STD/HIV Intervention and Research Programme Mwanza Region, NW Tanzania J Changalucha, a Gavyole, H Grosskurth, R Hayes, D Mabey
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i91 Sex Transm Infect: first published as 10.1136/sti.78.suppl_1.i91 on 1 April 2002. Downloaded from SYMPOSIUM STD/HIV intervention and research programme Mwanza Region, NW Tanzania J Changalucha, A Gavyole, H Grosskurth, R Hayes, D Mabey ............................................................................................................................. Sex Transm Infect 2002;78(Suppl I):i91–i96 The social determinants and epidemiology of sexually Population distribution transmitted disease (STD) were studied in rural The region had about 1.8 million inhabitants in 1988,1 and about 2.5 million inhabitants in 1999, communities in Mwanza Region, Tanzania, in the based on a population growth rate of 2.6% per context of the phase specific model of STD transmission. annum.3 The population in Mwanza town grows The prevalence of HIV and syphilis was higher in faster than that in rural areas (about 8% per annum), from around 200 000 people in 1988 to communities close to main roads, and lower in almost 500 000 by 1999. The region also has six communities living on islands in Lake Victoria, probably semiurban centres with a population of about reflecting the proportion of high risk individuals in the 20 000 each, serving as district administrative headquarters. The great majority of the popula- population. The prevalence of Herpes simplex virus type tion lives in rural villages or in communities with 2 infection, gonorrhoea, chlamydial infection, and widely scattered compounds. (A compound is a trichomoniasis was similar in all types of community, group of houses occupied by one or more families, and surrounded by their farm land.) reflecting the fact that these infections remain in the hyperendemic phase. The transmission of STDs is fuelled Important demographic data by high population mobility and by the presence of high The total fertility rate in Mwanza Region has been estimated at around 6.9.3 Life expectancy at birth risk individuals in rural as well as roadside communities. is 46 years for women and 50 years for men. .......................................................................... Under-five child mortality was 137/1000 live births during the five years preceding 1996. The wanza Region stretches along the age and sex composition of the population is southern shores of Lake Victoria, the typical of those with high growth rates, with almost 50% of the population under 15 years of largest of the African lakes, and includes M age. The density of population averages 71/km2, the Ukerewe Island archipelago. The area is situ- but varies in rural areas, depending on local soil http://sti.bmj.com/ ated 190–360 km south of the equator, on a pla- fertility. The Ukerewe archipelago is the most teau about 1100 m above sea level. The region densely populated rural district of Tanzania. extends about 260 km from east to west and up to 170 km from north to south. The landscape is Mobility and migration semiarid and comprises mostly cultivated bush- The population of Mwanza town is growing faster land, small areas of marshland, and patches of than that of rural areas, mainly because of net forest. During the rains, many villages become migration from rural to urban areas. Even the on September 24, 2021 by guest. Protected copyright. inaccessible, and even the main long distance rural population is rather mobile. For example, in truck routes may occasionally be blocked for the regional survey of 1990/91, 7% of men and some days. 16% of women reported that they had immi- grated into the study communities during the 4 Population structure and key demographic previous two years. Twenty six per cent of the data study population seen during the baseline survey of the Mwanza trial reported that they had lived Ethnicity elsewhere during the previous five years, and The region is almost entirely occupied by ethnic more than 40% of men and about 30% of women groups of Bantu origin, the Sukuma being the reported having travelled outside their district of See end of article for most numerous. Other ethnic groups from neigh- residence at least once during the past 12 authors’ affiliations bouring regions and other parts of Tanzania ....................... months.5 After two years of follow up, 14% of the including Indians and Arabs, can be found in study cohort were lost to follow up because they Correspondence to: Mwanza town and in centres along the main had migrated out of the community.6 Professor David Mabey, roads, Each ethnic group has its own language, The close links that Mwanza has with other Department of Infectious but Kiswahili is the official national language. and Tropical Diseases, countries provided safe haven for refugees from London School of Hygiene several places in times of distress. In 1994, about and Tropical Medicine, Keppel St, London Religion half a million Rwandese refugees entered the WC1E 7HT, UK; About 70% of the population in Mwanza town are neighbouring Kagera Region within a few weeks [email protected] Christians, 20% are Moslems, and 10% hold other following the events during and after the religious beliefs.1 In rural areas of Mwanza genocide in Rwanda. Most returned to Rwanda in Accepted 30 November 2001 Region, the corresponding figures are 76%, 5%, 1996, but a few thousand remained in Tanzania, ....................... and 29%.2 settling in Mwanza and other large towns of the www.sextransinf.com i92 Changalucha, Gavyole, Grosskurth, et al Sex Transm Infect: first published as 10.1136/sti.78.suppl_1.i91 on 1 April 2002. Downloaded from country, joining the refugees from other neighbouring Commercial sex work is not legalised in Tanzania, but toler- countries who have settled in the area since the early 1960s. ated without much interference by the police or other authorities. This attitude facilitates the implementation of Education intervention programmes. Where sex work exists, it is not Almost all children attend primary school for some time. Rates labelled as such. In Mwanza Region, commercial sex is often of schooling are higher in Mwanza town than in rural parts of provided by bar girls and guesthouse attendants, for whom the region. Most communities have a primary school. The sex work provides additional income. Although there is some adult literacy rate in Mwanza is about 60%. Nationwide, 61% stigma attached to commercial sex, most sex workers are of men and women aged 20 to 24 years completed primary ready to admit that they engage in it, and are open to school, and 13% of young men and 8% of young women com- intervention efforts if these avoid further stigmatisation. pleted secondary school. The number of sex workers in Mwanza town has been esti- mated at around 1500. They operate in and from hotels, guest- Overview of the social, political, and economic situation houses, bars, and around shops that sell local alcoholic bever- The rural population of the region lives mostly on subsistence ages (the so called pombe shops). Similar establishments can farming. Cotton and maize are the main cash crops. be found in the district headquarters, in bus and truck stops Inhabitants of the lake shore communities and of the Ukerewe along the two major highways, and in the mining areas. The islands engage in fishing, farming, or both. Some gold mining number of clients is usually restricted to two or three a week, is carried out in the western part of the region, partly under although sex workers around the mines have reported up to government auspices and partly by small scale miners. In 10 clients a night. recent years, foreign companies have increasingly engaged in There is anecdotal evidence of a much more clandestine the gold mining industry and these developments are likely to variety of sex work, whereby some women in the general bring about major changes in terms of demography, econom- population in Mwanza town and at truck stops engage in ics, and sexually transmitted disease (STD) epidemiology in commercial sex on an occasional basis. This sector is much the years to come. Some industrial development has occurred more difficult to reach through intervention activities. Both in Mwanza town over the past 10 years, comprising fish forms of commercial sex are poverty driven, although the processing factories, boat yards, a cotton ginnery, a textile fac- increased availability of luxury goods and the lack of cash tory, and two breweries. among the less advantaged majority of the population Mwanza town is a major traffic centre, situated at the junc- contributes to prostitution. tion of two important truck and bus routes that link Central From an interventionist point of view, it is important to Africa with Kenya and the coastal parts of Tanzania. Mwanza realise that local and Western concepts concerning commer- is connected with the capital, Dar es Salaam, by rail and road, cial sex differ to some extent. While genuine commercial sex and by shipping lines across the lake with the neighbouring work clearly exists, not all exchange of sex for money or goods Kagera Region and with Uganda and Kenya. The town has an is perceived as “prostitution”, and many men and women airport, offering regular flights to Dar es Salaam, Arusha, Zan- involved would feel offended if their sexual activity were zibar, Nairobi, and Entebbe. labelled as such. Much of it could be better described as an The gross national product (GNP) of Tanzania is US$241 per exchange of favours, mutual assistance, and friendliness. capita. Most families live on less than US$150 a month. Based Clients of sex workers include truck drivers, travellers, and on these figures, Tanzania is one of the world’s most disadvan- miners but also local residents. During a sexual behaviour taged countries. However, GNP data do not fully reflect the survey, only 2% of men from rural communities admitted to 2 value of farm products in an economy that to a large extent having sex with a bar girl or sex worker during the past year.