Determinants of Demand for Condoms to Prevent HIV Infections among Barmaids & Guesthouse Workers in Two Districts, Tanzania

Condoms are scientifically recommended as potential products for preventing infections attributable to human immuno-deficiency viruses (HIV). However, evidence on factors leading to their inadequate use in developing countries is still scanty. This paper reports an exploratory study of factors constraining condoms use in Tanzania from the perspectives of barmaids, guest-house workers and retailers.

Data were collected in two districts—Mpwapwa in Dodoma Region and Mbeya Rural in Mbeya Region—between October and December 2011, using structured interviews with 238 individuals including barmaids, guesthouse workers and 145 retailers. Data analysis was performed using STATA 11 software.

Awareness about condoms was high among all study groups. Male condoms were more popular and available than female ones. A considerable proportion of the barmaids and guesthouses were disappointed with condoms being promoted and distributed to young children and disliked condom use during sexual intercourse. Accessibility of condoms was reported as being lowered by condom prices, shortage of information concerning their availability; short supply of condoms; some people shying away to be watched by children or adult people while purchasing condoms; retailers’ using bad languages to condom customers; occasionally condom shops/kiosks found closed when they are urgently needed; and prevailing social perception of condoms to have low/no protective efficacy. Regression analysis of data from barmaids and guesthouse-workers indicated variations in the degree of condom acceptability and methods used to promote condoms among respondents with different demographic characteristics.

A combination of psychosocial and economic factors was found contributing to lower the demand for and actual use of condoms in study communities. Concerted measures for promoting condom use need to address the demand challenges and making operational research an integral element of monitoring and evaluation of the launched interventions, hence widening the evidence for informed policy decisions.

Table 1

Demographic backgrounds of barmaids and guesthouse workers interviewed in Mbeya (R) and Mpwapwa Districts, Tanzania in 2011

Demographic characteristics	Barmaids and guesthouse keepers		Condom retailers
	No.	%	No.	%
Sex
Male	78	32.9	71	48.9
Female	159	67.1	74	51.1
Total	237	100	145	100
Age group in years
<35 years	174	73.1	64	48.1
≥35 years	64	26.9	69	51.9
Mean = 29.4, SD = 8.1
Total	238	100	133	100
District of residence
Mbeya Rural	123	51.7	69	65.7
Mpwapwa	115	48.3	36	34.3
Total	238	100	105	100
Education
Never gone to school	28	11.8	2	1.4
Primary school	185	78.1	77	53.9
Secondary school	24	10.1	64	44.7
Total	237	100	143	100
Marital status
Married (in union)	89	37.7	–	–
Single	98	41.5	–	–
Never got married	49	20.8	–	–
Total	236	100	–	–

Full article at: http://goo.gl/NgWbgp

By: Godfrey M. Mubyazi, Amon Exavery, Filemoni Tenu, Julius J. Massaga, Jovitha Rugemalila, Hamisi M. Malebo, Victor Wiketye, Emmanuel A. Makundi, Joyce K. Ikingura, Adiel K. Mushi, Sia E. Malekia, Abubakary Mziray, John W. Ogondiek, Amos Kahwa, Mwanaidi M. Kafuye, and Mwelecele N. Malecela

National Institute for Medical Research (NIMR), P.O Box 9653, Dar es Salaam, Tanzania

Ifakara Health Institute (IHI), P.O Box 78373, Dar es Salaam, Tanzania

Amani Medical Research Centre (MRC), P.O Box 81, Muheza, Tanzania

National Bureau of Statistics (NBS), P.O Box 796, Dar es Salaam, Tanzania

NIMR Ngongongare Research Station, Usa River, P.O Box 514, Arusha, Tanzania

Muhimbili Medical Research Centre, P.O Box 5004, Dar es Salaam, Tanzania

Godfrey M. Mubyazi, Email: zt.ro.rmin@izaybumg, Email: moc.liamg@izaybummg.

  

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Official Invitation Letters to Promote Male Partner Attendance & Couple Voluntary HIV Counselling & Testing in Antenatal Care: An Implementation Study in Mbeya Region, Tanzania

The benefits of male partner involvement in antenatal care (ANC) and prevention of mother-to-child transmission of HIV (PMTCT) for maternal and infant health outcomes have been well recognised. However, in many sub-Saharan African settings, male involvement in these services remains low. Previous research has suggested written invitation letters as a way to promote male partner involvement.

In this implementation study conducted at three study sites in southwest Tanzania, acceptability of written invitation letters for male partners was assessed. Pre-study CVCT rates of 2–19 % had been recorded at the study sites. Pregnant women approaching ANC without a male partner were given an official letter, inviting the partner to attend a joint ANC and couple voluntary counselling and testing (CVCT) session. Partner attendance was recorded at subsequent antenatal visits, and the invitation was repeated if the partner did not attend. Analysis of socio-demographic indices associated with male partner attendance at ANC was also performed.

Out of 318 women who received an invitation letter for their partner, 53.5 % returned with their partners for a joint ANC session; of these, 81 % proceeded to CVCT. Self-reported HIV-positive status at baseline was negatively associated with partner return (p = 0.033). Male attendance varied significantly between the rural and urban study sites (p < 0.001) with rates as high as 76 % at the rural site compared to 31 % at the urban health centre. The majority of women assessed the joint ANC session as a favourable experience, however 7 (75 %) of women in HIV-positive discordant or concordant relationships reported problems during mutual disclosure. Beneficial outcomes reported one month after the session included improved client- provider relationship, improved intra-couple communication and enhanced sexual and reproductive health decision-making.

Official invitation letters are a feasible intervention in a resource limited sub-Saharan African context, they are highly accepted by couple members, and are an effective way to encourage men to attend ANC and CVCT. Pre-intervention CVCT rates were improved in all sites. However, urban settings might require extra emphasis to reach high rates of partner attendance compared to smaller rural health centres.

Table 3
Bivariate analysis of factors effecting partner attendance at ANC
Variable	Categories	Study participants N/%	Partner attended N/%	OR	95 % CI	P value
Health facility	Makongolosi	120/37.7	91/75.8	7.01	3.57–13.74	<0.001 c
	Tunduma	101/31.8	49/48.5	2.1	1.16–3.8	0.012 c
	Ruanda	97/30.5	30/30.9	1	-	-
Age	<26 years	218/68.6	126/57.8	1.74	1.08–2.8	0.022 c
	≥26 years	100/31.5	44/44	1	-	-
Travel time to clinic	≤15 min	186/58.5	108/58.1	1.56	0.99–2.46	0.051 c
	>15 min	132/41.5	62/47	1	-	-
Literate	Literate	301/95.9	157/52.2	0.33	0.088–1.22	0.08 c
	Illiterate	13/4.1	10/76.9	1	-	-
Marital status	Married	236/74.2	143/60.1	3.13	1.81–5.41	<0.001 c
	Partnership	82/25.8	27/32.9	1	-	-
Religion	Christian	284/90.5	149/52.5	1	-	-
	Muslim + Others	30/9.5	19/63.3	1.07	0.5–2.32	0.86 d
Partners age	≤26 years	117/38	69/59	1.45	0.91–2.32	0.115 c
	>26 years	191/62	95/49.7	1	-	-
Partner employment	None	10/3.6	5/50	0.81	0.23–2.85	0.041 e
	Formal	24/7.7	7/29.2	0.33	0.13–0.834	-
	Self-employed	278/89.1	154/55.4	1	-	-
Number of children at home	None	131/46.6	67/51.2	1	-	-
	1–2	110/39.2	50/45.6	0.79	0.48–1.32	-
	>2	40/14.2	22/55	1.17	0.57–2.38	0.51 e
IPV	IPV reported	75/24.4	28/37.3	1	-	-
	Not reported	232 75.6	133/57.3	2.26	1.31–3.39	0.003 d
Media	None	6/1.9	2/33.3	1		0.042 e
	Radio	190/59.8	112/59	2.87	0.51–16.25	-
	Media plus a	122/38.4	56/45.9	1.7	0.297–9.7	-
Previous partner attendance at ANC b	Yes	27/13.9	19.4/70.4	4.17	1.63–10.67	0.002 d
Self-reported HIV status (baseline)	Positive	8/2.6	1/12.5	0.11	0.01–0.92	0.025 e
	Negative	212/68.6	121/57.1	1	-	-
	Unknown	89/28.8	43/48.3	0.7	0.43–1.16	-

a Media plus = radio + TV +/− Newspaper, or TV or Newspaper only, or TV + Newspaper without radio

b Data from Tunduma & Ruanda health centres

P value calculated using : c Chi-squared test. d Fishers exact test. e Fishers exact test (homogeneity/equal odds)

Jefferys et al.

Jefferys et al. Reproductive Health 2015 12:95   doi:10.1186/s12978-015-0084-x

Full article at: http://goo.gl/c8s5Ac

By: Laura F. Jefferys¹, Philo Nchimbi², Paulina Mbezi², Julius Sewangi³ and Stefanie Theuring^1*

¹Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin, Berlin, Germany

²PMTCT Program Mbeya Region, Ministry of Health and Social Welfare, Mbeya, Tanzania

³Regional AIDS Control Program Mbeya, Ministry of Health and Social Welfare, Mbeya, Tanzania

  

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