WORKING PAPER WORKING WORKING PAPER WORKING WORKING PAPER WORKING Prevention Needs and Priorities among Vulnerable Female Populations Living with HIV: The Case of Temeke Municipality, Tanzania January 2017 Prevention Needs and Priorities among Vulnerable Female Populations Living with HIV: The Case of Temeke Municipality, Tanzania Idda M. Swai, MPAFF Dino Woiso Mwanaisha Mnaro January 2018 This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the MEASURE Evaluation–Tanzania United States Agency for International Development (USAID) under the terms of MEASURE Evaluation-Tanzania TCRS Building, associate award AID-621-LA-14-00001. MEASURE 1st Floor, Plot No. 436, Mwai Kibaki Evaluation–Tanzania is implemented by the Carolina Road, Mikocheni B. Population Center at the University of North Carolina at Dar es Salaam, Tanzania Chapel Hill, in partnership with ICF International; John Snow, Inc.; Management Sciences for Health; Palladium; +255 22 277 3023 and Tulane University. Views expressed are not necessarily www.measureevaluation.org/tanzania those of PEPFAR, USAID or the United States government. WP-18-203 ACKNOWLEDGMENTS All of us at Seeds of Hope (SOH) are grateful to everyone who contributed to this research. We thank the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) for funding the study through MEASURE Evaluation- Tanzania and providing technical backstop to the research team. We are especially grateful to Bridgit Adamou, technical advisor with MEASURE Evaluation, University of North Carolina at Chapel Hill, USA. We also wish to thank the participants and heads of the care and treatment centers for the time they set aside for interviews, discussions, and all other forms of tireless cooperation in this research. We recognize the support we received from the National Institute of Medical Research (NIMR), the Temeke municipal director, the Temeke district medical officer, and the Pastoral Services and Activities for People with AIDS Archdiocese of Dar es Salaam (PASADA). We thank the knowledge management team of MEASURE Evaluation for editorial and production services. Prevention Needs and Priorities of Women Living with HIV/AIDS 3 CONTENTS Acknowledgments............................................................................................................................ 3 Contents ........................................................................................................................................... 4 Tables ............................................................................................................................................... 6 Abbreviations ................................................................................................................................... 7 Executive Summary ......................................................................................................................... 8 Introduction ..................................................................................................................................... 9 Background ................................................................................................................................................................... 9 Study Justification ...................................................................................................................................................... 10 Research Objectives .................................................................................................................................................. 11 Methods .......................................................................................................................................... 12 Study Design ............................................................................................................................................................... 12 Study Setting ............................................................................................................................................................... 12 Data Collection ........................................................................................................................................................... 12 Sampling Procedures ................................................................................................................................................. 12 Ethics Review ............................................................................................................................................................. 14 Limitations and Challenges ...................................................................................................................................... 14 Results ............................................................................................................................................. 16 Study Participants’ Demographic Characteristics ................................................................................................. 16 Participants’ Use of Health Services ....................................................................................................................... 20 Use of Family Planning Methods and Services ..................................................................................................... 20 HIV Testing and Counselling .................................................................................................................................. 21 Condom Use ............................................................................................................................................................... 22 Care and Treatment Center Services ...................................................................................................................... 24 Prevention Needs and Priorities for Women Living with HIV ......................................................................... 25 Challenges Facing Vulnerable Female Populations Living with HIV ............................................................... 26 Results from the Focus Group Discussions .......................................................................................................... 27 Understanding of Prevention Needs/Measures ................................................................................................... 27 Application of Prevention Knowledge and Skills ................................................................................................. 28 Biomedical, Social, and Economic Needs and Priorities ..................................................................................... 28 Challenges with Accessing Priority Needs ............................................................................................................. 30 Self-Prevention and Preventing HIV Transmission to Others .......................................................................... 30 Results from Care and Treatment Center Heads .................................................................................................. 31 Discussion .......................................................................................................................................32 Establishing Socioeconomic Prevention Needs and Priorities of Vulnerable Female Populations Living with HIV ................................................................................................................................... 32 Establishing Individual Prevention Needs and Priorities of Vulnerable Female Populations Living with HIV ................................................................................................................................... 33 Identifying Challenges Faced by Vulnerable Female Populations Living with HIV ...................................... 34 Recommendations ..........................................................................................................................35 Pregnant Women ....................................................................................................................................................... 35 Adolescents ................................................................................................................................................................. 35 Female Sex Workers .................................................................................................................................................. 35 4 Prevention Needs and Priorities of Women Living with HIV/AIDS Women and Elderly Women ................................................................................................................................... 36 Conclusion ......................................................................................................................................37 References .......................................................................................................................................38 Appendix A. HIV/AIDS Prevention Intervention Programs .........................................................40 Prevention Needs and Priorities of Women Living with HIV/AIDS 5 TABLES Table 1. Research participants by facility name and type .................................................................................... 16 Table 2. Demographic characteristics of study