Sexual and reproductive health and HIV in border districts affected by migration and poverty in Tanzania

Abstract

Objectives To assess HIV knowledge, attitudes, sexual practices and sexual and reproductive health (SRH) service delivery in border areas of Tanzania, with a view to support the prioritisation of SRH interventions in border areas.

Methods The target sample comprised randomly selected people living near the border, aged 15 to 49 years. To gather information, we utilised: (i) a standardised questionnaire (n = 86; 42 men and 44 women) previously used in national household surveys conducted by the Tanzanian government; (ii) focus group discussions (ten male groups, n = 47; ten female groups, n = 51); and (iii) semi-structured interviews with service providers (n = 37).

Results The mean number of sexual partners, frequency of multiple concurrent partnerships and engagement in transactional sex were significantly higher in the border community than in the national population. Knowledge about HIV was comparable with that in the general population. Access to SRH services was limited in the border areas.

Conclusion Efforts to reduce HIV transmission and to improve SRH in the border areas should focus on gaps in service delivery rather than education and information activities alone. In addition, multi-sectorial efforts spanning the health, social, legal and private sectors addressing gender imbalances and poverty alleviation are imperative for reducing poverty-driven unsafe transactional sex.

Chinese Abstract

摘要 目的 为评估坦桑尼亚边境地区人群对于HIV的认知度与态度、性医学及性与生殖健康（sexual and reproductive health, SRH）工作的开展，优先支持边境地区的SRH干预。

方法随机抽取边境地区15至49岁人群为目标样本。数据采集应用到：(i)标准化调查表（n = 86; 42男性与44女性），该调查表此前被坦桑尼亚政府用于全国家庭调查；(ii) 焦点小组讨论（10组男性，n = 47; 10组女性，n = 51）；(iii) 与医务人员的半结构式访谈（n = 37）。

结果 边境地区人群的平均性伴侣数、同时多个性伴侣频率及参与性交易频率显著高于其他地区，对HIV的认知度与其他地区相当。边境地区SRH医疗水平低下。

结论 要降低边境地区的HIV传播、提高SRH水平，应着重填补医疗空缺，而非单一进行教育、信息等宣传活动。此外，跨越多部门如卫生、社会、法律、私营部门，共同解决性别失衡与贫困扶持问题，是减少贫困驱使下不安全性交易的必要措施。

Keywords:

• Reproductive health
• HIV
• Migration
• Tanzania

ACKNOWLEDGEMENTS

The authors thank the Tanzanian Ministry of Internal Affairs and the migration department, the Tanzania Commission for HIV and AIDS and the International Organization for Migration for their contributions to this study. We are also indebted to research assistants Helena Chikomo, Gladys John, Gonzaga Stephen Kananura, Marco Kitundo and Patrick Kossima for their assistance with translation and organisation during the data collection. Finally, we thank Annika Bergstöm and Michael Lee Burgess for editing the paper.

Declaration of interest: The authors report no conflicts of interest. The views they express in this article are theirs alone and do not necessarily reflect the views of, nor should they be attributed to, the International Organization for Migration, the Tanzanian Ministry of Internal Affairs or the Tanzania Commission for HIV and AIDS. The authors alone are responsible for the content and the writing of the paper.

Funding: The study was funded by the IOM programme, Partnership on Migration and Mobility in Southern Africa (PHAMSA), and supported by the Swedish International Development Cooperation (SIDA).