Coming to terms with HIV/AIDS in Arumeru: A community-based approach to HIV/AIDS prevention and care in Tanzania Case Study Click on the following links for further information about this case study: Teacher's Notes Student Activities Introduction It takes courage and determination to face life when you have been diagnosed with an illness for which there is no known cure and which is likely to be fatal. Julius and Diana (pictured in the following two photos) are two people in rural Tanzania who have HIV/AIDs but are actively involved in increasing awareness of the disease in their communities. They are part of the Arumeru HIV/AIDS Prevention and Care Project funded by the Australian Government's overseas aid program and implemented by World Vision in close collaboration with the Arumeru district government. Julius, with his young daughter. Julius After the death of their first child, Julius' wife tested positive to HIV. In time she became very ill and died. Julius delayed having himself tested, fearing the worst. When he finally found that he was HIV-positive, he resolved to be open about his status and to do all he could to help others and ensure that he could leave something to his surviving daughter. He is delighted that she has tested negative. Diana Diana lost her husband to AIDS more than ten years ago, when they were living in Uganda. Her two children, now teenagers, are living with her in-laws. Having learned she is HIV-positive and having very limited financial resources, Diana is glad to be able to stay with friends. Like other volunteers in Arumeru, she has devoted many hours to helping other people understand and come to terms with the illness. Often she relies on the hospitality of those whom she visits. Diana regularly addresses community seminars about how to live positively with HIV/AIDS. HIV/Aids in Tanzania Tanzania, a nation in east Africa, has a very high incidence of HIV/AIDS (see table). As in many parts of Africa, the virus is mainly transmitted by heterosexual sex and half the adults infected with HIV are women. Through mother to child transmission the number of young children infected continues to increase. (It is predicted that the under-five mortality rate could rise from around 100 per 1000 to 160 per 1000 by the year 2010, if current trends continue).   Tanzania Arumeru Population 1998 32 mill 211,837 (1988) Adults and children living with HIV/AIDS, 1998 1.4 million 26,000 deaths since the epidemic began 940,000 (est) n.a. Children without 1 or 2 parents due to AIDS 520,000 194 Initially people living in urban areas and along highways and transport routes were affected by the disease (mostly through truck drivers) but it has now spread throughout the countryside. Many men who have casual sex partners while working away from home in the city or in mines, become infected with HIV and other STDs, then transfer the infections to their wives. Girls are more exposed to the danger of becoming infected by the virus having less access to education and often marrying young or being forced into prostitution to earn an income. In some parts of Tanzania as many as one in five adults are living with the virus. Poverty makes people more vulnerable to HIV. Their poorer nutritional status means HIV develops more rapidly and they cannot afford medical treatment to treat AIDs related illnesses such as tuberculosis. Poverty is accentuated as there are fewer able-bodied men and women to cultivate crops and earn income. When children lose one or both parents, families are pushed deeper into poverty. Arumeru HIV/AIDs Prevention and Care Project To respond to such a serious problem, the Arumeru project included a combination of strategies: assessing the level of HIV/AIDS knowledge in the communities; providing information and education through seminars, films, posters, drama, music; providing counselling, home-based care and support to people living with HIV/AIDS as well as to orphans, widows and others affected by AIDS; and developing income-earning opportunities and recreational activities for youth and other vulnerable groups. Students dramatising the impact of AIDS.   Learning about HIV/AIDS is now part of the Tanzanian school curriculum. In Arumeru several teachers are community counsellors, and school students have performed dramas to increase community awareness. People of all ages have attended seminars in their neighbourhoods. A community survey in 1999 showed that almost all the interviewees are now aware that HIV/AIDS can be transmitted through unprotected sexual intercourse, though fewer understand that HIV can be transmitted from an infected mother to an unborn child, or through transfusion with infected blood. As well as explaining how HIV/AIDS is transmitted, the staff, trainers and community leaders have encouraged people to change high risk behaviours such as unprotected sex. As one community member summed-up: "For those who are already married, stick to one partner. For unmarried, wait until you get [= marry] your partner. For those who can avoid prostitution, it is better to stop prostitution. Those who can't avoid prostitution, use condoms." This approach fits closely with existing community and government attitudes. It is holistic because health is recognised as a social (and spiritual condition) as well as a physical one. To discourage excessive drinking and multiple sex partners is more readily acceptable in Arumeru than to increase the use of condoms, especially as women find it hard to persuade a man to use a condom. Activities such as vegetable gardens and other small businesses have been set up to provide a rewarding occupation for unemployed young people as well as to earn income to support families affected by AIDS. Community groups have encouraged youth leisure activities such as football (soccer) clubs to provide alternative outlets. Education about effective health care is also important. Traditional birth attendants have learned how they can help to prevent the spread of HIV/AIDS during pregnancy and childbirth, for example by wearing gloves, using plaster for wounds, and using a new razor blade to cut the umbilical cord. It is hard to overcome the secrecy and stigma that surrounds people living with HIV/AIDS. In spite of this, families and neighbours in Arumeru have accepted the responsibility to care for people affected by the virus. By being open about their HIV-positive status, Julius and Diana can inspire others to follow their example. It is planned that they will be part of a team visiting another HIV/AIDS prevention and care program in Uganda. An important feature of the project have been the active participation of community members (both men and women) on committees and as counsellors, and close cooperation with local health authorities. Families contribute to a village HIV/AIDS fund which finances the care for AIDS patients and their families. These strengths make it probable that the process of increasing awareness and providing support for AIDS patients will continue when external funding comes to an end.   Top © Commonwealth of Australia