Patterns of partnership and condom use in two communities of female sex workers in Tanzania.

Two rapid ethnographic studies have found that commercial sex workers (CSWs) and other high-risk women in Tanzania have different categories of partners, ranging from single-time contacts to long and enduring relationships. Since the advent of HIV/AIDS prevention programs in Tanzania in the late 1980s, CSWs and their clients have been aware of the multiple benefits of condom use for the prevention of pregnancy and STDs including HIV. These women often use condoms for the single-time contact. However, since the HIV/AIDS epidemic, casual partners have decreased in number. These days, most of their sexual contacts occur within long-term partnerships, and within these relationships, condom use is rare. Although the message that condoms should be used during high-risk behavior has been largely accepted, the definition of a high-risk relationship needs to be extended from casual partnerships to include multiple long-term partnerships. In addition, men and women's empowerment through education, business, and equal rights needs to be addressed at all levels of society.

Preventing HIV infection through peer education and condom promotion among truck drivers and their sexual partners in Tanzania, 1990-1993.

HIV prevention through peer education and condom promotion among truck drivers and their sexual partners is described. Trends during an initial 18-month intensive phase, followed by a 24-month maintenance phase, were monitored with surveys. Trends for self-reported condom use were: increase among men (56 to 74%) during the first phase with a decrease (72%) during the maintenance phase. Respective figures for women were 51%, 91% and 70%. Multivariate analyses revealed that men most likely to report using condoms were unmarried, had children, were more educated, had previously reported a genital ulcer, and perceived themselves at risk for HIV infection (OR = 1.95-3.47). Women tending to use condoms were unmarried, aware of the limitations of condoms, not in denial as to the existence of HIV, harboured inaccurate information about HIV transmission and were afraid (OR = 1.35-2.52). Both sets of results suggest that the most sexually experienced men and women who did not have a permanent stable relationship and who perceived themselves at risk, were most likely to use a condom. Peer education was an effective tool for increasing knowledge and encouraging appropriate behaviour change. It was most effective as an intensive high-input intervention and sustainable with the relatively stable population of truck drivers.

STD services for women at truck stop in Tanzania: evaluation of acceptable approaches.

AIDS continues to be the commonest cause of death in Tanzania among those aged between 15 and 45 years. Both ulcerative and non-ulcerative sexually transmitted diseases have been identified as major co-factors in HIV transmission. Certain groups including long distance truck drivers and their sexual partners have been reported as having a disporportionate effect on the transmission dynamics of STD including HIV, in a population. In 1993 African Medical and Research Foundation decided to add an STD component to their HIV/AIDS prevention programme along the Tanzania-Zambia highway which had been targeting truck drivers and their sexual partners through peer education and condom distribution since 1989. A study to evaluate the acceptability and feasibility of four different approaches of delivering STD services, was conducted over a period of one year. The approaches for delivering STD services were: special STD services offered twice a week at a site and at hours of the women's choice, special outreach services once every three months, or STD services integrated into the nearest Primary Health Clinic. Drugs were provided at three of the four interventions. 1,330 women at seven truckstops, participated in the evaluation study. The women were generally satisfied with all approaches that included the provision of drugs. The most expensive and ineffective way of treating STD was by not providing drugs. These findings confirm the fact that it is feasible to provide STD services to women at high risk in HIV high transmission areas. These women would utilise STD services provided in a manner that suits them if mobilised and encouraged by their peer educators.

PIP: Long-distance truck drivers and their sexual partners have a disproportionate effect on the transmission dynamics of sexually transmitted diseases (STDs), including HIV infections, in Tanzania. In 1993, the African Medical and Research Foundation added an STD component (peer education and condom distribution) to its HIV/AIDS prevention program along the Tanzania-Zambia highway. The present study of 1330 women (mean age, 27.3 years) recruited from 7 highway truckstops assessed the acceptability and feasibility of 4 approaches to the prevention of STDs: special STD services offered twice a week at a site and hours chosen by women, special clinic-based outreach services for women once every 3 months, integration of STD services into the nearest primary health care clinic, and provision of STD drugs. Most study participants were local brew sellers (47.2%), bar/guest house attendants (27%), and petty traders (21.1%). The overall HIV prevalence was 50%. Attendance per woman was higher when services were offered outside a health facility (1.23) or at times other than normal clinic hours (1.43) than when STD services were integrated with primary health care (1.0). The total cost per patient was US$11 when the clinic did not provide STD drugs, $12 for special clinic-based services for women, $11.50 for non-clinic-based services, and $11 for the integrated STD/primary health care approach. Women were equally satisfied with the 3 service delivery strategies, but highly dissatisfied when STD-specific drugs were not provided and their infection was not cured.