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ETD Template FACTORS INFLUENCING ADHERENCE TO HIV/AIDS TREATMENT AND PREVENTION AMONG PEOPLE LIVING WITH HIV/AIDS IN DAR-ES-SALAAM TANZANIA by Theresa J. Kaijage Bachelor of Arts, BA (Ed), University of Dar-es-Salaam, 1978 Master of Social Work (MSW), Washington University, 1985 Master of Public Health (MPH), University of Pittsburgh, 2004 Submitted to the Graduate Faculty of the School of Social Work in partial fulfillment of the requirements for the degree of Doctor of Philosophy University of Pittsburgh December, 2004 UNIVERSITY OF PITTSBURGH SCHOOL OF SOCIAL WORK This dissertation was presented by [Theresa J. Kaijage] It was defended on [December 2, 2004] and approved by [Esther Sales, Ph.D., School of Social Work] [Gary F. Koeske, Ph.D., School of Social Work] [Anthony J. Silvestre, Ph.D., Graduate School of Public Health] [Sandra Wexler, Ph.D., School of Social Work] Dissertation Director ii FACTORS INFLUENCING ADHERENCE TO HIV/AIDS TREATMENT AND PREVENTION AMONG PEOPLE LIVING WITH HIV/AIDS IN DAR-ES-SALAAM TANZANIA Theresa J. Kaijage, Ph.D. University of Pittsburgh, 2004 There is a need to sustain African people living with HIV/AIDS (PLHAs) in good health for as long as possible, while at the same time preventing further risks of HIV transmission to self and others. Living with a HIV diagnosis creates what I have called HIV status stress. Using a HIV Status Stress Scale and an Adherence to HIV/AIDS Treatment and Prevention Scale that were developed for this investigation, along with two existing measures--the Sources of Social Support Scale and the Multidimensional Health Locus of Control Scale, this study sought to determine adherence to HIV/AIDS treatment and prevention among 212 participants randomly selected from two non-profit organizations in Dar-es-Salaam, Tanzania. Study findings highlight the direct effect of HIV status stress on decreased adherence to treatment and prevention regimes and on increased sexual risk behaviors. Informal social support was found to buffer the impact of HIV status stress on sexual risk. These findings hold important implications for public health and social work practice. iii TABLE OF CONTENTS ACKNOWLEDGEMENT ............................................................................................................. ix 1. CHAPTER ONE: INTRODUCTION..................................................................................... 1 1.1. HIV/AIDS in Tanzania ................................................................................................... 3 1.1.1. AIDS Service Organizations................................................................................... 4 1.2. Theoretical Background to the Problem ......................................................................... 7 1.3. The Current Study........................................................................................................... 9 1.3.1. Significance of the Current Study......................................................................... 10 2. CHAPTER TWO: TANZANIA PAST AND PRESENT..................................................... 12 2.1. A Brief History of Tanzania ......................................................................................... 14 2.1.1. The Pre-Colonial Period ....................................................................................... 14 2.2. The Arrival of the Europeans and the Advent of Colonialism ..................................... 15 2.2.1. Portuguese East Africa................................................................................................ 15 2.2.2. German East Africa..................................................................................................... 17 2.2.3. The British Rule.......................................................................................................... 19 2.3. Post-Colonial Tanzania................................................................................................. 21 2.4. Health Care and Social Services: Distribution, Delivery, and Implications for HIV/AIDS................................................................................................................................. 24 2.4.1. Health Services ..................................................................................................... 24 2.4.1.1. Village health facility........................................................................................... 26 2.4.1.2. Dispensary............................................................................................................ 26 2.4.1.3. Health center. ....................................................................................................... 26 2.4.1.4. District hospital.................................................................................................... 27 2.4.1.5. Regional hospitals................................................................................................ 27 2.4.1.6. Consultancy hospitals. ......................................................................................... 28 2.4.2. Social Services...................................................................................................... 30 2.4.2.1. Ministry of Agriculture and Food Security.......................................................... 31 2.4.2.2. Ministry of Community Development, Women and Children (MCDWC). ........ 31 2.4.2.3. Ministry of Education and Culture. ..................................................................... 32 2.4.2.4. Ministry of Labor, Youth, and Sports Development. .......................................... 33 2.5. HIV/AIDS in Dar-es-Salaam ........................................................................................ 34 2.6. Summary....................................................................................................................... 37 3. CHAPTER THREE: THEORY ............................................................................................ 38 3.1. Stress Theory ................................................................................................................ 39 3.1.1. Stressors ................................................................................................................ 41 3.1.2. HIV Status Stress .................................................................................................. 42 3.2. Social Support Theory .................................................................................................. 45 3.2.1. Stress and Social Support in HIV/AIDS............................................................... 49 3.3. Health Locus of Control................................................................................................ 52 3.4. Study Hypotheses.......................................................................................................... 54 iv 4. CHAPTER FOUR: METHODOLOGY ............................................................................... 57 4.1. Study Sample ................................................................................................................ 57 4.2. Instrumentation ............................................................................................................. 59 4.2.1. HIV Status Stress Scale ........................................................................................ 59 4.2.2. Health Locus of Control Scale.............................................................................. 60 4.2.2.1. Factor analysis. .................................................................................................... 61 4.2.3. Sources of Social Support (SOSS) Scale (Informal and Formal)......................... 62 4.2.4. Demographic and Background Information ......................................................... 66 4.2.5. Translation ............................................................................................................ 68 4.2.6. Pre-testing ............................................................................................................. 68 4.3. Data Collection ............................................................................................................. 69 4.3.1. Training of the Research Assistants...................................................................... 70 4.4. Protection of Human Subjects ...................................................................................... 70 4.5. Analytic Plan................................................................................................................. 71 5. CHAPTER FIVE: STUDY RESULTS................................................................................. 73 5.1. Description of the Study Sample .................................................................................. 73 5.1.1. Demographic and Background Characteristics..................................................... 73 5.1.2. Health Status ......................................................................................................... 78 5.1.3. Involvement with AIDS Service Organizations ................................................... 81 5.2. Descriptive Analyses of Study Variables ..................................................................... 82 5.2.1. Univariate Statistics .............................................................................................. 82 5.2.1.2. HIV status stress (HSS) Scale.............................................................................
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