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The Adolescent Experience In-Depth: Using Data to Identify and Reach the Most Vulnerable Young People

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The Adolescent Experience In-Depth: Using Data to Identify and Reach the Most Vulnerable Young People THE ADOLESCENT EXPERIENCE IN-DEPTH: USING DATA TO IDENTIFY AND REACH THE MOST VULNERABLE YOUNG PEOPLE TANZANIA 2009-2012 The Adolescent Experience In-Depth: Using Data to Identify and Reach the Most Vulnerable Young People Tanzania 2009-2012 Population Council New York, New York USA Tanzania Commission for AIDS (TACAIDS) Dar es Salaam, Tanzania Zanzibar AIDS Commission (ZAC) Zanzibar, Tanzania United Nations Children’s Fund (UNICEF) Dar es Salaam, Tanzania ii The Population Council confronts critical health and development issues—from stopping the spread of HIV to improving reproductive health and ensuring that young people lead full and productive lives. Through biomedical, social science, and public health research in 50 countries, we work with our partners to deliver solutions that lead to more effective policies, programmes, and technologies that improve lives around the world. Established in 1952 and headquartered in New York, the Council is a nongovernmental, nonprofit organization governed by an international board of trustees. Population Council 1 Dag Hammarskjold Plaza New York, NY 10017 USA Tel: +1 212 339 0500 Fax: +1 212 755 6052 email: [email protected] popcouncil.org Suggested citation: Population Council, Tanzania Commission for AIDS (TACAIDS), Zanzibar AIDS Commission (ZAC), and UNICEF Tanzania. 2015. The Adolescent Experience In-Depth: Using Data to Identify and Reach the Most Vulnerable Young People, Tanzania 2009-2012. Dar es Salaam: Population Council, TACAIDS, ZAC and UNICEF Tanzania. iii Table of Contents FOREWORD VII ACKNOWLEDGEMENTS VIII LIST OF ACRONYMS IX TECHNICAL NOTES 1 MAP OF TANZANIA 3 EXECUTIVE SUMMARY 4 1. MAPPING THE DIVERSITY OF ADOLESCENTS 7 1.1. Population Distribution 7 1.2. Parental Co-Residence in Household 7 1.3. Parental Survival (Orphan Status) 9 1.4. Education 11 1.4.1. Current School Attendance 11 1.4.2. Current School Attendance by Year of Age and Gender 14 1.4.3. In School and in the Recommended Grade for Age (GFA) 16 1.4.4. Current School Attendance by Household Wealth Quintile 18 1.5. Illiteracy 18 1.6. Marital Status among Females 19 1.6.1. Marital Status by Household Wealth Quintile 21 2. KEY EXPERIENCES IN ADOLESCENCE THAT CAN CONTRIBUTE TO DISADVANTAGE 22 2.1. Adolescents Not in School and Not Living with Parents 22 2.2. Illiteracy and Marriage before Age 15/18 23 2.3. School Attendance, by Marital and Childbearing Status 23 3. CONTEXT OF SEXUAL ACTIVITY 24 3.1. Age at First Marriage or Union among Females 24 3.2. Age at First Sex 26 3.2.1. Age at First Sex by Household Wealth Quintile 27 3.3. Pregnancy and Childbearing among Females 27 3.3.1. Pregnancy Status by Household Wealth Quintile 28 3.3.2. Childbearing Before Ages 15 and 18 among Females 28 3.4. Age Difference between Current Partners 29 iv 3.5. Gender Norms related to Domestic Violence 29 4. EXPOSURE TO VIOLENCE 31 4.1. Forced First Sex 31 4.1.1. Age of First Forced Sex 32 4.1.2. Perpetrators of First Forced Sex 33 4.2. Ever Experience Sexual Violence 34 4.3. Experience of Physical Violence 35 4.4. Combinations of Violence Experienced 37 4.5. Perpetrators of Sexual Violence 39 4.6. Perpetrators of Physical Violence 40 4.7. Violence during Pregnancy 41 4.8. Orphan Status and Exposure to Violence 42 5. HIV/AIDS: KNOWLEDGE AND PREVALENCE 44 5.1. Knowledge of HIV Prevention Methods 44 5.2. Comprehensive HIV Knowledge 46 5.3. Knowledge of Prevention of Mother-to-Child HIV Transmission (PMTCT) 48 5.4. Attitudes Towards People Living with HIV/AIDS 50 5.5. HIV Testing and Counselling 53 5.6. HIV Prevalence 55 6. SEXUAL RISK BEHAVIOURS 59 6.1. Multiple Sexual Partners and Condom Use 59 6.2. Paid Sex in Last 12 Months and Condom use (Males) 60 6.3. Attitudes Towards Negotiating Condom Use with Husband 61 6.4. Condom Use During Premarital Sex 62 7. REPRODUCTIVE AND MATERNAL HEALTH 64 7.1. Current Contraceptive Use by Marital Status 64 7.2. Antenatal Care During Most Recent Pregnancy 64 7.3. Birth Attendance During Delivery 65 8. EXPOSURE TO MASS MEDIA 66 v 9. GEOGRAPHIC HOTSPOTS 70 Female Hotspots (Extreme) 72 Female Hotspots (Moderate) 73 Male Hotspots (Moderate) 74 10. POLICY, PROGRAMMATIC AND RESEARCH RECOMMENDATIONS 75 11. REFERENCES 77 12. ANNEXES 80 vi FOREWORD Adolescents (10-19 years) have been recognized as one of the groups most vulnerable to HIV transmission, and comprise 23% of the Tanzanian population. The Joint United Nations Programme on HIV and AIDS (UNAIDS) and UNICEF agreed on June 6 2014 to co-lead a multi-partner effort to put this crisis on the radar of policymakers and articulate a bold, clear, and achievable plan to elevate collective actions to close the prevention and treatment gap among adolescents. The All In! initiative towards ending the adolescent AIDS epidemic was announced on 20 July 2014 by UNAIDS Executive Director (Michel Sidibe) at the International AIDS Society Conference in Melbourne, Australia. In order to achieve the above, programmes and policies meant to improve the well-being and life opportunities of adolescents are urgently needed to take action on HIV and AIDS in young people in order to mitigate the impact of the HIV epidemic. At the same time, there is limited information to facilitate informed decisions on advocacy, monitoring, resource mobilization and allocation. The available data on adolescents are not disaggregated and analysed to support evidence-based programming, particularly in regards to younger adolescent girls. The objectives of the secondary data analysis/triangulation presented here were to analyse approximately 40 key indicators related to knowledge, attitudes and behaviours and outcomes (including living arrangements, school attendance, illiteracy, marriage, pregnancy, violence and HIV) of females and males ages 10-14, 15-19 and 20-24 years, to determine their specific vulnerabilities at national and regional levels, where possible. The report Adolescent Experience in Depth: Using Data to Identify and Reach the Most Vulnerable Young People, Tanzania 2009–2012 presents the findings from the in-depth analysis of data from the Tanzania Demographic and Health Survey (TDHS) 2010, the Tanzania HIV and Malaria Indicator Survey (THMIS) 2011-12, and the Violence Against Children in Tanzania Survey (VACS) 2009, to provide evidence for the specific vulnerabilities of male and female young people. The tables and text contained in this report cover many of the most important indicators and should be used by policy makers and programme implementers to evaluate their activities and plan future directions. We hope that stakeholders take advantage of this valuable information to inform policy formulation, planning, monitoring, and evaluation of HIV and AIDS, health and nutrition, education, child protection, and social protection programmes. Dr. Fatma H. Mrisho Dr. Omar Shauri EXECUTIVE CHAIRPERSON EXECUTIVE DIRECTOR Tanzania Commission for AIDS Zanzibar AIDS Commission vii ACKNOWLEDGEMENTS The report Adolescent Experience in Depth: Using Data to Identify and Reach the Most Vulnerable Young People, Tanzania 2009–2012 is only possible because of the extensive research carried out during the 2010 Tanzania Demographic and Health Survey, the 2011-2012 Tanzania HIV/AIDS and Malaria Indicator Survey, and the 2009 Violence Against Children in Tanzania Survey. In addition, this report could not have been generated without the invaluable technical support of the Population Council and technical and financial assistance from the United Nations Children’s Fund (UNICEF). This report represents a collaborative effort of many stakeholders from other organizations and individuals whose participation is acknowledged with gratitude, particularly: the Ministry of Health and Social Welfare (MoHSW); the Ministry of Community Development, Gender and Children (MCDGC); the Zanzibar AIDS Commission (ZAC); the National Bureau of Statistics (NBS); the Office of Chief Government Statistician (OCGS-Zanzibar); the United Nations Fund for Population (UNFPA); the United States Centers for Diseases Control and Prevention (CDC); and the United States Agency for International Development (USAID) in Tanzania. The Tanzania Commission for AIDS (TACAIDS) and the Zanzibar AIDS Commission (ZAC) would like to acknowledge and extend gratitude to the Adolescent Study Reference Group, which provided technical oversight of this the report. The team comprised Dr. Alison Jenkins, Ms. Victoria Chuwa, Ms. Edith Mbatia and Mr. Tumaini Charles (UNICEF Tanzania); Mr. Deogratius Malamsha and Ms. Elinzuu Nicodemo (NBS); Ms. Mayasa M. Mwinyi (OCGS-Zanzibar); Ms. Nuru Mbarouk and Mr. Said Othman (ZAC); Dr. Aroldia Mulokozi, Dr. Samwel Sumba and Dr. Subilaga K. Kaganda (TACAIDS); Dr. Majaliwa Marwa and Ms. Amina Kheri (UNFPA); Mr. Mathias Haule (MCDGC); and Mr. Clement Kihinga and Dr. Elizabeth Mapella (MoHSW). From the Population Council, Ms. Katharine McCarthy contributed to the writing of the narrative, data analysis, and production of the data tables associated with the report, while Dr. Kelly Hallman provided intellectual leadership and the policy summary. We also acknowledge Ms. Judith Bruce for her creative input and review of the report, and Ms. Michelle Chau for her assistance with the technical analysis. Also thanked for invaluable contributions are: Mr. Mlemba Abassy Kamwe (NBS); Ms. Yolande Baker, Ms. Birgithe Lund-Henriksen and Mr. Ayoub Kafyulilo (UNICEF Tanzania), Dr. Judith Diers (UNICEF HQ); Ms. Kathryn Kaplan (CDC); Ms. Maggie Bangser and Dr. Mary Plummer (independent consultants). Finally, useful feedback received during a January 2015 national validation meeting of the preliminary report helped to refine and improve this final report, particularly its recommendations section. We are very grateful to the 73 individuals who participated in that meeting, including those representing the Mainland and Zanzibar governments (MESWYWC, MIYCS, MOEVT, MOHSW/NACP, OCGS, PMO-RALG, WHUUM); development partners (DfID, UNFPA, UNICEF); international NGOs (Africare, DSW, EngenderHealth, EQUIP, FHI 360, ICAP, JHPIEGO, JHU/CCP, PACT, PSI); and Tanzanian CSOs and other partners (CHAI, Femina-HIP, NACOPHA, Restless Development, TAYOA, THPS, T-MARC, UDSM, ZALA, ZAPHAY, ZAYEDESA, ZHAI, ZIHTLP).
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