Condom holes, stigma and 2nd class citizens: AIDS in Tanzania

I've spent most of this week talking to lots of doctors, nurses, specialists and local people about AIDS in Tanzania. For my masters dissertation I'm trying to gather enough information to compare access to ARV treatment (AIDS treatment drugs) in Mwanza region to Metropolitan Washington DC. Getting anything done here takes far more time than I had imagined, and it is only after being here for a few weeks that I am just now managing to successfully meet with people. This week has been an eye opening experience.

On Monday I met with Singira, a doctor at a local dispensary, who told me that the biggest problem by far is that people are afraid of the stigma associated with being HIV+. Singira said that men who contract HIV are usually affluent and well connected. They fear that the community will discover they have AIDS and shun them, so they don't seek treatment even when they obviously have AIDS. When they become very sick, they would rather stay home and die than have the communities know they have AIDS and get treatment. Biologically, women are two to six times more likely to be infected through heterosexual sex with an infected man than a man would be with an infected woman. This usually (although not always) means that men infected with the virus have access to sexual relations with more women because they are wealthier and can attract more partners or can pay for sex, and have therefore been exposed more times. It also means that once they are infected, they can spread the virus more easily to more women.

In Tanzania, women are made much more vulnerable to infection through lack of empowerment and cultural practices that render women more at risk. Women’s initial biological risk increases with each cut or scrape that occurs during sex. Patrice, a staff member of Hisani, told me that FGM (female genital mutilation) is common in rural areas, that 'dry sex' is encouraged to increase male pleasure, and that forced sexual encounters is the norm. These practices are often caused and encouraged by the belief that removing women's desire for sex will keep them faithful. According to Dr. Kabole at AMREF, HIV prevalence rates in Mwanza region are something like 2-4% of all men and about 16-20% of women.

Patrice, two local health workers and I discussed trying to stop the spread of HIV over lunch. I was shocked when the men told me they had never used condoms and asked whether or not they were effective. In the region with one of the highest HIV prevalence rates in the world, health workers didn't believe themselves that condoms worked, and wanted to know what they could tell people who asked the same question. They were dubious about the effectiveness of something that could be destroyed by oil and told me that when you fill a condom with water, some water would form on the outside so there muct be holes in the condoms which the virus could pass through. I tried to explain that water on the outside was most probably caused by condensation, like a glass of water on a hot day, and that condoms are the most effective prevention technique we have. I asked them was it better to use something that has a 3% failure rate or something that has 100% failure rate. They were not entirely convinced so I have promised to bring condoms and air temperature water to the office to try and prove that the water does not go through holes in the condom. We talked for several hours, and all of us agreed that effective prevention techniques were missing and necessary to stop the spread of HIV.

Despite all the depressing things I've heard this week, Dr. Kabole made me feel hopeful this morning. She told me about an exciting microbicide pilot programme that is about to be started in Mwanza region. Microbicides are not yet available, but would prevent the sexual transmission of HIV and other sexually transmitted diseases when applied topically. They would give women the power to protect themselves, and have been very well received in Tanzania, with 98% of the women surveyed enthusiastic about participating in an effectiveness trial. Let's hope development can be sped up and microbicides in general use as soon as possible: millions of lives are at stake.

For more info on anything in this post, please email me: I would be more than happy to answer questions.