International Union Against Tuberculosis and Lung Disease Public Health Action Health solutions for the poor VOL 11 NO 2 PUBLISHED 21 JUNE 2021 Knowledge, awareness and use of HIV services among the youth from nomadic and agricultural communities in Tanzania E. Ngadaya,1 G. Kimaro,1 A. Kahwa,1 N. P. Mnyambwa,1 E. Shemaghembe,2 T. Mwenyeheri,1,3 A. Wilfred,1 S. G. Mfinanga1 http://dx.doi.org/10.5588/pha.20.0081 Despite recent advancements in treatment strategies, AFFILIATIONS BACKGROUND: Nomadic life not only prevents the 1 Muhimbili Medical many people with HIV or at risk for HIV still do not Research Centre, National community from accessing and utilising HIV services but have access to HIV services. This is particularly true for Institute for Medical also deters them from obtaining reliable information on Research, Dar es Salaam, sub-Saharan Africa, where a considerable population in- Tanzania HIV. fected with HIV are unaware of their status and, once di- 2 Department of Sociology METHODS: We conducted a cross-sectional study of agnosed, experience high rates of loss to follow-up. In and Anthropology, youth aged 10–24 years from the Kilindi and Ngoron- University of Dar es Tanzania, 5.1% of its population is HIV-infected, while Salaam, Dar es Salaam, goro Districts in Tanzania to assess knowledge, accessibil- 2% of youth aged 15–24 years are HIV-positive.6 The sex- Tanzania ity and utilisation of HIV/AIDS services among nomadic 3 Centre for Disease Control ual debut of adolescents in Tanzania has been reported and Prevention, Dar es and agricultural youths. to be as low as 9 years; hence, the higher risk of acquir- Salaam, Tanzania RESULTS: Of 518 youths interviewed, 279 (53.9%) were ing HIV/AIDS and other sexually transmitted diseases.7 CORRESPONDENCE males, and 276 (53.3%) were from agricultural commu- Although there has been an increase in knowledge Correspondence to: Esther nities. A significant proportion of youths from agricultural Ngadaya, Muhimbili Medical among the youth (15–24 years), comprehensive and ac- Research Centre, National communities had correct knowledge of AIDS (n = 126, curate understanding of HIV remain below average.8 Institute for Medical 45.8%; P = 0.002), HIV transmission (n = 273, 98.9%; P = Research, Dar es Salaam, Nomadic communities constantly change loca- Tanzania. email: engadaya@ 0.001) and comprehensive knowledge of HIV/AIDS (n = tions; ensuring the accessibility of HIV services to yahoo.com 78, 28.5%; P = 0.009) compared to nomads. Youths these communities might thus prove challenging than ACKNOWLEDGMENTS from agricultural communities were two times (OR 1.8, when dealing with communities in permanent settle- This research was supported by the Global Fund Round 8 95% CI 1.2–2.6) more likely to be aware of the availabil- 9 ments. Inadequate access to comprehensive sex edu- through Health Users Trust ity of formal HIV services. Awareness of the availability of cation among youths who are sexually active under- Fund of Tanzanian National HIV services was higher among married individuals than Institute for Medical mine efforts aimed at protecting them from Research, Dar es Salaam, in unmarried ones (OR 3.8, 95% CI 2.0–7.4), and signifi- contracting HIV through access to high-quality HIV Tanzania. cantly higher among youths with secondary/college edu- 9,10 Data analysed in this study services. Utilisation of the HIV services can also be have been included in this cation than in those who did not have formal education hampered by limited financial resources, lack of article, except some datasets (OR 5.3, 95% CI 2.3–12.4). The uptake of HIV services health care facilities and poor means of transport.11 which may be obtained from was lower among nomadic youths. the corresponding author on The availability and accessibility of HIV/AIDS services, reasonable request. CONCLUSION: Knowledge, awareness and utilisation of coupled with raising awareness among children ap- Conflict of interests: none declared. HIV/AIDS transmission services were low in general, and proaching sexual maturity, offer the best hope in HIV even lower among nomadic youths, calling for more tar- prevention. This article highlights the difference in KEY WORDS geted interventions. youth; nomadic; terms of HIV knowledge, awareness, accessibility, and agriculturalist; HIV/AIDS utilisation of HIV services among youths from no- madic and agricultural communities as a means to un- dolescents and young people represent a signifi- derstanding barriers to the optimal utilisation of HIV/ Acant proportion of people living with HIV world- AIDs services among such communities. wide.2 Adolescence is a dynamic developmental phase that is associated with significant physiological and psychosocial changes that may, to some extent, con- METHODS tribute to increased HIV/AIDS risk, especially when This was a cross-sectional study conducted in 2010 in- there is poor and limited availability of healthcare ser- volving youths from nomadic and agricultural commu- vices.1 In 2019 alone, 460,000 young people aged 10– nities living in the districts of Kilindi (Tanga Region) 24 years were newly infected with HIV, of whom and Ngorongoro (Arusha Region) in Tanzania. We used 170,000 were adolescents aged 10–19 years.2 This wor- both qualitative and quantitative data collection ap- rying global trend is even worse in sub-Saharan Africa, proaches. The study was conducted at three different where young and adolescents, especially women con- levels: health care facilities, schools (secondary and pri- tinue to be disproportionately affected by HIV.3 Ado- mary) and at the community level. Data were collected lescents, especially those living in poverty, are at using semi-structured interviews of youths aged 10–24 heightened risk for HIV/AIDS, and the majority drop 4 years and in-depth interviews with key informants (KIs). Received 9 December 2020 out of school to help their families survive. Many Accepted 2 March 2021 women get pregnant or give birth before the age of 18; Study areas three times more cases are therefore reported from ru- The study was conducted in Ngorongoro and Kilindi PHA 2021; 11(2): 69–74 ral areas and poor communities.5 Districts in Arusha and Tanga Regions, respectively. e-ISSN 2220-8372 Public Health Action HIV services among nomadic youth in Tanzania 70 Kilindi (area: 6444 km2; population: 236,833)12 is one of the eight ordinators, council multi-sectorial HIV/AIDS coordinators and vil- districts of Tanga Region, located in the north-east of Tanzania lage leaders. We collected information on the availability, and bordered to the east by the Handeni District and Handeni accessibility, and utilisation of HIV/AIDS services among youth Town Council, to the north and west by the Kilimanjaro Region and any perceived hindering factors. and the south by the Morogoro Region. Sample size Ngorongoro District (area: 14,036 km2; population: 174,278)12 A minimum sample size of 572 respondents from both Kilindi is one of the five districts of the Arusha Region, located in north- and Ngorongoro Districts was calculated using a proportion of ern Tanzania and bordered to the north by Kenya, to the east by 45% of youths with comprehensive knowledge about HIV/AIDS6 Monduli District, to the south by the Karatu District and the west at 80% power of a test, marginal of error 5% and 1.5 design effect by the Mara Region. The district is mainly inhabited by Maasai to clear variations between clusters. The sample size was then ad- people whose major socio-economic activity is pastoralism. justed by adding a non-response rate of 10% making a total of 628 respondents. Sampling procedure and data collection Selection of adolescents Data collection The two districts of Ngorongoro and Kilindi were purposefully se- Semi-structured questionnaires were used to collect information lected due to the presence of both cultivators and pastoralists. Vil- on HIV/AIDS awareness and service availability, accessibility and lages in the districts were listed based on predominant economic utilisation among youths. In-depth interview guides were used to activities (cultivators vs. pastoralists) to ensure mutual exclusivity gather the desired HIV services-related information from the KIs of the population study. Four villages were randomly selected in and health service providers. Before the actual data collection, Ngorongoro: two villages with the majority of cultivators and the pre-testing was performed to validate the questionnaire tool. remaining two villages where the majority were pastoralists. Nine Data management and analysis villages were selected in Kilindi District, of which five villages had Quantitative data analysis a large proportion of cultivators, whereas the remaining four vil- Data were double-entered and cleaned using EpiData v3.1 (Epi- lages had a large proportion of pastoralists. In the selected vil- Data Association, Odense, Denmark). For open-ended responses, lages, we conducted interviews with both in-school and out-of- the study team coded the responses before the actual analysis. school youths (i.e., have either never been to school or have Cleaned data were exported to Stata v3.1 (Stata Corp, College Sta- completed their primary or secondary schools, or were school tion, TX, USA) for analysis. Cross-tabulation using the χ2 test was dropouts). To gain access to both in-school and out-of-school performed to assess the relationship between dependent variables youths, interviews were conducted at schools and in the commu- and explanatory variables. For all variables with a P value of nity. Primary students aged 10–14 years were conveniently se- 0.05, univariate analysis was performed to examine the odds of lected to participate in the study, while all secondary school one outcome for an explanatory variable which includes the classes were eligible for sampling and participation in the study.