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Tanzania’s AIDS Truths
***Many Tanzanians still think AIDS is a bewitchment and young people see It as a disease of adutts Julie Flint reports on the battle for information and education.***
Dennis is a geruaJ ->i year-old who Is HIV positive and keeping it quiet for the sake of a bit ol company In his declining years. He separated from his first wife after she ran off to Kenya to work as a prostitute but took her back when she returned. This, he says is how he become Infected
Since his wife s death he has scratched a living cleaning fish In a muddy, stinking inlet on the western bank of l^ke Victoria He helps his new girl out with scraps of fish when she Is hungry — but has not told her he is sick
It la a common enough story. A decade after AIDS was first recorded In northern Tanzania's Kagera province, behaviour does not appear to be changing significantly, al though AIDS awareness is high Adults have changed a little they don't go to bars quite so much - but the young laugh when we'talk to them, says Paschasia Rugumlra. a Tanzanian nurse working for World Vision "Only educated people are giving sex educa tloh at home Kids say AIDS is an adult disease
Stigma is also a problem. Across the border in Uganda Kampala’s remarkable frankness has taken away much of the secrecy surrounding AIDS. But herein Tanzania, where the government has been only marginally less open, many families still deny they have a problem.
"Stigma was huge until 1992." says Gaston Salvatory, a government counsellor based In Bukoba, the capital of Kagera. "It Is decreasing now. with the intraduction of homebased care, because people are seen to .Improve." But group therapy sessions at Bukoba hospital still attract only a handful of people, a fraction of those affected In the town. Dr.-Japhet Killewo. head of epidemiology at Dar es Salaam University, has demonstrated that "the prevalence of HIV infection in Bukoba has remained unchanged since 1987 at roughly 24 %.
This is the region featured by the influential British newspaper The Sunday Times in a two page spread, widely condemned within the medical profession, entitled "The plague that never was". Soon after the article was published, based glmost entirely on anec-dotaL testimony from a "medically trained charity. worker." a Tanzanian newspa-
per dedicated Ils Iron! page to the story under the headline No AIDS
Tanzanians doubt the assertion will have miK-h effect on Bukoba. which has been devas lated by AIDS but are concerned about its impact on ar eas where HIV Infection is still hidden.
One of the most important methods of cornbating HIV Is Information, says Dr Killewo "If this falls, every other method will fail " Dr Ronald Swai. head of the govern-merrt's AIDS Control Pro gramme, says "It's Unfortunate that this has come at this stage
of the epidemic just at 'he lime when people are more willing to come out There is no disease which kills and Incapacitates people like AIDS.
Tanzania » ministry of health predicts that around 2.4 million people will be Infected with HIX’ by the year 2000 As tn other African countries. HIV has brought a resurgence of once controlled epidemics like tuberculosis. Child mortality, which decreased steadily for 20 years, is again increasing
"Mention any ministry or parastatal corporation and they w111 tell you they have lost a
person. says Dr Swal. "We are losing a lot of people now especially chief executives."
Although HIV is devastate many urban areas with wealtly mobile populations, the epidemic varies in strength and, in many rural areas Is still reia ' lively minor Limiting the spread tn these areas where a majority of Africans live. Is one of the major challenges facing governments today
Researchers at the African Medical and Research Foun dation (AM REF) believe the best line of attack lies In targeting high risk groups and say programmes using peer educators have had very en couraging" Initial results. "Four years ago they said Condoms in Africa? You can forget it!"' says AMREF”s Dr Ulrich Laukamm Josten But now there's no doubt that people use condoms. Logistics is the problem. And church leaders continue — at least in public pronouncements — to oppose the use of condoms.
Government officials. doctors and aid workers refute charges that too much is being spent on AIDS control. "Any money you invest now in AIDS, control Is much better spent than 10 years ahead." says Dr Laukamm Josten 'There is k natural curve In the epidemic It will reach a plateau. You can debate whether it will be 10. 20 or 30 %. but It's never be yond 30%. In terms of devel opment. AIDS Is a disaster better skilled people are more affected because they travel As a donor you should say: This is an exceptional event, the number one health problem. So for a period — five or ten years - you concentrate on control, primarily prevention."
After two years' discussion with UNICEF, the Tanzanian government has agreed to introduce sex education for children above the age of 12.1 "Education is vital because older me are looking for younger sexual partners." says Amina All. UNICEF's project office for AIDS. "Many people still believe AIDS Is a bewitchment. It's 10 years on and these people still lack the basic facts. It’s essential they be told the truth."
— World AIDS