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Yamanis TNJ, Mulawa MI, Kilonzo MN, Maman S, Singh B, Kajula L. Reaching Out-of-school Adolescent Girls and Young Women at Risk for HIV Through Their Social Networks. AIDS Behav 2024; 28:1457-1468. [PMID: 37725236 DOI: 10.1007/s10461-023-04168-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
Out-of-school adolescent girls/young women (AGYW) in Africa are at increased risk for HIV and are underserved by HIV prevention interventions. Identifying social networks of out-of-school AGYW may be a strategic approach for reaching them. A sequential mixed methods study design was used. The PLACE (Priorities for Local AIDS Control Efforts) methodology, implemented in one ward of Dar es Salaam, Tanzania, identified 69 networks of AGYW. We randomly selected 28 networks and conducted surveys and network assessments with 80.9% (n = 310) of the members. On average, the networks consisted of 13.7 members, and had a density of 0.65 and a transitivity of 0.80, indicating high cohesion. The networks were mostly female (92%). On average, 67% of network membership were AGYW aged 15-24 years, of whom 70% were out-of-school and 67% were sexually active. Among sexually active AGYW aged 15-24, self-reported HIV seropositivity was 12.2%. We then conducted focus group discussions with 6 purposively selected networks. AGYW described their networks as sources of support and advice. Social norms supported AGYW engaging in transactional sex to alleviate life's hardships; it was the easiest way to earn income without "sweating". AGYW discussed IPV as a common experience, and social norms stigmatized AGYWs' use of condoms. AGYW were largely unaware of pre-exposure prophylaxis. The self-reported HIV prevalence rates of this cohort were higher than national averages, suggesting we tapped into high-risk networks. Social norms promoted transactional and unprotected sex. Social networks are an acceptable channel for HIV prevention intervention delivery to out-of-school AGYW.
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Affiliation(s)
- Thespina Nina J Yamanis
- School of International Service, American University, 4400 Massachusetts Ave NW, Washington, DC, 20016, United States of America.
| | - Marta I Mulawa
- School of Nursing, Duke University, Durham, NC, United States of America
| | - Mrema Noel Kilonzo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Lusajo Kajula
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Empathea Consulting, Dar es Salaam, Tanzania
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Rogers K, Kajula L, Kilonzo MN, Palermo T, Ranganathan M, Collins RL, Livingston JA, Yamanis T. 'You are looked upon as a luxury tool': Young Tanzanian women's perception of community norms supporting partner violence during transactional sex ( kudanga). Cult Health Sex 2024:1-16. [PMID: 38669268 DOI: 10.1080/13691058.2024.2339280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 04/02/2024] [Indexed: 04/28/2024]
Abstract
This paper explores the definition of, and perceived community attitudes, toward kudanga, a Swahili street term for a type of transactional sex practised in Dar es Salaam, Tanzania. Rooted in economic and gender disparity, transactional sex increases adolescent girls' and young women's vulnerability to HIV and gender-based violence. We sought to understand perceived community attitudes about kudanga, and how the internalisation of norms surrounding gender-based violence relate to the experiences of young women who practise kudanga. Using qualitative data from focus group discussions with 37 young women, we found that community perceptions of kudanga were largely negative, and those who engaged in it were looked down upon and despised. Violence and lack of sexual agency were normalised when doing kudanga. However, young women understood kudanga to often be their best option to obtain economic stability and felt strongly that those who practised kudanga should not be stigmatised. Our research provides further evidence that transactional sex exists on a continuum and highlights the importance of reducing community stigma surrounding transactional sex as a means of decreasing risk of HIV and gender-based violence for young women. To our knowledge, this article is the first to explore kudanga.
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Affiliation(s)
- Kate Rogers
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | - Lusajo Kajula
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania and Gillings School of Global Public Health, UNC-Chapel Hill, NC, USA
| | - Mrema Noel Kilonzo
- UNICEF Office of Research, Innocenti, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tia Palermo
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA
| | | | - R Lorraine Collins
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | | | - Thespina Yamanis
- School of International Service, American University, WA, DC, USA
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Zuilkowski SS, Quinones S, Kihanzah H, Marwerwe G, Prencipe L, Kajula L, Palermo T. Economic vulnerabilities, mental health, and coping strategies among Tanzanian youth during COVID-19. BMC Public Health 2024; 24:577. [PMID: 38388862 PMCID: PMC10885560 DOI: 10.1186/s12889-024-18074-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/12/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has exacerbated struggles for youth living in poor households. Youth in rural Tanzania are particularly vulnerable given widespread poverty, lack of formal sector employment opportunities, and health risks. We examine influences of the pandemic on economic insecurity and mental health and explore the coping strategies employed by youth and their households. METHODS We conducted mixed-method data collection with youth (N = 760 quantitative and N = 44 qualitative interviews) and households (n = 542) via mobile phone among a sub-set of a cohort from an on-going longitudinal sample in two rural regions in Tanzania. In addition to phone interviews, we collected data bi-weekly via SMS messaging. We present mixed-methods, descriptive analysis of the outcomes and longitudinally compare quantitative outcomes pre- and post-COVID-19, within the same individuals. RESULTS Adverse economic impacts were most salient, and to cope, youth engaged in more labor and domestic chores. Compared to prior the COVID-19 pandemic, youth reported spending more time caring for elderly or sick household members and gathering firewood or nuts. CONCLUSIONS These findings underscore the potential opportunity to promote policies and programs which address risks youth face. Recommended measures include expansion and adaptation of social protection policies, strengthened food and nutrition surveillance and referral systems, and scaling up community-based mental health programming.
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Affiliation(s)
- Stephanie Simmons Zuilkowski
- Educational Leadership and Policy Studies Learning Systems Institute University Center C4600, Florida State University, Tallahassee, FL, USA.
| | - Sarah Quinones
- Department of Epidemiology and Environmental Health, Division of Health Services Policy and Practice, University at Buffalo (State University of New York) , Buffalo, NY, USA
| | - Hassan Kihanzah
- Independent Researcher , and University at Buffalo (State University of New York) , Dar es Salaam, Tanzania
| | - Graca Marwerwe
- Independent Researcher , and University at Buffalo (State University of New York) , Dar es Salaam, Tanzania
| | - Leah Prencipe
- Department of Social Epidemiology, Erasmus MC, Rotterdam, Netherlands
| | - Lusajo Kajula
- Independent Researcher , and Muhimbili University of Health and Allied Sciences , Dar es Salaam, Tanzania
| | - Tia Palermo
- Department of Epidemiology and Environmental Health, Division of Health Services Policy and Practice, University at Buffalo (State University of New York) , Buffalo, NY, USA
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Rogers K, Ranganathan M, Kajula L, Lorraine Collins R, Livingston JA, Palermo T. The influence of gender-equitable attitudes on sexual behaviour among unmarried adolescents in rural Tanzania: a longitudinal study. Sex Reprod Health Matters 2023; 31:2260169. [PMID: 37850724 PMCID: PMC10586071 DOI: 10.1080/26410397.2023.2260169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
PLAIN LANGUAGE STATEMENT Gender norms that centre men and disadvantage women create gender inequality, which can lead to risky sexual behaviour. This study examined how both community and individual attitudes toward gender norms influenced risky sexual behaviour in adolescents, and whether that influence was different between males and females. We found that higher gender-equitable attitudes were linked to increased odds of HIV testing in the last 12 months, and decreased odds of engaging in a sexual relationship with a much older partner. Individual high gender-equitable attitudes among girls were also linked to higher odds of them using condoms and contraceptives. Gender-equitable attitudes did not seem to influence early sexual debut, engagement in transactional sex, having multiple sexual partners at the same time, or the number of sexual partners a participant had in the last 12 months. Based on these findings, programming designed to increase gender-equitable attitudes might be helpful in increasing HIV testing and condom and contraceptive use, but it needs to involve the entire community, not just individual boys and girls.
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Affiliation(s)
- Kate Rogers
- PhD Candidate, Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, SUNY, 330 Kimball Tower, Buffalo, NY14212, USA
| | - Meghna Ranganathan
- Assistant Professor, London School of Hygiene and Tropical Medicine, London, UK
| | - Lusajo Kajula
- Independent Consultant, UNICEF Office of Research-Innocenti, Dar es Salaam, Tanzania
| | - R. Lorraine Collins
- Associate Dean for Research, Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | | | - Tia Palermo
- Associate Professor, Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA
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Prencipe L, Houweling TAJ, van Lenthe FJ, Kajula L, Palermo T. Climate distress, climate-sensitive risk factors, and mental health among Tanzanian youth: a cross-sectional study. Lancet Planet Health 2023; 7:e877-e887. [PMID: 37940208 DOI: 10.1016/s2542-5196(23)00234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/18/2023] [Accepted: 10/11/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Climate change threatens youth mental health through multiple mechanisms, yet empirical studies typically focus on single pathways. We explored feelings of distress over climate change among Tanzanian youth, considering associations with climate change awareness and climate-sensitive risk factors, and assessed how these factors relate to mental health. METHODS Tanzanian youth (aged 18-23 years) from a cluster randomised controlled trial in Mbeya and Iringa regions of Tanzania were interviewed between Jan 25, and March 3, 2021, and included in this cross-sectional study. A threshold of at least 10 on the ten-item Centre for Epidemiological Studies Depression Scale was used to classify symptom severity indicative of depression. Regardless of climate change awareness, respondents were asked about their feelings of distress on climate change using inclusive language (changing weather patterns or changing seasons). We estimated rate differences in climate change distress (slight or moderate or extreme vs none) by youth characteristics, extent of climate awareness, and climate-sensitive livelihoods (eg, agriculture, tending livestock) and climate-sensitive living conditions (eg, food or water insecurity), using generalised linear models. We compared depression prevalence by extent of climate change distress and climate-sensitive living conditions. FINDINGS Among 2053 youth (1123 [55%] were male and 930 [45%] were female) included in this analysis, 946 (46%) had reported any distress about climate change. Distress was higher among female, more educated, more religious, older youth, and those working in extreme temperatures. Adjusting for climate awareness-a factor strongly associated with climate distress-helped to explain some of these associations. Depression was 23 percentage points (95% CI 17-28) higher among youth who had severe water insecurity than those who did not. Similarly, youth who had severe food insecurity had 23 percentage points higher depression (95% CI 17-28) compared with those who did not. Those reporting climate change distress also had worse mental health-extremely distressed youth had 18 percentage points (95% CI 6-30) higher depression than those reporting none. INTERPRETATION Living in conditions worsened by climate change and feeling distressed over climate change have mental health implications among young people from low-resource settings, indicating that climate change can impact youth mental health through multiple pathways. FUNDING Erasmus Trustfonds, Centre for Global Health Inequalities Research, UK's Foreign, Commonwealth, and Development Office, Oak Foundation, UNICEF, UK's Department of International Development, the Swedish Development Cooperation Agency, Irish Aid.
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Affiliation(s)
- Leah Prencipe
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
| | - Tanja A J Houweling
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Frank J van Lenthe
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Lusajo Kajula
- UNICEF Office of Research-Innocenti, Florence, Italy
| | - Tia Palermo
- Department of Epidemiology and Environmental Health, University of New York at Buffalo, Buffalo, NY, USA
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Ranganathan M, Quinones S, Palermo T, Gilbert U, Kajula L, Quinones S, Kajula L, de Hoop J, Prencipe L, Groppo V, Tirivayi N, Waidler J, Nkolo JC, Mitti R, Mallet M, Munanka B, Luchemba P, Lukongo TM, Mulokozi A, Gilbert U, van Ufford PQ, Le Kirkegaard R, Eetaama F, Matafu J, Angemi D, Natali L. Transactional sex among adolescent girls and young women enrolled in a cash plus intervention in rural Tanzania: a mixed-methods study. J Int AIDS Soc 2022; 25:e26038. [PMID: 36451279 PMCID: PMC9712808 DOI: 10.1002/jia2.26038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 10/31/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Transactional sex or material exchange for sex is associated with HIV infection among adolescent girls and young women in sub-Saharan Africa. The motivations for engaging in transactional sex vary from the fulfilment of basic needs, to enhancing social status or for romantic reasons with the expectation that men should provide. Transactional sex is also associated with HIV risk behaviours, such as multiple sexual partners and other determinants of HIV risk, including partner violence and abuse, alcohol consumption and inconsistent condom use. METHODS We use data from a mixed-method, cluster randomised controlled trial of the Ujana Salama cash "plus" intervention in rural Tanzania. The data are from the first and third rounds of data collection (2017-2019). The impact evaluation consisted of a parallel mixed-methods design where the quantitative and qualitative data collection occurred simultaneously, and integration of the findings was done during the discussion. We first examine contextual factors associated with transactional sex using multivariable logistic regression models and then estimate whether the "plus" intervention reduced transactional sex among adolescent girls and young women using analysis of covariance. We used thematic content analysis for analysing qualitative transcripts. RESULTS The prevalence of transactional sex among unmarried adolescent girls and young women at round 3 was 26%. Findings show that increasing age is a risk factor for transactional sex (OR = 1.80; 95% CI: [1.50, 2.17]), staying in school was negatively associated with engagement in transactional sex (OR = 0.24; 95% CI: [0.14, 0.40]). The cash plus intervention showed no impacts on reducing transactional sex (β = 0.003, p = 0.905). CONCLUSIONS The mechanisms of impact for a cash plus intervention on transactional sex are complex; economic insecurity is an important driver of transactional sex and HIV infection, but psychosocial factors and gendered social norms need consideration in intervention development. Our findings suggest that combination prevention interventions to address the structural drivers of HIV infection should focus on efforts to increase school enrolment and completion.
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Affiliation(s)
| | - Sarah Quinones
- Department of Epidemiology and Environmental HealthUniversity at BuffaloBuffaloNew YorkUSA
| | - Tia Palermo
- Department of Epidemiology and Environmental HealthUniversity at BuffaloBuffaloNew YorkUSA
| | | | - Lusajo Kajula
- UNICEF Office of Research—InnocentiDar es SalaamTanzania
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Reyes HLM, Maman S, Kajula L, Mulawa M. Intimate partner violence perpetration and sexual risk behaviour: Identifying shared determinants among young men in Tanzania. Glob Public Health 2022; 17:2792-2806. [PMID: 35129086 PMCID: PMC9356116 DOI: 10.1080/17441692.2022.2032257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/31/2021] [Indexed: 12/15/2022]
Abstract
In this study we examined factors that predict involvement in different patterns of sexual risk behavior and IPV perpetration among young men in Tanzania (n = 979), with a focus on identifying factors that distinguish men who engage in both behaviours from those who do not. Risk factors were drawn from three domains thought to be upstream drivers of both IPV and sexual risk: poverty, adverse childhood experiences, and inequitable gender norms. A three-step latent class analysis was used to assess whether and how factors from each domain distinguished subgroups of men whose behaviour patterns were characterised as comorbid (involvement in IPV and sexual risk behaviour), IPV-only, sexual risk only, and normative (low risk). Consistent with expectations, greater food insecurity, adverse childhood experiences, and inequitable gender norms related to violence and sexual behaviour predicted increased risk of membership in the comorbid group compared to other sub-groups. Findings support the promise of integrated prevention programmes targeting the common causes of IPV perpetration and sexual risk behaviour.
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Affiliation(s)
- H. Luz McNaughton Reyes
- Department of Health Behavior, Gillings School of Global Public Health, UNC Chapel Hill, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC 27599-7440
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, UNC Chapel Hill, 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC 27599-7440
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Zietz S, Kajula L, Martin S, Moracco B, Shanahan M, Maman S. "Mtoto Wa Nyoka Ni Nyoka," The Child of a Snake is a Snake: A Narrative Analysis of Adverse Childhood Experiences and Perpetration of Interpersonal Violence Among Men in Dar es Salaam, Tanzania. J Interpers Violence 2022; 37:NP12040-NP12065. [PMID: 33666115 PMCID: PMC8418622 DOI: 10.1177/0886260521997443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Childhood exposure to adversity, including abuse and neglect, is consistently found to be a predictor of intimate partner violence (IPV) and peer violence (PV) perpetration in adulthood. The purpose of this study is to qualitatively examine factors that may facilitate or impede the use of violence among those who have been exposed to adversity early in life. We are particularly interested in protective experiences or environments for these participants. The qualitative data were analyzed through thematic coding and narrative analysis of participant life histories.We found three salient themes: (a) parental acceptance and early attachment is protective for coping with stress with intimate partners in adulthood; (b) certain key life turning points can provide a protective context against violent behavior in adulthood; and (c) poverty in adulthood compromises one's ability to cope with stress and anger in adulthood.Our findings contextualize the different factors that may affect the behavior of perpetration of interpersonal violence among high-risk men in Dar es Salaam who have been exposed to adversity in childhood. These findings provide important information on the risk and protective factors for interpersonal violence spanning from childhood to adulthood. This study highlights the importance of child development interventions in this situation, both for the primary prevention of child adversity and for promoting resilience and mitigating the effects of childhood adversity that put men at risk for perpetration of interpersonal violence in adulthood.
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Affiliation(s)
| | - Lusajo Kajula
- UNICEF Office of Research-Innocenti, Florence, Italy
| | - Sandra Martin
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Beth Moracco
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Meghan Shanahan
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Suzanne Maman
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Prencipe L, Houweling TAJ, van Lenthe FJ, Kajula L, Palermo T. Effects of Adolescent-Focused Integrated Social Protection on Depression: A Pragmatic Cluster-Randomized Controlled Trial of Tanzania's Cash Plus Intervention. Am J Epidemiol 2022; 191:1601-1613. [PMID: 35581169 PMCID: PMC9437816 DOI: 10.1093/aje/kwac093] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/29/2022] [Accepted: 05/12/2022] [Indexed: 01/29/2023] Open
Abstract
We assessed the impacts of Tanzania's adolescent-focused Cash Plus intervention on depression. In this pragmatic cluster-randomized controlled trial, 130 villages were randomly allocated to an intervention or control arm (1:1). Youth aged 14-19 years living in households receiving governmental cash transfers were invited to participate. The intervention included an intensive period (a 12-session course) and an aftercare period (9 months of mentoring, productive grants, and strengthened health services). We examined intervention impacts on a depressive symptoms scale (10-item Center for Epidemiologic Studies Depression Scale score (range, 0-30)) and rates of depressive symptomatology (score ≥10 points on the scale), recorded at study baseline (April-June 2017), midline (May-July 2018), and endline (June-August 2019). Using intention-to-treat methodology, we employed logistic and generalized linear models to estimate effects for binary and continuous outcomes, respectively. Quantile regression was used to estimate effects across the scale. From 2,458 baseline participants, 941 intervention and 992 control adolescents were reinterviewed at both follow-ups. At endline, the intervention reduced the odds of depressive symptomatology (adjusted odds ratio = 0.67, 95% confidence interval: 0.52, 0.86), with an undetectable mean scale difference (risk difference = -0.36, 95% confidence interval: -0.84, 0.11). Quantile regression results demonstrated an intervention effect along the upper distribution of the scale. Integration of multisectoral initiatives within existing social protection systems shows potential to improve mental health among youth in low-resource settings.
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Affiliation(s)
- Leah Prencipe
- Correspondence to Leah Prencipe, Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands (e-mail: )
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Palermo T, Prencipe L, Kajula L. Effects of Government-Implemented Cash Plus Model on Violence Experiences and Perpetration Among Adolescents in Tanzania, 2018‒2019. Am J Public Health 2021; 111:2227-2238. [PMID: 34878869 PMCID: PMC8667840 DOI: 10.2105/ajph.2021.306509] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To examine the impacts of a government-implemented cash plus program on violence experiences and perpetration among Tanzanian adolescents. Methods. We used data from a cluster randomized controlled trial (n = 130 communities) conducted in the Mbeya and Iringa regions of Tanzania to isolate impacts of the "plus" components of the cash plus intervention. The panel sample comprised 904 adolescents aged 14 to 19 years living in households receiving a government cash transfer. We estimated intent-to-treat impacts on violence experiences, violence perpetration, and pathways of impact. Results. The plus intervention reduced female participants' experiences of sexual violence by 5 percentage points and male participants' perpetration of physical violence by 6 percentage points. There were no intervention impacts on emotional violence, physical violence, or help seeking. Examining pathways, we found positive impacts on self-esteem and participation in livestock tending and, among female participants, a positive impact on sexual debut delays and a negative effect on school attendance. Conclusions. By addressing poverty and multidimensional vulnerability, integrated social protection can reduce violence. Public Health Implications. There is high potential for scale-up and sustainability, and this program reaches some of the most vulnerable and marginalized adolescents. (Am J Public Health. 2021;111(12):2227-2238. https://doi.org/10.2105/AJPH.2021.306509).
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Affiliation(s)
- Tia Palermo
- Tia Palermo is with the the Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York. Leah Prencipe is a PhD candidate and is with the Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands, and the Social and Economic Policy Unit, United Nations Children's Fund (UNICEF) Office of Research‒Innocenti, Florence, Italy. Lusajo Kajula is with the Social and Economic Policy Unit, UNICEF Office of Research‒Innocenti
| | - Leah Prencipe
- Tia Palermo is with the the Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York. Leah Prencipe is a PhD candidate and is with the Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands, and the Social and Economic Policy Unit, United Nations Children's Fund (UNICEF) Office of Research‒Innocenti, Florence, Italy. Lusajo Kajula is with the Social and Economic Policy Unit, UNICEF Office of Research‒Innocenti
| | - Lusajo Kajula
- Tia Palermo is with the the Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York. Leah Prencipe is a PhD candidate and is with the Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands, and the Social and Economic Policy Unit, United Nations Children's Fund (UNICEF) Office of Research‒Innocenti, Florence, Italy. Lusajo Kajula is with the Social and Economic Policy Unit, UNICEF Office of Research‒Innocenti
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Prencipe L, Houweling TA, van Lenthe FJ, Palermo TM, Kajula L. Exploring multilevel social determinants of depressive symptoms for Tanzanian adolescents: evidence from a cross-sectional study. J Epidemiol Community Health 2021; 75:944-954. [PMID: 33782050 PMCID: PMC8458088 DOI: 10.1136/jech-2020-216200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/19/2021] [Accepted: 03/04/2021] [Indexed: 01/23/2023]
Abstract
Background Depression has substantial and enduring impacts for adolescents, particularly those living in poverty. Yet, evidence on its determinants in low-income countries remains scarce. We examined the social determinants of depressive symptoms for Tanzanian adolescents. Methods We used cross-sectional data for 2458 adolescents (aged 14–19), to describe associations with depressive symptoms within and across five domains—demographic, economic, neighbourhood, environmental and social-cultural—using linear mixed models. We estimated depressive symptoms using the 10-item Centre for Epidemiological Studies Depression Scale, which ranges from 0 to 30 and increases with additional symptoms. Results Factors associated with depressive symptoms in the fully adjusted models included experiencing five or more household economic shocks (β=2.40; 95% CI 1.48 to 3.32), experiencing droughts/floods (β=0.76; 95% CI 0.36 to 1.17), being in a relationship (β=1.82; 95% CI 1.30 to 2.33), and having moderate (β=1.26; 95% CI 0.80 to 1.71) or low (β=2.27; 95% CI 1.81 to 2.74) social support. Exclusive schooling was protective compared with being engaged in both school and paid work (β=1.07; 95% CI 0.05 to 2.61) and not engaged in either (β=0.73; 95% CI 0.24 to 1.22). Household size and relationship status were more important factors for girls, while employment status, and extreme precipitation were more important for boys. Conclusion Mental health is associated with determinants from multiple domains. Results suggest that environmental shocks related to climate change contribute to poor mental health in adolescents, highlighting an important area for intervention and research.
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Affiliation(s)
- Leah Prencipe
- Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Tanja Aj Houweling
- Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Frank J van Lenthe
- Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Tia M Palermo
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York, USA
| | - Lusajo Kajula
- UNICEF Office of Research - Innocenti, Florence, Italy
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Carney A, Kaaya S, Kajula L, Ibitoye M, Marwerwe G, Sommer M. ‘Most of the Youth Are Drinking Because They Have Nothing to Do’: How Idle Time Facilitates Adolescent Alcohol Use in Urban Tanzania. Journal of Child & Adolescent Substance Abuse 2021. [DOI: 10.1080/1067828x.2021.1888169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Allison Carney
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sylvia Kaaya
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lusajo Kajula
- Office of Research – Innocenti, UNICEF, Dar es Salaam, Tanzania
| | - Mobolaji Ibitoye
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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Sommer M, Kaaya S, Kajula L, Marwerwe G, Hamisi H, Parker R. Social and structural determinants of youth alcohol use in Tanzania: The role of gender, social vulnerability and stigma. Glob Public Health 2021; 16:75-87. [PMID: 32744916 PMCID: PMC7790840 DOI: 10.1080/17441692.2020.1801792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
Adolescent alcohol use remains an under-addressed population health issue across Africa. Although the literature explores the intersection of alcohol use and vulnerability to HIV and AIDS, there is limited evidence on the gendered uptake and use of alcohol among adolescents. Capturing adolescents' voiced experiences about the societal influences shaping their alcohol usage is essential for identifying contextually relevant interventions to reduce their vulnerability to alcohol and related risky behaviours, such as unsafe sex. We conducted qualitative research in urban Tanzania, including key informant interviews, systematic mapping of alcohol availability, in-depth interviews with adolescents in and out of school and adults, and participatory methodologies with adolescents ages 15-19. The findings described here were drawn from the participatory methodologies (n = 177); and in-depth interviews with adolescents (n = 24) and adults (n = 24). Three key themes emerged: (1) boys' increased social vulnerability to alcohol consumption; (2) the ways in which stigma shapes girls' alcohol usage; and (3) how gendered perceptions of alcohol use reinforce societal inequalities. There exists an urgent need to address the social and gendered vulnerabilities of youth in Africa to the uptake and use of alcohol, and identify interventions that reshape notions of masculinity increasing boy's vulnerability to use.
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Affiliation(s)
- Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Sylvia Kaaya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lusajo Kajula
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Graca Marwerwe
- Independent Research Consultant, Dar es Salaam, Tanzania
| | - Hassan Hamisi
- Independent Research Consultant, Dar es Salaam, Tanzania
| | - Richard Parker
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
- Institute for the Study of Collective Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- ABIA, Brazilian Interdisciplinary AIDS Association, Rio de Janeiro, Brazil
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McNaughton Reyes HL, Graham LM, Chen MS, Baron D, Gibbs A, Groves AK, Kajula L, Bowler S, Maman S. Adolescent dating violence prevention programmes: a global systematic review of evaluation studies. Lancet Child Adolesc Health 2020; 5:223-232. [PMID: 33220790 DOI: 10.1016/s2352-4642(20)30276-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/18/2020] [Accepted: 08/10/2020] [Indexed: 11/16/2022]
Abstract
Adolescent dating violence negatively affects millions of young people worldwide. Through a global systematic review, we synthesised evidence from rigorous studies of prevention programmes for adolescent dating violence. Our aims were to: (1) describe the breadth of research in this area and evidence of programme effects, and (2) identify gaps in the evidence base. We included experimental and controlled quasi-experimental programme evaluations, published before Jan 1, 2020, that assessed effects on victimisation or perpetration, or both, in adolescent dating violence and in which at least half of the study population was 10-19 years old. Study design, programme elements, and outcomes were compared between evaluations implemented in high-income countries (HICs) and low-income and middle-income countries (LMICs). 52 evaluations met inclusion criteria, of which 20 (38%) were implemented in LMICs. Evaluations in HICs were more likely to assess effects on adolescent dating violence victimisation and perpetration, rather than just victimisation, than those in LMICs, and they were also more likely to include boys and girls, as opposed to just a single sex. Overall, 26 (50%) of the 52 evaluations reported a significant preventive effect on at least one outcome for adolescent dating violence, of which nine were implemented in LMICs. Across LMICs and HICs, findings suggest research is needed to shed light on how adolescent dating violence prevention programmes work and to identify whether programme effects generalise across different settings, outcomes, and subgroups. TRANSLATIONS: For the Chinese, French and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- H Luz McNaughton Reyes
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Laurie M Graham
- School of Social Work, University of Maryland, Baltimore, MD, USA
| | - May S Chen
- Division of Violence Prevention, National Center for Injury Prevention and Control, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Deborah Baron
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Durban, South Africa
| | - Alison K Groves
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | - Sarah Bowler
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Palermo T, Chzhen Y, Balvin N, Kajula L. Examining determinants of gender attitudes: evidence among Tanzanian adolescents. BMC Womens Health 2020; 20:195. [PMID: 32912210 PMCID: PMC7488302 DOI: 10.1186/s12905-020-01057-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/26/2020] [Indexed: 12/03/2022]
Abstract
Background The shaping of gender beliefs and attitudes in early adolescence affects the way young people internalize and self-enforce prevalent notions of masculinity and femininity, with lifelong consequences for sexual and reproductive health. This cross-sectional study examines determinants of gender attitudes among some of the poorest and most vulnerable adolescents in Tanzania using an ecological model. Methods Data come from baseline interviews with 2458 males and females aged 14–19 years conducted as part of a larger impact evaluation. Structural equation models are used to examine how factors at the community-, household-, and individual-levels influence gender attitudes in the four domains measured by the Gender Equitable Men (GEM) Scale (i.e. violence, sexual relationships, reproductive health and disease prevention, and domestic chores and daily life). Results A structural equation model of the four latent domains of the GEM scale regressed on individual, social-interactional and structural level characteristics indicated that secondary school attendance was associated with more equitable gender attitudes, while females held less equitable attitudes than males in the sample. Having had sexual intercourse was associated with more gender equitable attitudes among females, but the reverse was true among males. Conclusions Addressing gender inequity requires understanding gender socialisation at the socio-interactional level. As females had more inequitable gender attitudes than males in the study, a special emphasis on highlighting the rights of women to girls should be considered. This study will inform future analysis of programme impacts on gender attitudes and sexual and reproductive health.
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Affiliation(s)
- Tia Palermo
- Department of Epidemiology and Environmental Health, University at Buffalo (State University of New York), 268F Farber Hall, Buffalo, NY, 14214, USA.
| | - Yekaterina Chzhen
- Department of Sociology, Trinity College Dublin, 3 College Green, Dublin 2, Dublin, Ireland
| | - Nikola Balvin
- UNICEF India, Near 73, Near, Lodhi Rd, Lodhi Gardens, Lodhi Estate, New Delhi, Delhi, 110003, India
| | - Lusajo Kajula
- UNICEF Office of Research - Innocenti, Via degli Alfani 58, 50121, Florence, Italy
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Zietz S, Kajula L, McNaughton Reyes HL, Moracco B, Shanahan M, Martin S, Maman S. Patterns of adverse childhood experiences and subsequent risk of interpersonal violence perpetration among men in Dar es Salaam, Tanzania. Child Abuse Negl 2020; 99:104256. [PMID: 31835233 PMCID: PMC7719339 DOI: 10.1016/j.chiabu.2019.104256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/21/2019] [Accepted: 10/28/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs), including abuse and neglect, are consistently found to be predictors of perpetration of intimate partner violence (IPV) and peer violence (PV) in adulthood. Children are often exposed to patterns of ongoing and/or multiple-type polyvictimization throughout the life course. OBJECTIVES To identify and characterize patterns of ACEs among men in Dar es Salaam, Tanzania and to examine the relationship between these patterns and perpetration of intimate partner violence (IPV) and peer violence (PV) in adulthood. METHODS We used latent class analysis to identify respondents with similar patterns of ACEs. The analysis was conducted with a sample of 987 men. RESULTS We uncovered five distinct classes of men with specific patterns of ACEs. One consisted of nonvictims and four included various forms of polyvictimization. Men in the polyvictimization classes that included non-violent family dysfunction had significantly higher odds of perpetrating psychological IPV compared to the other three classes (AORs 2.33 and 3.04 compared to nonvictims). Men in the polyvictimization classes that included any sexual violence and/or non-violent family dysfunction had significantly higher odds of perpetrating PV compared to the other two classes (AORs 3.54, 6.10, and 7.42 compared to nonvictims). CONCLUSIONS These findings suggest that distinct patterns of exposure to ACEs among this population are differentially related to perpetration of IPV and PV in adulthood. These findings highlight the importance of child development interventions in low-and middle-income countries, both for the primary prevention of child adversity and for mitigation of the cognitive and emotional effects of ACEs.
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Affiliation(s)
- Susannah Zietz
- Duke Center for Child and Family Policy, Erwin Square Mill Building, 202 West Main Street, Bay C, Durham, NC, United States.
| | - Lusajo Kajula
- UNICEF Office of Research-Innocenti, Florence, Italy
| | - H Luz McNaughton Reyes
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Beth Moracco
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Meghan Shanahan
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Sandra Martin
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Suzanne Maman
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
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Sommer M, Parker R, Msacky G, Kajula L, Kaaya S. How Alcohol, Space, and Time Influence Young People's Sexual Encounters in Tanzania: A Qualitative Analysis. Arch Sex Behav 2019; 48:1847-1857. [PMID: 30631988 PMCID: PMC6669242 DOI: 10.1007/s10508-018-1311-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 06/09/2023]
Abstract
A significant under-addressed issue in the global adolescent health agenda is the interaction between alcohol use and sexual encounters among adolescent boys and girls in sub-Saharan Africa. The aim of this study was to explore the structural and environmental factors influencing young people's access to and use of alcohol, and subsequent engagement in safe or unsafe sexual behaviors in such contexts, from the perspective of young people themselves. We used qualitative and participatory methodologies to explore the experiences and perspectives of 177 adolescent girls and boys in and out of school in four sites across Dar es Salaam, Tanzania. Findings suggest that alcohol use intersects with a spatial dimension in relation to where youths are consuming alcohol and subsequently engaging in sex. This in turn influences young people's likelihood of using condoms and practicing safer sex. The spatial dimension was found to be influenced by time, gender, age, economics, and social norms around the carrying of and use of condoms. Interventions are needed that both address the gendered and social sanctioning of youth carrying condoms in Tanzania and that increase the availability of condoms where alcohol is sold and consumed.
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Affiliation(s)
- Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, Room 537, New York, NY, 10032, USA.
| | - Richard Parker
- Institute for the Study of Collective Health (IESC), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Lusajo Kajula
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sylvia Kaaya
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Conserve DF, Bay C, Kilonzo MN, Makyao NE, Kajula L, Maman S. Sexual and Social Network Correlates of Willingness to Self-Test for HIV Among Ever-Tested and Never-Tested Men: Implications for the Tanzania STEP Project. AIDS Care 2018; 31:169-176. [PMID: 30362377 DOI: 10.1080/09540121.2018.1537466] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We examined factors associated with HIV self-testing (HIVST) willingness among male ever-testers and never-testers who participated in a midpoint survey of a cluster randomized controlled HIV prevention trial in Dar es Salaam. Linear mixed binary logistic regression models were constructed to examine factors (demographic, HIV risk behavior, and sexual/social network) associated with willingness to self-test. Sixtyseven percent of 301 never-testers were willing to self-test for HIV compared to 72% 577 of ever-testers. Among never-testers, having discussed testing for HIV with a sexual partner was the only factor associated with HIVST willingness (2.36, 95% CI: 1.35-4.15). For evertesters, younger men were less willing to self-test than older men while men with higher education were more willing to self-test than less educated men. Having a moderate/great HIV risk perception decreased the odds of HIVST willingness relative to no risk perception (0.40, 95% CI 0.23-0.70) for ever-testers. Discussing HIV testing with a sexual partner and having been encouraged to test for HIV by a friend were associated with higher odds of being willing to self-test (2.22, 2.23; 95% CI 1.34-3.67, 1.14-4.39, respectively) among ever-testers. These findings suggest that HIVST willingness is highly acceptable among both male ever-testers and never-testers.
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Affiliation(s)
- Donaldson F Conserve
- a Arnold School of Public Health, Department of Health Promotion, Education, and Behavior , University of South Carolina , Columbia , SC , USA
| | - Camden Bay
- b Center for AIDS Research , University of North Carolina , Chapel Hill , NC , USA
| | - Mrema N Kilonzo
- c Department of Psychiatry and Mental Health , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Neema E Makyao
- d National AIDS Control Programme , Dar es Salaam , Tanzania
| | - Lusajo Kajula
- c Department of Psychiatry and Mental Health , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Suzanne Maman
- e Gillings School of Global Public Health, Department of Health Behavior , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
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Conserve DF, Muessig KE, Maboko LL, Shirima S, Kilonzo MN, Maman S, Kajula L. Mate Yako Afya Yako: Formative research to develop the Tanzania HIV self-testing education and promotion (Tanzania STEP) project for men. PLoS One 2018; 13:e0202521. [PMID: 30148846 PMCID: PMC6110473 DOI: 10.1371/journal.pone.0202521] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 08/03/2018] [Indexed: 11/22/2022] Open
Abstract
The purpose of this formative research, guided by the Integrated Behavioral Model, was to assess men's attitudes and personal agency towards HIV self-testing (HIVST) and confirmatory HIV testing in order to inform the development of the Tanzania STEP (Self-Testing Education and Promotion) Project, a peer-based HIV self-testing intervention for young men in Tanzania. Qualitative in-depth interviews were conducted with 23 men in Dar es Salaam, Tanzania who socialize in networks locally referred to as "camps". Men reported privacy, confidentiality, and saving time as the primary reasons for their self-testing interest. Most participants had high perceived control and self-efficacy to self-test and seek confirmatory HIV testing. Nevertheless, men reported concerns related to their ability to perform the test and the potential lack of post-test counseling. Specific recommendations for the intervention included providing HIVST education and pre-test counseling, and using mobile health (mHealth) strategies for participants to reach a healthcare professional for further assistance. The findings suggest that while HIVST is highly acceptable among men in Tanzania, future interventions will need to address the challenges that men may face with HIVST before promoting it as an alternative or supplement to facility-based HIV testing.
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Affiliation(s)
- Donaldson F. Conserve
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Kathryn E. Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | - Sylvia Shirima
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Mrema N. Kilonzo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Lusajo Kajula
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Conserve DF, Alemu D, Yamanis T, Maman S, Kajula L. "He Told Me to Check My Health": A Qualitative Exploration of Social Network Influence on Men's HIV Testing Behavior and HIV Self-Testing Willingness in Tanzania. Am J Mens Health 2018; 12:1185-1196. [PMID: 29808781 PMCID: PMC6142152 DOI: 10.1177/1557988318777674] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Men continue to test for HIV at a low rate in sub-Saharan Africa. Recent quantitative evidence from sub-Saharan Africa indicates that encouragement to test for HIV from men’s network members is associated with higher previous HIV testing and HIV self-testing (HIVST) willingness. Leveraging this positive network influence to promote HIVST among men is a promising strategy that could increase HIV testing. This study investigated the reasons and strategies men used to encourage their peers to test for HIV and the outcomes in order to inform the development of a social network-based HIVST intervention for men called STEP (Self-Testing Education and Promotion). Twenty-three men from networks locally referred to as “camps” were interviewed to explore reasons for encouraging HIV testing, strategies to encourage HIV testing, and outcomes of HIV testing encouragement. Reasons men reported for encouraging their peers to test for HIV included awareness of their peers’ risky sexual behavior, knowing an HIV-positive peer, and having HIV testing experience. Strategies for encouraging testing included engaging in formal and informal conversations and accompanying friends to the clinic. Encouragement outcomes included HIV testing for some men while others remained untested due to lack of privacy in the clinic and fear of HIV stigma. Willingness to self-test for HIV and an interest to educate peers about HIVST were other outcomes of HIV testing encouragement. These findings underscore the potential of leveraging men’s existing HIV testing encouragement strategies to promote HIVST among their peers.
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Affiliation(s)
- Donaldson F Conserve
- 1 Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Dawit Alemu
- 1 Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Thespina Yamanis
- 2 School of International Service, American University, Washington, DC, USA
| | - Suzanne Maman
- 3 Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lusajo Kajula
- 4 Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Jennings L, Conserve DF, Merrill J, Kajula L, Iwelunmor J, Linnemayr S, Maman S. Perceived Cost Advantages and Disadvantages of Purchasing HIV Self-Testing Kits among Urban Tanzanian Men: An Inductive Content Analysis. ACTA ACUST UNITED AC 2017; 8. [PMID: 29051841 PMCID: PMC5645025 DOI: 10.4172/2155-6113.1000725] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Impoverished men have lower rates of facility-based HIV counseling and testing and higher unknown HIV-positive status than women. Economic theory suggests that individuals will obtain an HIV test if anticipated benefits are greater than anticipated costs. Yet, few studies have investigated the range of financial preferences of HIV self-testing (HIVST) among poor men who decline testing or do not test regularly. Twenty-three interviews were conducted to qualitatively assess perceived costs saved and costs incurred from use of HIVST kits in infrequently- or never-tested Tanzanian men. All men were shown an HIVST kit and video. They were then asked about the costs associated with provider-led HIV testing, financial benefits and concerns of HIVST and willingness to pay for HIVST. Data were transcribed, coded and analyzed using inductive content analyses. We then grouped codes into perceived cost advantages and disadvantages and tabulated the range of prices men were willing to pay for a self-test kit. Perceived cost advantages of HIVST were avoidance of spending money to test in facilities, omission of follow-up fees, affordability relative to private clinics, and increased time for earning income and other activities. Men also discussed the imbalance of the financial benefit of accessing free, public HIV testing with the resources spent for transport, purchasing meals away from home and long wait lines. Perceived cost disadvantages of HIVST were prohibitive kit costs, required prior savings to purchase kits, expenditures relating to death and preferences for free provider-performed testing. Men were also concerned about the psychological costs of inaccurate results. HIVST willingness to pay varied among men. Men’s decisions to self-test for HIV takes into account expected financial gains and losses. Demand generation for HIVST among men should consider use of low fees or free HIVST, while emphasizing potential savings from reduced travel, clinical costs, or time way from work. Efforts are also needed to address anticipated emotional costs of HIVST, such as anxiety from kit errors, purchasing “death” or testing alone, which for some men was a substantial barrier.
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Affiliation(s)
- Larissa Jennings
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Social and Behavioral Interventions Program, Baltimore, USA
| | - Donaldson F Conserve
- University of South Carolina, Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, Columbia, USA
| | - Jamison Merrill
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Social and Behavioral Interventions Program, Baltimore, USA
| | - Lusajo Kajula
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Juliet Iwelunmor
- University of Illinois Urbana Champaign, Department of Kinesiology and Community Health, Champaign, IL, USA
| | | | - Suzanne Maman
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
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Mmbaga EJ, Kajula L, Aarø LE, Kilonzo M, Wubs AG, Eggers SM, de Vries H, Kaaya S. Effect of the PREPARE intervention on sexual initiation and condom use among adolescents aged 12-14: a cluster randomised controlled trial in Dar es Salaam, Tanzania. BMC Public Health 2017; 17:322. [PMID: 28415973 PMCID: PMC5392916 DOI: 10.1186/s12889-017-4245-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 04/07/2017] [Indexed: 11/16/2022] Open
Abstract
Background Unsafe sexual practices continue to put adolescents at risk for a number of negative health outcomes in Tanzania. While there are some effective theory-based intervention packages with positive impact on important mediators of sexual behaviours, a context specific and tested intervention is urgently needed in Tanzania. Purpose To develop and evaluate an intervention that will have a significant effect in reducing sexual initiation and promoting condom use among adolescents aged 12–14 in Dar es Salaam, Tanzania. Design A school-based Cluster Randomised Controlled Trial was conducted during 2011–2014 in Kinondoni Municipality. Methods A total of 38 public primary schools were randomly selected, of which half were assigned to the intervention and half to the control group based on their size and geographic location. Participants were interviewed using a self-administered questionnaire at baseline before the PREPARE intervention and then, 6 and 12 months following intervention. The primary outcomes were self-reported sex initiation and condom use during the past 6 months. Data analysis was done using Generalized Estimating Equation (GEE) modelling controlling for repeated measures and clustering of students within schools. Results A total of 5091 students were recruited at baseline, and interviewed again at 6 (n = 4783) and 12 months (n = 4370). Mean age of participants at baseline was 12.4 years. Baseline sociodemographic, psychometric and behavioural characteristics did not significantly differ between the two study arms. The GEE analysis indicated that the intervention had a significant effect on sexual initiation in both sexes after controlling for clustering and correlated repeated measures. A significantly higher level of action planning to use condoms was reported among female adolescent in the intervention arm than those in the control arm (p = 0.042). An effect on condom use behaviour was observed among male adolescent (p = 0.004), but not among female (p = 0.463). Conclusions The PREPARE intervention had an effect in delaying self-reported sexual initiation among adolescents aged 12–14 in Dar es Salaam Tanzania. The intervention positively influenced action planning to use condoms for both sexes and increased actual condom use among male adolescents only. Future interventions addressing adolescent sexual and reproductive health should focus on impacting mediators of behaviour change. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613000900718, registered on 13 August, 2013.
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Affiliation(s)
- Elia John Mmbaga
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, PO Box 65015, Dar es Salaam, Tanzania.
| | - Lusajo Kajula
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Leif Edvard Aarø
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway.,Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Mrema Kilonzo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Annegreet Gera Wubs
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Sander Matthijs Eggers
- Department of Health Education and Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Hein de Vries
- Department of Health Education and Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Conserve D, Kajula L, Yamanis T, Maman S. Formative Research to Develop Human Immunodeficiency Virus (HIV) Self-Testing Intervention Among Networks of Men in Dar es Salaam, Tanzania: A Mixed Methods Approach. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Donaldson Conserve
- Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lusajo Kajula
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | | | - Suzanne Maman
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Iseselo MK, Kajula L, Yahya-Malima KI. The psychosocial problems of families caring for relatives with mental illnesses and their coping strategies: a qualitative urban based study in Dar es Salaam, Tanzania. BMC Psychiatry 2016; 16:146. [PMID: 27177934 PMCID: PMC4867081 DOI: 10.1186/s12888-016-0857-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 05/10/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mental illness may cause a variety of psychosocial problems such as decreased quality of life of the patient's family members as well as increased social distance for the patient and the family caring for the patient. Psychosocial challenges are enhanced by the stigma attached to mental illness, which is a problem affecting not only the patient but also the family as a whole. Coping mechanisms for dealing with mentally ill patients differ from one family to another for a variety of reasons. The aim of the study was to determine the psychosocial problems of mental illness on the family including the coping strategies utilized by family members caring for a person with mental illness. METHOD A qualitative study was conducted, involving four focus group discussions and 2 in-depth interviews of family members who were caring for patient with mental illness at Temeke Municipality, Dar es Salaam. Purposive sampling procedure was used to select participants for the study. Audio-recorded interviews in Swahili were conducted with all study participants. The recorded interview was transcribed and qualitative content thematic analysis was used to analyse the data. RESULTS Financial constraints, lack of social support, disruption of family functioning, stigma, discrimination, and patients' disruptive behaviour emerged as the main themes in this study. Acceptance and religious practice emerged as the major coping strategies used by family members. CONCLUSION Familial care for a person with mental illness has its advantages, yet it has multiple social and psychological challenges. Coping strategies and skills are important for the well-being of the caregiver and the patient. Addressing these psychosocial challenges requires a collaborative approach between the health care providers and government so that the needs of the family caregivers and those of the patients can be addressed accordingly.
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Affiliation(s)
- Masunga K Iseselo
- Department of Clinical Nursing, Muhimbili University of Health & Allied Sciences (MUHAS), P.O.Box 65004, Dar es Salaam, Tanzania.
| | - Lusajo Kajula
- Department of Psychiatry and Mental Health, Muhimbili University of Health & Allied Sciences (MUHAS), P.O.Box 65001, Dar es Salaam, Tanzania
| | - Khadija I Yahya-Malima
- Tanzania Commission for Science & Technology (COSTECH), Ali Hassan Mwinyi Road, Kijitonyama (Sayansi) COSTECH Building, P.O. Box 4302, Dar es Salaam, Tanzania
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Kajula L, Balvanz P, Kilonzo MN, Mwikoko G, Yamanis T, Mulawa M, Kajuna D, Hill L, Conserve D, Reyes HLM, Leatherman S, Singh B, Maman S. Vijana Vijiweni II: a cluster-randomized trial to evaluate the efficacy of a microfinance and peer health leadership intervention for HIV and intimate partner violence prevention among social networks of young men in Dar es Salaam. BMC Public Health 2016; 16:113. [PMID: 26842360 PMCID: PMC4738785 DOI: 10.1186/s12889-016-2774-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/22/2016] [Indexed: 12/01/2022] Open
Abstract
Background Intimate partner violence (IPV) and sexually transmitted infections (STIs), including HIV, remain important public health problems with devastating health effects for men and women in sub-Saharan Africa. There have been calls to engage men in prevention efforts, however, we lack effective approaches to reach and engage them. Social network approaches have demonstrated effective and sustained outcomes on changing risk behaviors in the U.S. Our team has identified and engaged naturally occurring social networks comprised mostly of young men in Dar es Salaam in an intervention designed to jointly reduce STI incidence and the perpetration of IPV. These stable networks are locally referred to as “camps.” In a pilot study we demonstrated the feasibility and acceptability of a combined microfinance and peer health leadership intervention within these camp-based peer networks. Methods design We are implementing a cluster-randomized trial to evaluate the efficacy of an intervention combining microfinance with health leadership training in 60 camps in Dar es Salaam, Tanzania. Half of the camps have been randomized to the intervention arm, and half to a control arm. The camps in the intervention arm will receive a combined microfinance and health leadership intervention for a period of two years. The camps in the control arm will receive a delayed intervention. We have enrolled 1,258 men across the 60 study camps. Behavioral surveys will be conducted at baseline, 12-months post intervention launch and 30-month post intervention launch and biological samples will be drawn to test for Neisseria gonorrhea (NG), Chlamydia trachomatis (CT), and Trichomonas vaginalis (TV) at baseline and 30-months. The primary endpoints for assessing intervention impact are IPV perpetration and STI incidence. Discussion This is the first cluster-randomized trial targeting social networks of men in sub-Saharan Africa that jointly addresses HIV and IPV perpetration and has both biological and behavioral endpoints. Effective approaches to engage men in HIV and IPV prevention are needed in low resource, high prevalence settings like Tanzania. If we determine that this approach is effective, we will examine how to adapt and scale up this approach to other urban, sub-Saharan African settings. Trial registration Clinical Trials.gov: NCT01865383. Registration date: May 24, 2013.
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Affiliation(s)
- Lusajo Kajula
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, PO Box 65466, Dar es Salaam, Tanzania.
| | - Peter Balvanz
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
| | - Mrema Noel Kilonzo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, PO Box 65466, Dar es Salaam, Tanzania
| | - Gema Mwikoko
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, PO Box 65466, Dar es Salaam, Tanzania
| | - Thespina Yamanis
- American University, School of International Service, 4400 Massachusetts Avenue, NW, Washington, DC 20016, USA
| | - Marta Mulawa
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
| | - Deus Kajuna
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, PO Box 65466, Dar es Salaam, Tanzania
| | - Lauren Hill
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
| | - Donaldson Conserve
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
| | - Heathe Luz McNaughton Reyes
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
| | - Sheila Leatherman
- Department of Health Policy and Management, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7411, Chapel Hill, NC, 27599, USA
| | - Basant Singh
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA
| | - Suzanne Maman
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Rosenau Hall, CB 7440, Chapel Hill, NC, 27599, USA
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Maman S, Kajula L, Balvanz P, Kilonzo M, Mulawa M, Yamanis T. Leveraging strong social ties among young men in Dar es Salaam: A pilot intervention of microfinance and peer leadership for HIV and gender-based violence prevention. Glob Public Health 2015; 11:1202-1215. [PMID: 26588115 DOI: 10.1080/17441692.2015.1094105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gender inequality is at the core of the HIV patterns that are evident in sub-Saharan Africa. Gender-based violence (GBV) and lack of economic opportunity are important structural determinants of HIV risk. We piloted a microfinance and health promotion intervention among social networks of primarily young men in Dar es Salaam. Twenty-two individuals participated in the microfinance component and 30 peer leaders were recruited and trained in the peer health leadership component. We collected and analysed observational data from trainings, monitoring data on loan repayment, and reports of peer conversations to assess the feasibility and acceptability of the intervention. Eighteen of the loan recipients (82%) paid back their loans, and of these 15 (83%) received a second, larger loan. Among the loan defaulters, one died, one had chronic health problems, and two disappeared, one of whom was imprisoned for theft. The majority of conversations reported by peer health leaders focused on condoms, sexual partner selection, and HIV testing. Few peer leaders reported conversations about GBV. We demonstrated the feasibility and acceptability of this innovative HIV and GBV prevention intervention. The lessons learned from this pilot have informed the implementation of a cluster-randomised trial of the microfinance and peer health leadership intervention.
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Affiliation(s)
- Suzanne Maman
- a Department of Health Behavior , The University of North Carolina at Chapel Hill, Gillings School of Global Public Health , Chapel Hill , NC , USA
| | - Lusajo Kajula
- b Department of Psychiatry and Mental Health , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Peter Balvanz
- a Department of Health Behavior , The University of North Carolina at Chapel Hill, Gillings School of Global Public Health , Chapel Hill , NC , USA
| | - Mrema Kilonzo
- b Department of Psychiatry and Mental Health , Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Marta Mulawa
- a Department of Health Behavior , The University of North Carolina at Chapel Hill, Gillings School of Global Public Health , Chapel Hill , NC , USA
| | - Thespina Yamanis
- c School of International Service , American University , Washington , DC , USA
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Kawai K, Kaaya SF, Kajula L, Mbwambo J, Kilonzo GP, Fawzi WW. Parents' and teachers' communication about HIV and sex in relation to the timing of sexual initiation among young adolescents in Tanzania. Scand J Public Health 2009; 36:879-88. [PMID: 19004907 DOI: 10.1177/1403494808094243] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Early sexual debut is associated with increased HIV risk among young adolescents in sub-Saharan Africa. Our study examines parents' and teachers' communication about sexual matters in relation to the timing of sexual initiation among students aged 12-14 years old in Dar es Salaam, Tanzania. METHODS Virgin primary school students were followed prospectively for 6 months to assess sexual initiation. Socio-demographic, psychosocial, and behavioural factors were assessed with a structured questionnaire. Univariate and multivariate logistic regression analyses were performed. RESULTS Of 2477 adolescents, 26.9% of students reported communicating about HIV and sex with parents and 35.6% communicated with teachers. Communication with teachers about HIV and sex was associated with delayed sexual initiation among adolescents after adjusting for potential confounding factors (OR=0.59, 95%CI=0.40-0.89, p=0.01). However, parental communication was not associated with the timing of sexual initiation. The perception that most peers are sexually active was a significant predictor of early sexual debut (test for linear trend, p=0.002). Students who do not live with a biological mother were marginally more likely to initiate sex compared to those who live with a biological mother (OR=1.39, 95%CI=0.97-1.99, p=0.08). CONCLUSIONS Teachers can play an effective role in discussing HIV and sex with young adolescents. Our study highlights the necessity of responsible adults discussing sexual matters with young adolescents in sub-Saharan Africa. More research is required to better understand the role of parental communication about sexual matters and strategies for improving the quality of parental communication.
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Affiliation(s)
- Kosuke Kawai
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
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