Competence, Compassion, Convenience: Lifesaving Care for Tanzanians

This is the first in a series of stories about Jhpiego's work in support of the Tanzanian government's efforts to strengthen and improve health care for women and families.

By Ann LoLordo

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Community outreach workers set up a temporary HIV counseling and testing site behind a local bar in Tanga, Tanzania, to expand access and reach at-risk individuals.

Tanga, Tanzania—The crowd on the back patio of the Arizona Bar wasn’t there for a cold beer or to score or even to unwind after work. The men and women coming and going were there to get tested for HIV, most of them eager for the opportunity to check their status. 

The venue—a noisy brew pub on a dimly lit strip of bars, fast food stands and repair shops—was chosen purposefully: to give Tanzanians with transient jobs, unconventional lifestyles or risky sexual behavior easy access to HIV counselling and testing services. Not everyone fell into one of those categories; some stopped by after seeing the leaflet that was distributed earlier in the day by an AIDS awareness group. By the looks of things, the patrons felt at ease—they could just as easily have been lining up at the local version of Starbucks in this oceanfront town known for its sisal farms.

“People fear going to a hospital. It’s too far,” said a 29-year-old student named Yuma, who was seated with others waiting for group education and individual counseling. “When the service comes nearby, it’s good for them.”

The outreach event helped kick off the next phase of the Jhpiego-led Universal HIV/AIDS Intervention for Counseling and Testing (UHAI-CT) initiative in Tanga region, which is funded by the U.S. President’s Emergency Plan for AIDS Relief through the U.S. Agency for International Development. UHAI-CT, which is supported by the Tanzanian government, has been working to roll out provider-initiated counselling and testing in Tanga region, where, during a client’s visit to a health center for any reason, providers offer HIV testing as an extra benefit.

Since the UHAI-CT program began three years ago, Jhpiego and partners Africare and the Tanzania Marketing and Communication (T-MARC) Company have helped develop and strengthen the capacity of Tanzanian health workers to deliver basic but essential services to fight HIV/AIDS in Tanzania. Nearly 300,000 Tanzanians across nine regions have been tested for HIV, learned their status and been referred to a care and treatment center if appropriate. This partnership is in cooperation with the Tanzanian government, which is making it possible to provide HIV care and treatment to people in communities.

The next phase of the program in Tanga region involves community-based testing, and four civic groups have been awarded grants to do just that.

“The HIV rate in our country is high. Although we have done much to sensitize the community to seek HIV services so they can know their status, still people have not completely adhered. . . . This kind of support for us will really enhance the access to these services,” said Dr. Ali S. Uredi, the regional medical officer who is the leading health administrator for Tanga region.  

The Ministry of Health and Social Welfare has supported UHAI-CT as a vehicle to bring essential care to communities where HIV prevalence can range from 1.5 percent in the pastoral Manyara region in the north to 15.7 percent in the southern highlands of Iringa region.

As part of the new community-based initiative of UHAI-CT in Tanga, civic groups will focus on reaching at-risk people and others who don’t have access to services. Benedict Ole Kuyang, the Regional Administrative Secretary and top government official in Tanga region, applauded the program’s expansion.

“With your support, I believe we will lower the HIV prevalence in Tanga and especially that of Tanga region,” Ole Kuyang said at a recent ceremony attended by more than 30 district representatives.

At the Arizona Bar, representatives from the Tanga AIDS Working Group erected a makeshift counseling and testing tent in the back patio by stringing a traditional East African cloth known as a kanga between two walls. A handwritten sign tacked to the cloth alerted patrons that counseling and testing were in progress. But the slogan imprinted on the kanga reflected the purpose of the night’s event: Pima VVU – Don’t Wait, Get an HIV Test Today.

Behind the curtain, counselor Evelyn Chauya sat at a table piled high with AIDS prevention brochures and boxes of condoms. A group of four men were in chairs, listening as she explained the basics of HIV transmission and the myths, the reasons to practice safe sex, the testing procedures and the voluntary nature of the effort. Chauya is affable, precise about steps that should be taken and firm about protecting one’s self and partners.

“Any questions?” she asked. 

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Patrons of the Arizona Bar in Tanga, Tz. wait their turn to discuss HIV prevention and participate in voluntary counseling and testing as part of a special outreach event.

 Her audience didn’t appear to need much persuading to be tested. Many had been tested before and repeatedly. “Knowing that there is treatment, it makes people come forward,” said Yuma, the student who left the brew pub with a box of condoms.

Chite, a 36-year-old taxi driver, has been tested three times before. He’s reduced his sexual partners to just two, but remains reluctant about using condoms. He admitted that there are many “risky behaviors” in his line of work and Chauya prodded him to practice safe sex. 

A hair stylist, Samuel, 21, has been tested four times, but not in the past year. He said he decided to get tested again because he sometimes needs to use a razor when he cuts hair, and with frequent power cuts, he has nicked himself. He also cared for his grandfather who had HIV and died last year. “My grandfather counseled me on sexual relations and the need not to have many partners,” said Samuel, whose says his one partner was tested a year ago.

While Samuel waited to see the counselor for a one-on-one session outside the screened-off area, patrons continued to file in, about 50 within the first two hours. When his number was called, Samuel slipped back behind the curtain to test and get his results. He emerged some time later and flashed a thumbs up.

“We are happy to be bringing this successful outreach counseling and testing program—which was piloted in Iringa region—to Tanga,” said Hally Mahler, Chief of Party of the UHAI-CT program. “I am confident that the people of Tanga will benefit from this extra opportunity to learn their HIV status and take appropriate follow-up actions.”

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