to scale up awareness of the pandemic at family and community levels. Through these campaigns, the government aims to support the discussions about HIV throughout the country by using the media. Some of the strategies used to facilitate this initiative include publicizing the availability of testing and counseling services in health clinics. These campaigns have greatly helped to scale up HIV awareness especially in rural areas where the pandemic is very severe (McCurdy, 2009). iii. Distribution and Encouragement of Condom usage Usage of condoms is significantly growing in Tanzania. National surveys have shown that young people show the highest rates of condom usage, a factor that bodes well regarding the future of HIV prevention and can partly explain the impressive decline in HIV incidence and prevalence among young adults and teenagers (Cock, Mbori-Ngacha & Marum, 2002). iv. HIV/AIDS and Sex Education Comparative assessment of risk for Tanzania indicates that unsafe sex is the main cause of HIV/AIDS. HIV and sex education have been incorporated into school curriculum and covers topics such as prevention, treatment and nutrition. The quality of education, has however, been hindered due to lack of enough qualified teachers and unwillingness on the part of schools to provide this vital education. In addition, high school drop out rates is a major issue that could potentially compromise the effectiveness of HIV and sex education. It is on this reasoning that the government has directed HIV education programs to young children while they are still in school before some of them drop out of school or become sexually active (McCurdy, 2009). v. Circumcision Several studies of HIV and male circumcision have produced strong evidence to show that the procedure reduces the risks of sexual transmission by over 50% percent. The transmission that is reduced in this case is that from women to men. On the basis of these studies, the government of Tanzania has included voluntary medical male circumcision as an integral part of its counseling and testing campaigns. Sustained support for this campaign is expected to prevent about half a million cases of HIV infections as well as thousands of deaths within a decade (Dixon, McDonald & Roberts, 2002). vi. Sex workers and HIV in Tanzania Sex work contributes greatly to the spread of the HIV pandemic in Tanzania. It is estimated that 20% of new HIV infections are related to sex work and hence the need for the government to address the issue of sex work in its HIV prevention campaigns. Generally, Tanzanian sex workers are often exposed to various factors which make them vulnerable to HIV. They may be subjected to gender-based violence, live in poverty and may inject drugs. The government has however initiated various measures to address the rights as well as prevention needs of this group, which is an important step in preventing the spread of HIV (Roura, 2009). Role of Non-Governmental Organizations (NGOs) and Private Sector Organizations in Fighting the Epidemic For about a decade and half, various non-governmental organizations as well as private sector institutions have been involved in developing policy objectives for combating the spread of HIV/AIDS in Tanzania. Chief among these organizations is the British Red Cross. This institution has been working closely with the government in supporting various HIV prevention programs in the country since 1999. The main focus of the British Red Cross’ initiatives are: to prevent further transmission of HIV and related ailments such as TB; to reduce stigma and discrimination; to support and increase the capacity of the Tanzanian Red Cross and to expand and improve the quality of care, treatment and support given to those infected with HIV (Sweat, 2011). The British Red Cross organizes and facilitates HIV awareness campaigns in different parts of the county. These campaigns are generally aimed at improving the quality of the lives of those people living with HIV and their families more especially the vulnerable children and orphans. The organization also helps the affected people to get access to food, social and health services. The awareness campaigns are conducted by teams of specialist volunteers who deliver structured health education seminars on HIV/AIDS, TB, sexual and reproductive health, gender-based violence issues and related health issues in community-based settings (Fenton, 2004). The British Red Cross works closely with other organizations and institutions to offer youth beer education about HIV/ AIDS. In these education programs, peer educators (mostly aged between 18 and 25 years) are trained to promote positive living and life skills to other young people in communities and schools. Some NGOs are specifically involved in facilitating access to testing and treatment. As an example, the Tanzanian Red Cross runs awareness campaigns encouraging people to go for HIV tests and seek treatment. This important service has helped the people living with HIV to seek early treatment and also to work with the organization in preventing further infections as well as mother-to-child infections. The organization is actively involved in increasing advocacy and championing the rights of the people living with HIV/AIDS (McCurdy, 2009). Conclusion Tanzania still has a long way to go in responding to the HIV pandemic. The country still falls short of what is possible and has lacked the vital progress that has been achieved by its neighbors and countries across the globe. While previous administrations did little to avert the course of HIV pandemic in the country, current efforts in tackling the pandemic are being facilitated by the government although there are still a vast majority of people who still have no access to treatment. Recent trends have shown progressive decrease in infection rates, a notable achievement in the fight against HIV. Nevertheless, far more will have to be done in order to substantially minimize the transmission rates in the country. References Cock, K.M., Mbori-Ngacha, D. and Marum, E. (2002). Shadow on the continent: public health and HIV/AIDS in Africa in the 21st century. The Lancet, 360, 67-72. Desapriya, E.B.R. (2004). Stigma of AIDS needs to be overcome. British Medical Journal, 329, 573-589. Dixon S., McDonald S. and Roberts J. (2002). 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