NATIONAL HIV AND AIDS RES PON SE R EPOR T 2012 TA N Z A N IA M A IN L A N D R EPO R T 2 0 1 2 THE UNITED REPUBLIC OF TANZANIA PRIME MINISTER S OFFICE Tanzania Commission for AIDS (TACAIDS) NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND AUGUST 2013 a NATIONAL RESPONSE REPORT 2012 word.indd 1
REPORT 2012 NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND b NATIONAL RESPONSE REPORT 2012 word.indd 2
NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND REPORT 2012 THE UNITED REPUBLIC OF TANZANIA PRIME MINISTER S OFFICE Tanzania Commission for AIDS (TACAIDS) NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND AUGUST 2013 i NATIONAL RESPONSE REPORT 2012 word.indd 1
REPORT 2012 NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND CONTENTS FOREWORD...iv ACKNOWLEDGEMENTS...v LIST OF ACRONYMS AND ABBREVIATIONS...vi EXECUTIVE SUMMARY...ix CHAPTER ONE...1 1.0 PREFACE OF THE REPORT...1 1.1 Report Structure...1 1.2 Methodology...1 1.3 Limitations...1 CHAPTER TWO...2 HIV AND AIDS SITUATION IN TANZANIA MAINLAND...2 2.0 HIV Epidemiology...2 CHAPTER THREE...5 HIV AND AIDS PREVENTION INITIATIVES...5 3.0 Overview of HIV and AIDS Prevention Initiatives...5 3.1 Status of HIV Prevention Indicators...5 3.3. Challenges...10 3.4. Recommendations...10 CHAPTER FOUR...11 HIV CARE, TREATMENT AND SUPPORT...11 4.1 Overview of HIV Care, Treatment and Support Services...11 4.2 Status of Indicators on HIV Care, Treatment and Support...11 4.3 Challenges...14 4.4 Recommendations...15 CHAPTER FIVE...16 HIV AND AIDS IMPACT MITIGATION INTERVENTIONS IN TANZANIA...16 5.1. Overview of HIV and AIDS Impact Mitigation...16 5.2 Status of HIV and AIDS Impact Mitigation Interventions...16 5.3 Challenges...19 5.4 Recommendations...19 ii NATIONAL RESPONSE REPORT 2012 word.indd 2
NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND REPORT 2012 CHAPTER SIX...20 MANAGEMENT OF NATIONAL RESPONSEANAGEMENT OF NATIONARESPONSE...20 6.0 Overview of the Management of National Response...20 6.1 Status of Indicators for Management of National Response...20 6.2 Support to the National Multisectoral Strategic Framework (NMSF II, 2008-12)...21 6.3 Challenges...21 6.4 Recommendations...21 CHAPTER SEVEN...22 PARTNERSHIP IN HIV AND AIDS RESPONSE...22 PARTNERSHIP IN HIV AND AIDS RESPONSE...22 7.0 Overview Partnership in HIV and AIDS Response...2 7.1 International Partnership...22 7.2 Regional Initiatives...22 7.3 National Partnership...23 7.4 Private Sector s Response to the HIV Epidemic...23 7.5 CSOs Response to HIV and AIDS...25 7.6 International Non Governmental Organizations...25 7.7 The HIV and AIDS Technical Working Committees...26 7.8 Challenges...26 7.9 Recommendations...26 CHAPTER EIGHT...26 8.0 GENDER AND HIV and AIDS STRATEGIC FOCUS...27 8.1 Challenges...29 8.2 Recommendations...30 CHAPTER NINE...31 STATUS OF TANZANIA S MONITORING AND EVALUATION SYSTEM...31 9.0 Overview of Status of Tanzania s HIV and AIDS Monitoring and Evaluation System...31 9.1 Achievements of National HIV and AIDS M&E System by Components...31 9.2 Challenges...34 9.3 Recommendations...34 iii NATIONAL RESPONSE REPORT 2012 word.indd 3
REPORT 2012 NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND FOREWORD HIV and AIDS was reported for the fi rst time in Tanzania in the year 1983. Since then, the number of people newly reported to be living with the virus has been on the increase. Tanzania is confronted by a generalized epidemic in the general population; however the epidemic is concentrated among the Key Populations group. Women are disproportionally affected by the epidemic. Generally, HIV prevalence is higher among women than among men in all age groups. The overwhelming effect of HIV and AIDS is felt in all sectors and brings in a wide spread of suffering among individuals, families and communities across the country. The Government of the United Republic of Tanzania in collaboration with other stakeholders on HIV and AIDS has continued to scale up HIV and AIDS interventions programs. The Programs on HIV care and treatment, prevention and impact mitigation have been scaled up in order to sustain the momentum already gained. The current downward trend of resources for HIV and AIDS programs, has led to the establishment of AIDS Trust Fund with which its implementation is very critical in order to sustain the achievements gained over the last three decades in the response to the epidemic. In addition to this initiative, the well focused and targeted HIV and AIDS programs are very imperative for a successful and sustainable national response to the epidemic. The implementation of the HIV and AIDS interventions was guided by the National Multisectoral Strategic Framework II (2008-2012). The framework provides guidance to all stakeholders involved in HIV and AIDS response in the country. This annual National HIV and AIDS response report provides information on the annual progress the country has made towards HIV prevention, care and treatment and support. The report draws information/data from both medical and non medical HIV and AIDS interventions. In each chapter, this report discusses the challenges that were faced in the implementation of HIV and AIDS programs and provides recommendations for action at all levels. The national response to the HIV epidemic requires commitment from all those who are involved in the national response at all levels across the country. It is my sincere hope that this report will serve as a useful resource for stakeholders to capitalize on the strengths, and work on the available opportunities and strengthen programs to yield desired results. Dr. Fatma H.Mrisho Executive Chairman Tanzania Commission for AIDS (TACAIDS) iv NATIONAL RESPONSE REPORT 2012 word.indd 4
NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND REPORT 2012 ACKNOWLEDGEMENTS The Tanzania Commission for AIDS wishes to recognize the contribution made by various Government Stakeholders, Development Partners, Civil Society Organizations and other Stakeholders who supported the development of this National HIV and AIDS response report for 2012 The Commission wishes to particularly express appreciation to the Monitoring and Evaluation Technical Working Group for ensuring that data provided in this report are reliable and valid. More specifi cally, the Commission wishes to thank the core team of professionals who were immensely involved in writing and editing of this National HIV and AIDS response report for 2012. In developing this report, the professional team was overseen and guided by staff from the Directorate of Monitoring and Evaluation -TACAIDS. Sincere appreciations go to the Development Partners for their both technical and fi nancial support during the development of this report. Thanks to different Stakeholders whose efforts have resulted into the accomplishment of this report. Thank you. Dr. Fatma H.Mrisho Executive Chairman Tanzania Commission for AIDS (TACAIDS) v NATIONAL RESPONSE REPORT 2012 word.indd 5
REPORT 2012 NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND LIST OF ACRONYMS AND ABBREVIATIONS ABCT AIDS ANC ART ARV ATE ATF AZT BCC BSS CDC CHAC CMAC CPT CSOs DACC DANIDA DBS DHS DPs EALVP EMIS FBO FSW GBV GLIA GOP GoT HAS HIV ICT IDUs IEC INGO LGA LVBC AIDS Business Coalition of Tanzania Acquired Immuno`-Defi ciency Syndrome Ante Natal Care Anti Retroviral Therapy Anti Retroviral Association of Tanzania Employers AIDS Trust Fund Zidovudine Behaviour Change Communication Behavioural Surveillance Survey Centre for Disease Control and Prevention Council HIV and AIDS Coordinator Council Multisectoral AIDS Committee Combination Prevention Therapy Civil Society Organizations District AIDS Control Coordinator Danish International Development Agency Dried Blood Sample Demographic and Health Survey Development Partners East African Lake Victoria Program Education Management Information System Faith Based Organization Female Sex Worker Gender Based Violence Great lakes Initiative on AIDS Gender Operational Plan Government of Tanzania Heterosexual Anal Sex Human Immune Defi ciency Virus Information Communication Technology Injecting Drug Users Information Education and Communication International Non Governmental Organization Local Government Authority Lake Victoria Basin Commission vi NATIONAL RESPONSE REPORT 2012 word.indd 6
NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND REPORT 2012 M&E MDAs MKUKUTA (NSGRP) MNCH MoHSW MSD MSM MTEF MVC NACOPHA NACP NBS NGO NHCAS NMSF II NSC OVC PEPFAR PLHIV PMTCT PSI RACC REPOA SADC SRH STI T MARC TAF TAIFO TAPAC TB THIS THMIS TOMSHA TPSF TWC UN UNAIDS UNDAP Monitoring and Evaluation Ministries, Departments and Agencies National Strategy for Growth and Reduction of Poverty Maternal, Neonatal and Child Health Ministry of Health and Social Welfare Medical Store Department Men who Sex with men Medium Term Expenditure Framework Most Vulnerable Children National Council of People Living with HIV and AIDS National AIDS Control Program National Bureau of Statistic Non Governmental Organization National HIV and AIDS Communication Strategy National Multisectoral Strategic Framework II National Steering Committee Orphans and Vulnerable Children President s Emergency Plan for AIDS Relief People Living with HIV Prevention of Mother to Child Transmission Public Services International Regional AIDS Control Coordinator Research on Poverty Alleviation Southern African Development Community Sexual and Reproductive Health Sexually Transmitted Infection Tanzania Marketing and Communication Company Tanzania AIDS Forum Tanzania Interfaith Forum Tanzania Parliamentarian AIDS Coalition Tuberculosis Tanzania HIV and AIDS Indicator Survey Tanzania HIV and AIDS and Malaria Indicator Survey Tanzania Output Monitoring System for HIV and AIDS Tanzania Private Sector Foundation Technical Working Committee United Nations Joint United Nations Programme on HIV and AIDS United Nations Development Assistance Plan vii NATIONAL RESPONSE REPORT 2012 word.indd 7
REPORT 2012 NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND UNESCO UNGASS UNICEF USAID VAC VCT WMAC ZAPHA+ United Nations Educational, Scientifi c and Cultural Organization United Nations General Assembly Special Session United Nations Children s Fund United States Agency for International Development Violence Against Children Voluntary Counseling and Testing Ward Multisectoral AIDS Committee Zanzibar Association of People Living with HIV and AIDS viii NATIONAL RESPONSE REPORT 2012 word.indd 8
NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND REPORT 2012 EXECUTIVE SUMMARY Tanzania Mainland is experiencing a generalized HIV epidemic in the general population. The epidemic is concentrated among key Population groups. According to the HIV and AIDS population surveys (THIS and THMIS), HIV prevalence is showing a declining trend in the general population among adults aged 15-49. The prevalence has declined, from 7.0% in 2003/04 to 5.7% in 2007/08 to 5.1% in 2011/2012. HIV prevalence varies by regions and within region, Njombe region has the highest HIV prevalence at 14.8%, the lowest prevalence is recorded in Manyara region at 1.5%. Women are disproportionally affected by the epidemic; HIV prevalence is higher among women than men in all age groups. By the end of 2012, the estimated number of people living with HIV was 1.6 million and a total of 68,447 newly HIV infected people aged 15-49 years. In Tanzania Mainland, evidence suggests that specifi c populations are at increased risk for HIV infections, including injecting drug users (IDUs), Men who have Sex with Men (MSM), females sex workers (FSW). Several studies have found high rates of HIV infections among IDUs, female bar workers and female sex workers. Among Female Sex Workers in Dar es Salaam, HIV prevalence has been reported to be as high as 31.4% (BSS 2010). HIV prevention initiatives are very critical for containing the epidemic. The country has continued to implement programs on PMTCT, HIV Testing and Counseling, Home Based Care, Voluntary Medical Male Circumcision, condom promotion and programming, diagnosis and treatment of sexually transmitted infections, Behavior Change Communication, provision of comprehensive sexual and reproductive health, HIV and AIDS and life skills education through peer education particularly for in and out of school youth. Health facilities providing HIV care and treatment services have increased from 1,112 in 2011 to 1,176 by the end of December 2012. A total of 1,135,390 PLHIV were cumulatively enrolled in care and treatment services and 663,911 eligible adults and children were cumulatively put on ART and 432,338 were currently on ART. The cumulative percentage on ART as of December 2012 was 58.4 (663,911/1,135,390) and currently on ART was 84.2 (432,338/513,359). The cumulative number of children enrolled in care and treatment was 86,929 and a total of 50,980 of children were put on ART (this accounts for 7.7% of the cumulative number of all clients ever on ART). In this reporting period a total of 82,811 pregnant women tested positive for HIV. The number of infants tested positive for HIV was 2,328, which is 2.8% of all the HIV exposed infants. Support to Orphans and Vulnerable Children initiatives have been ongoing, about 127,385 OVC received support ranging from health care, psychosocial, food and nutrition; and educational materials. As of December 2012, 4,289,130 orphans and non orphaned children were enrolled in school, 50.5% (2,167,376/4,289,130) were females and 49.5% (2,121,754/4,289,130) were males. PLHIV clusters have been strengthened for advocacy on stigma and discrimination, promotion of Income Generation Activities and Home Based Care. Spending on HIV and AIDS programmes ix NATIONAL RESPONSE REPORT 2012 word.indd 9
REPORT 2012 NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND has entirely depended on Development Partners. About 98% of funds for HIV and AIDS came from donor support. The Private Sector through the Association of Tanzania Employer and Engender health/champion has continued to strengthen capacity among employers to implement HIV and AIDS workplace interventions. Civil Society Organizations have continued to play an important role in the response to the HIV epidemic. Currently there are over 6,000 (six thousand) community and civil society organizations that provide HIV and AIDS services to communities in Tanzania. The services include HIV prevention, care and support, impact mitigation and advocacy. Gender inequality and gender based violence have been cited in different reports to have contributed to HIV infections. The Government of Tanzania in collaboration with partners has developed and disseminated the National Gender Operational Plan for HIV response (2010-2012). The plan provides framework for stakeholders for mainstreaming gender in all HIV and AIDS interventions. The M&E plan for Gender Operational Plan and data collection tools are being developed. Gender and Children Desks are established in 417 police stations throughout the country and 917 Police offi cers working in Gender and Children Desks have been trained on provision of services to GBV and VAC survivors. x NATIONAL RESPONSE REPORT 2012 word.indd 10
NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND REPORT 2012 1 CHAPTER 1.0 PREFACE OF THE REPORT The National HIV and AIDS annual response report provides details on the progress the country has made in response to the HIV epidemic for the period of January to December 2012. The status of the national response to the HIV is assessed through indicator values as per the National Multisectoral M&E Plan for HIV and AIDS 2010-2012). The report covers indicators on HIV prevention, Care, Treatment and support services and Impact mitigation. This report used data generated from routine HIV and AIDS programs that were implemented through health facilities and community groups, as well as those collected from surveys and surveillance. 1.1 Report Structure The report is divided into nine chapters which provide an overview of the progress the country has made in responding to the epidemic for the period from January to December, 2012. It also outlines challenges emerged during the implementation of HIV and AIDS interventions as well as providing recommendations for action for future improvements. 1.2 Methodology The data used to write this report were collected through the review of HIV and AIDS programs reports and through consolidation of programmatic data from various data sources of the national M&E system at National level. In order to monitor data validity the report was circulated to stakeholders for comments and validation particularly by the National HIV and AIDS Monitoring and Evaluation Technical Working Group. 1.3 Limitations This report could not go without some limitations. Despite the reality that a number of CSOSs and public entities provide non medical HIV and AIDS Services, it was established that their reporting compliance through TOMSHA was still low. Moreover, the information on Home Based Cares services that were provided at the health facility level was not adequately available at the national level. At the same time, the Information on condom availability surveys and workplace HIV and AIDS programs were also not available. 1 NATIONAL RESPONSE REPORT 2012 word.indd 1
REPORT 2012 NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND 2 CHAPTER HIV AND AIDS SITUATION IN TANZANIA MAINLAND 2.0 HIV Epidemiology Trend comparative analysis of epidemiological information on HIV from THIS 2003/2004, THMIS 2007/2008 and THMIS 2011/2012 represent the following HIV prevalence fi ndings in different categories: General HIV Prevalence Tanzania Mainland is experiencing a generalized HIV epidemic; on the other hand the epidemic is much concentrated among the Key Population groups. HIV prevalence is showing a declining trend in the general population among adults aged 15-49. The prevalence has declined from 7.0% in 2003/04 to 5.7% in 2007/08 to 5.1% in 2011/2012. By the end of 2012, the estimated number of people living with HIV was 1.6 million and a total of 68,447 newly HIV infected people aged 15-49 years (UNAIDS Spectrum 2012). Gender dimensions with HIV Prevalence: HIV estimates among adults aged 15-49 years measured over the course of the three surveys in Tanzania Mainland show a downward trend.hiv prevalence varies with age and sex, in the sense that HIV prevalence is higher among women than men at 6% and 4% respectively. Generally, HIV prevalence increases with age for both women and men aged 15-49 years at all age cohorts. HIV prevalence has declined among women from 8% to 7% to 6%, and among men from 6% to 5% to 4%. The regional variation is high from 14.8% in Njombe to 1.5% in Manyara. HIV prevalence is higher among individuals with regular income than those without (6% and 3% respectively) urban residents than rural residents at 7.2% and 4.2% respectively. According to THMIS 2011/2012, in relation to marital status, the highest HIV prevalence is among adults who have been widowed (25%) followed by those that are divorced (13%). Fifteen percent of women and nine percent of men who are divorced or separated are HIV positive, compared with 5% of women or men who are currently in union. One percent of never married women and men who have never had sex are HIV positive HIV Prevalence among Key Population: In Tanzania Mainland, evidence suggests that specifi c populations are at increased risk for HIV infection particularly among the injecting drug users (IDUs), men who have Sex with Men (MSM), and females sex workers (FSW). Several studies have found high rates of HIV infections among IDUs and female bar workers and female sex workers. Among Female Sex Workers in Dar es Salaam, HIV prevalence has been found to be as high as 31.4% (BSS 2010). 2 NATIONAL RESPONSE REPORT 2012 word.indd 2
NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND REPORT 2012 Figure 1: HIV Prevalence by sex Figure 2: Regional Variation in HIV Prevalence 3 NATIONAL RESPONSE REPORT 2012 word.indd 3
REPORT 2012 NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND Figure 3: HIV Prevalence by age and sex Figure 4: HIV Prevalence by marital status 4 NATIONAL RESPONSE REPORT 2012 word.indd 4
NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND REPORT 2012 3 CHAPTER HIV AND AIDS PREVENTION INITIATIVES 3. 0 Overview of HIV and AIDS Prevention Initiatives Tanzania Mainland has implemented various programs towards achieving the global initiatives targeted at zeroing new HIV infections. The HIV prevention interventions in the country include: the Prevention of Mother to Child Transmission (PMTCT), HIV testing and Counseling (HTC), Home Based Care (HBC), Voluntary Medical Male Circumcision, condom promotion and programming, Behavior Change Communication programs (BCC), provision of comprehensive sexual and reproductive health, HIV and AIDS and life skills education through peer education programs particularly for in and out of school youth. The achievements that have been accorded so far on HIV prevention, is a clear evidence of the existing collaboration between the government and implementing partners including MDAs, CSOs, NGOs and Development Partners. Below are the indicator values which provide information on the status of the national response during this reporting period:- 3.1 Status of HIV Prevention Indicators Indicator # 10: Percentage of young women and men aged 15 24 who have had sexual intercourse before the age of 15 (UNGASS (15), UA6) The THMIS 2011-12 Survey indicates that 9% of young women and 10% of men aged of 15-24, reported to have sexual intercourse for the fi rst time before the age of 15. Furthermore 50% of women and 43% of men had reported to have sexual intercourse before the age of 18 years. Indicator # 11: Percentage of women and men aged 15 49 who have had sexual intercourse with more than one partner in the last 12 months (UNGASS (16) Data from the 2011-12 THMIS show that 3.8% of women and 20.8% of men had reported to have sexual intercourse with more than one partner in the last 12 months while in 2007/2008 data; 2.7% of women and 17.9% of men had reported to have sexual intercourse with more than one partner in the last 12 months. Indicator # 21: Percentage of women and men aged 15 49 who had more than one sexual partner in the past 12 months reporting the use of a condom during their last sexual intercourse (UNGASS (17) Data from THMIS 2011-12 indicate that 27.3% of women and 26.8% of men reported to have used a condom during their last sexual intercourse. Indicator # 19: Percentage of HIV-positive pregnant women who received antiretroviral to reduce the risk of mother-to-child transmission (UNGASS (5), UA3) In the reporting period, a total of 73,955 women which is equivalent to 82.1% of total eligible women received anti-retroviral to reduce the risk of mother to child transmission. 5 NATIONAL RESPONSE REPORT 2012 word.indd 5
REPORT 2012 NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND Indicator # 3: Percentage of young women and men aged 15 24 who are HIV infected (UNGASS (22), MKUKUTA) THMIS 2011/2012 report indicates that, among women and men aged between 15-19 the HIV prevalence is 1.3 and 1.0 respectively while for the age band of 20-24 the HIV prevalence among women and men is 4.4% and 1.7% respectively. Indicator # 4: Percentage of infants born to HIV infected mothers who are HIV positive (UNGASS (25) In this reporting period, a total of 82,811 pregnant women tested positive for HIV. The number of infants tested positive for HIV was 2,328, which is 2.8% of all the HIV exposed infants. The table below provides summary of PMTCT program data for the period of January-December 2012. Table 1: PMTCT summary data (Jan-December 2012) Estimated pregnant women annually (Projection from 2002 census) 1,833,930 HIV Prevalence in pregnant women attending ANC (Surveillance Report 2010) 6.9% Pregnant women reach at ANC by PMTCT services 1,625,811 Pregnant women tested for HIV 1,036,948 Previously known HIV positive 27,833 Pregnant women tested HIV positive 54,978 Total HIV Positive 82,811 Pregnant women received post test counseling at ANC 840,536 Number of women with unknown HIV status at delivery 232,218 Pregnant women who received Combined Regimen (AZT) 47,799 Pregnant women who were on ART 26,156 Total women received ARV 73,955 Number of HIV +ve pregnant women assessed for ART eligibility 20,892 Pregnant women intended to choose Exclusive Breast Feeding 65,070 Pregnant women intended to choose Replacement Feeding 3,581 Infants tested for HIV (DBS) before 2 months of age 26,608 Infants tested positive 2,328 Total Infants received ARV 71,571 Infants initiated Cotrimoxazole by 2 months of age 48,858 Partners Tested for HIV 219,895 Partners tested positive 34,278 Proportion of Infants received ARV Prophylaxis in the program 86% Proportion of Infants received ARV Prophylaxis in the population 57% Proportion of women received ARV Prophylaxis in the programme 89% Proportion of women received ARV Prophylaxis VS estimated HIV + pregnant women in the population 58% Percentage of pregnant women assessed for ART eligibility through either clinical staging or CD4 testing 38% Total number of PMTCT implementing sites. 4,832 Source of data NACP (PMTCT) 2012 6 NATIONAL RESPONSE REPORT 2012 word.indd 6
NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND REPORT 2012 Indicator # 13: Percentage of women who feel that a wife is justifi ed in refusing sex or proposing use of condom if she knows her husband has a sexually transmitted infection The attitude toward having safe sex is a paramount measure toward containing spread of HIV among married couples. THMIS 2011-12 indicates that 79.4% of women felt justified to refusal of having sex or proposing the use of condom with her husband who have sexually transmitted infection. Indicator # 12: Percentage of schools that provided HIV education based on life-skills in the last academic year (UNGASS (11) The Ministry of Education and Vocational Training with support from UNESCO had managed to integrate routine HIV and AIDS related indicators in the EMIS. During this reporting period, data on percentage of school providing HIV education based on life-skills was collected, but the indicator value will be reported in the next reporting period. Indicator # 17: Percentage of women and men aged 15-49 who received HIV test in the last 12 months and who know their results (UNGASS (7), UA4) Percentage of men and women who tested for HIV and received their test results in the last 12 months has increased during this reporting period. Data from Demographic and Health Survey (DHS 2010) show that 29.5% of women and 25.0% of men tested and received their results; the THMIS (2011-12) indicates that 30.3% of women and 26.5% of men tested and received their results in the last 12 months. In addition to this, available information from NACP shows that there are 2,168 health facilities that are providing HIV Counseling and Testing services. HIV Counseling and Testing is also provided through stand alone and mobile facilities. The table below provides number of HIV Counseling and Testing sites per region. Table 2: Number of HIV Counseling and Testing sites per region Region Number HIV Counseling and Testing sites Arusha 86 Dar es salaam 136 Dodoma 63 Iringa 124 Kagera 111 Kigoma 67 Kilimanjaro 126 Lindi 72 Manyara 93 Mara 65 Mbeya 163 Morogoro 104 Mtwara 92 Mwanza 86 Pwani 175 Rukwa 68 Ruvuma 70 Shinyanga 136 Singida 89 Tabora 126 Tanga 116 Tanzania 2,168 Source of data (NACP program data 2012) 7 NATIONAL RESPONSE REPORT 2012 word.indd 7
REPORT 2012 NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND Indicator # 33: Percentage of people expressing accepting attitudes towards people living with HIV People s acceptance towards people living with HIV is assessed through the following measures; percent of people willing to care for a family member with the AIDS virus in the respondent s home, would buy fresh vegetables from shopkeeper who has the AIDS virus, say that a female teacher who has the AIDS virus but is not sick should be allowed to continue teaching and would want to keep secret that a family member got infected with HIV. The THMIS 2011-12 indicates that percentage of women and men expressing accepting attitudes towards those living with HIV on all four indicators is 25.4% and 40.4% respectively. The fi gure below shows, the percentage of women and men expressing accepting attitudes on each of the four indicators separately. The data provides the comparison of 2007-08 and 2011-12 THMIS. Figure 5: Attitudes towards PLHIV Indicator # 38: Number of male and female condoms distributed to end users in the last 12 months (UA5) Available information from TOMSHA indicates that, a total of 8,216,984 male and 428,834 female condoms were distributed to end user during this reporting period. Condoms from the MSD are mainly distributed through health facilities. A total of 68,413,356 condoms were distributed through Social Marketing schemes. Indicator # 15: Percentage of large workplaces (public & private) that have prevention and care policies and Programme In response to the secular number 2 of 2006 released by the President s Offi ce responsible for 8 NATIONAL RESPONSE REPORT 2012 word.indd 8
NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND REPORT 2012 Public Service Management, all Ministries, Departments and Agencies (MDAs) have HIV and AIDS workplace programs with annual plans; however the implementation of workplace programs is impeded by budgetary constraints. Information on workplace HIV and AIDS programs in private sector is not available. Indicator # 22: Percentage of donated blood units screened for HIV in a quality assured manner (UNGASS (3)) Tanzania has policy guidelines for blood transfusion activities. The guidelines emphasize voluntary, non-remunerated repeat donations from low risk as well as well informed donors and provide a roadmap for standardized ways of recruiting and retaining safe blood donors. In this reporting period a total of 110,000 units of blood for transfusion were collected and screened for HIV, hepatitis B, C virus and syphilis. Figure 6: Number of Blood units collected Source: NBTS report, 2012 Indicator # 36: Number of learners exposed to life skills-based HIV/AIDS education in the last 12 months Data from TOMSHA shows that by end of December 2012, a total of 109,210 learners were exposed to life skills-based HIV and AIDS education. The intervention areas covered by Life Skills Based Education include HIV prevention, problem solving, communications and decision making skills and sexual and reproductive health. Indicator # 37: Number of persons reached with HIV prevention programme In the reporting period, HIV and AIDS Implementers reported through TOMSHA to have reached the general population with various HIV and AIDS prevention services, such services include provision of awareness education, consistency use of condom and peer related education. The fi gure below indicates the total number of people reached per HIV and AIDS prevention services. 9 NATIONAL RESPONSE REPORT 2012 word.indd 9
REPORT 2012 NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND Figure 7: Number of people in a general population by age reached by various HIV prevention programs Source: TOMSHA report, 2012 3.3. Challenges Challenges that were noted during the implementation of HIV prevention initiatives include:- Lack of comprehensive HIV and AIDS programs for Key Populations Low use of condom during high risk sex Inadequate postpartum/postnatal link for care and follow up services for mothers and HIV exposed babies Limited workplace programmes for HIV and AIDS interventions in both public, private and informal sectors Presence of social cultural norms fuelling the spread of HIV and AIDS Behaviour change interventions towards application of ABC Few programs addressing gender based violence and violence against children 3.4. Recommendations The Government of Tanzania in collaboration with other HIV and AIDS stakeholders need to design and implement HIV and AIDS programs for Key Populations The Government of Tanzania should continue and scale up of condom programming activities The Ministry of Health and Social Welfare in collaboration with partners should strengthen care and link for care and follow up of mothers and HIV exposed babies The Government should budget and implement workplace HIV and AIDS programs The Government of Tanzania in collaboration with development partners should initiate programs addressing gender violence and violence against the children 10 NATIONAL RESPONSE REPORT 2012 word.indd 10
NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND REPORT 2012 CHAPTER 4 HIV CARE, TREATMENT AND SUPPORT 4.1 Overview of HIV Care, Treatment and Support Services The Health Sector HIV and AIDS Strategic Plan (HSHSP) II-2008-2012, which was developed in 2003 builds on the National HIV and AIDS Care and Treatment Plan for People Living with HIV and AIDS (PLHIV) and also calls for provision of quality HIV and AIDS services at all health facilities across the country. Moreover, the ARVs and other clinical services for the management of opportunistic infections are provided at health facilities. Community Based Services are provided at the community level; the community based services are focusing at mitigating the physical, mental, spiritual, and socio-economic needs experienced by PLHIVs and their families and in turn bridge the gap in the continuum of care for health services to the community. The Government of Tanzania strategically aims to strengthen and scale up the implementation of comprehensive care and treatment services in both public and private health facilities. 4.2 Status of Indicators on HIV Care, Treatment and Support Indicator #5: Percentage of adults and children with HIV known to be on treatment 12 months after initiation of anti-retroviral therapy (UNGASS (24), MKUKUTA Available information from the second report of implementation of care and treatment services in Tanzania (2010) shows that, the estimated three yearly cohort (2005, 2006, and 2007) retained to be on ART as of 12 months since initiation of ART by values of 78%, 74% and 76% for adults, and for children 83%, 79% and 81%. Indicator # 25: Percentage of adults and children with advanced HIV infection receiving antiretroviral therapy (UNGASS (4), UA1) As of the December 2012, a total of 1,135,390 People Living with HIV and AIDS were cumulatively enrolled in care and treatment services and 663,911 eligible adults and children PLHIV were cumulatively put on ART and 432,338 were currently on ART. The cumulative percentage on ART as of December 2012 was 58.4% (663,911/1,135,390) and currently on ART was 84.2% (432,338/513,359). The cumulative number of children enrolled in care and treatment was 86,929 as of the December 2012, and a total of 50,980 of HIV positive children were put on ART (this accounts for 7.7% of the cumulative number of all clients ever on ART). Source of data is from routine NACP reporting 2012. 11 NATIONAL RESPONSE REPORT 2012 word.indd 11
REPORT 2012 NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND Table 3: Cumulative number enrolled on CTC and those on ART Cumulative number enrolled in HIV care Cumulative number on ART Region Women Men Women Men Children Adult Children Adult Total in Children Adult Children Adult Total in Care care Arusha 1,980 27,173 1,883 11,101 42,137 1,261 15,478 1,220 7,416 25,375 Dar es 6,358 117,474 5,946 48,372 178,150 4,305 75,368 4,151 34,162 117,986 salaam Dodoma 1,377 17,799 1,375 7,768 28,319 758 9,397 750 5,508 16,413 Iringa 5,565 70,595 5,466 43,412 125,038 3,142 41,718 3,208 26,878 74,946 Kagera 1,445 26,041 1,392 14,931 43,809 912 13,008 935 8,403 23,258 Kigoma 521 7,341 463 3,329 11,654 280 3,694 274 1,824 6,072 Kilimanjaro 2,487 21,913 2,309 10,330 37,039 1,429 13,306 1,367 6,487 22,589 Lindi 745 13,872 697 5,880 21,194 424 6,155 442 3,182 10,203 Manyara 807 12,019 806 4,978 18,610 439 7,085 507 3,015 11,046 Mara 1,161 24,360 1,001 11,692 38,214 619 14,178 585 7,135 22,517 Mbeya 5,346 81,164 5,264 45,522 137,296 2,476 43,484 2,431 28,432 76,823 Morogoro 1,649 27,903 1,577 12,906 44,035 944 17,023 970 8,381 27,318 Mtwara 885 17,466 829 7,414 26,594 515 9,382 493 4,325 14,715 Mwanza 3,332 62,376 3,239 35,688 104,635 1,764 32,787 1,799 19,491 55,841 Pwani 1,625 23,927 1,311 10,414 37,277 890 12,186 760 5,779 19,615 Rukwa 1,233 18,656 1,025 11,272 32,186 513 12,168 499 7,410 20,590 Ruvuma 1,309 20,634 1,269 11,356 34,568 1,202 11,579 786 6,708 20,275 Shinyanga 2,195 39,700 2,201 24,394 68,490 1,397 21,371 1,384 14,014 38,166 Singida 663 9,154 639 4,207 14,663 360 5,677 366 2,913 9,316 Tabora 1,812 26,084 1,818 15,168 44,882 786 11,586 819 7,036 20,227 Tanga 2,216 30,055 2,011 12,318 46,600 1,452 19,428 1,367 8,373 30,620 Njombe 0 - Katavi 0 - Simiyu 0 - Geita 0 - Tanzania 44,711 695,706 42,521 352,452 1,135,390 25,868 396,058 25,113 216,872 663,911 Source of data (NACP program data 2012) 12 NATIONAL RESPONSE REPORT 2012 word.indd 12
NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND REPORT 2012 Indicator # 24: Number of ARV sites per 100000 population per district and region By December 2012, health facilities providing HIV and AIDS care and treatment services had increased to 1,176 from 700 in 2008 out of 6,342 facilities across Tanzania Mainland. Table 4: Number of CTC Facilities per region Regions Regional population HIV prevalence (%) 15-49 years TMHIS 2011/12 Total Number of CTC Facilities Cumulative Clients enrolled in HIV care by Dec 2012 Cumulative Clients on ART by Dec 2012 Number Number Number Number Number Arusha 1,694,310 3.2 45 42137 25375 Dar es salaam 4,364,541 6.9 100 178150 117986 Dodoma 2,083,588 2.9 33 28319 16413 Iringa 941,238 9.1 77 125038 74946 Kagera 2,458,023 4.8 63 43809 23258 Kigoma 2,127,930 3.4 29 11654 6072 Kilimanjaro 1,640,087 3.8 40 37039 22589 Lindi 864,652 2.9 70 21194 10203 Manyara 1,425,131 1.5 29 18610 11046 Mara 1,743,830 4.5 46 38214 22517 Mbeya 2,707,410 9 51 137296 76823 Morogoro 2,218,492 3.8 51 44035 27318 Mtwara 1,270,854 4.1 85 26594 14715 Mwanza 2,772,509 4.2 90 104635 55841 Pwani 1,098,668 5.9 39 37277 19615 Rukwa 1,004,539 6.2 42 32186 20590 Ruvuma 1,376,891 7 61 34568 20275 Shinyanga 1,534,808 7.4 77 68490 38166 Singida 1,370,637 3.3 32 14663 9316 Tabora 2,291,623 5.1 56 44882 20227 Tanga 2,045,205 2.4 40 46600 30620 Njombe 702,097 14.8 0 0 0 Katavi 564,604 5.9 0 0 0 Simiyu 1,584,157 3.6 0 0 0 Geita 1,739,530 4.7 0 0 0 Tanzania 43,625,354 5.1 1,156 1,135,390 663,911 Source of data: NACP 2012 13 NATIONAL RESPONSE REPORT 2012 word.indd 13
REPORT 2012 NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND Indicator # 26: Percentage of women and men with advanced HIV infection receiving ARV combination therapy in the last 12 months (UNGASS (7) The cumulative percentage on ART as of December 2012 was 58.4% (663,911/1,135,390) and currently on ART was 84.2% (432,338/513,359). Indicator # 41: Number of health facilities that provide nutritional support to persons on ART in the last 12 months The Government of the United Republic of Tanzania in collaboration with partners on HIV care and treatment services is providing nutritional support in some Care and Treatment sites. During this reporting period, PLHIV who received nutritional support were as follows:- Table 5: Number of individuals who received nutritional support Quarter 1(2012) Quarter 2 ( 2012) Quarter 3 ( 2012) Quarter 4 ( 2012) 7,861 8,315 9,546 10,602 According to NACP report of 2012 the number of PLHIV who received nutritional support during this reporting period accounted for about 2.2% of all PLHIV who were under care and treatment settings in Tanzania Mainland by end of December 2012. Indicator # 27: Percentage of estimated HIV-positive incident TB cases that received treatment for TB and HIV (UNGASS (6) By the end of 2008, the collaborative TB/HIV activities covered over 90% of all health facilities in Tanzania Mainland. The Available information from the National Tuberculosis and Leprosy Program (2011) showed that 95% of TB/HIV infected patients received Combination Prevention Therapy (CPT), whereas 86% of PLHIV were screened for TB while 38% were treated for both TB and HIV. From January to December 2012, 89.4% (357,400/399,588) of PLHIV were screened for TB in their last visit in the HIV care and treatment settings. 4.3 Challenges While the country has recorded remarkable achievements in terms of HIV care, treatment and support, however, it was observed that there are a number of barriers that hinder rapidly scale up and provision of quality HIV care, treatment and support. These include:- Inadequate Human resources for health in quality and quantity Uneven distribution of human resources for health Inadequate medical supplies and commodities including drugs for Opportunistic Infections, laboratory reagents and HIV test kits and lack of regular maintenance of CD4 count machines Weak integration of HIV care and treatment with other general services such as (HTC,TB,RCH) and Community Based HIV Counselling services Late initiation of ART to eligible PLHIV according to National guidelines Weakness in the recording and reporting system for Home Based Care services 14 NATIONAL RESPONSE REPORT 2012 word.indd 14
NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND REPORT 2012 4.4 Recommendations The Ministry of Health and Social Welfare should deploy and recruit more health care workers, design and implement proper retention policy and strategy The Ministry of Health and Social Welfare should strengthen the Logistic Supply Chain Management (LSCM) and support regular maintenance of CD4 machines across the country The Ministry of Health and Social Welfare should strengthen the linkage of HIV care and treatment with other general (HTC, TB, RCH) and Community Based HIV Counselling services. National guidelines on early initiation of ARV treatment for HIV patients should be promoted and implemented. The Ministry of Health and Social Welfare should strengthen the recording and reporting system for Home Based Care services 15 NATIONAL RESPONSE REPORT 2012 word.indd 15
REPORT 2012 NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND CHAPTER5 HIV AND AIDS IMPACT MITIGATION INTERVENTIONS IN TANZANIA 5.1. Overview of HIV and AIDS Impact Mitigation As HIV and AIDS causes widespread sufferings among individuals, families and communities, mitigating the impact brought in by the epidemic improves not only the quality of lives of those infected and affected by the epidemic but also promotes the well-being of the entire community. The implementation of HIV and AIDS mitigation interventions is guided by the National Multisectoral Strategic Framework II (NMSF II, 2008-2012). The interventions aim to reduce the adverse effect of HIV and AIDS to the community; hence, improve the quality of lives of the OVCs, the PLHIVs, the elderly as well as those affected by HIV and AIDS such as widows and widowers. The socio- economic impact of HIV and AIDS include an increase in number of orphans and vulnerable children living in diffi cult conditions, with poor nutrition and inadequate access to important social services such as education, health, shelter, food, nutrition, legal support, psychosocial support and protection. Many families have been affected by HIV and AIDS resulting to an increase in number of the Most Vulnerable Children (MVC) and the elderly care takers who carry the burden of care without suffi cient support. The Government of Tanzania in collaboration with implementing partners have continued to strengthen efforts to mitigate the impact of the epidemic through implementing community based care and protection action plan for MVC. The reviewed MKUKUTA II version has incorporated HIV and AIDS issues in order to address the element of poverty among those infected and affected. Other efforts include the PLHIV Cluster strengthening across the country under the coordination of NACOPHA. Different interventions have been implemented during 2012 with focus on reducing the impact of HIV and AIDS through advocacy on Stigma and Discrimination, promotion of Income Generating Activities and Home Based Care. 5.2 Status of HIV and AIDS Impact Mitigation Interventions Indicator # 6: Current school attendance among orphan and non orphans aged 10-14 (UNGASS 12, MDG). The MoEVT BEST Report-2012 neither captures information that identifi es orphans in schools nor information on the overall students attendance rate. The available information mainly focuses on students enrolment and drop-out rates. According to the BEST Report (2012), a total of 4,289,130 students were successfully enrolled, among which 50.5% (2,167,376/4,289,130) were females and 49.5% (2,121, 754/4,289,130) were males. 16 NATIONAL RESPONSE REPORT 2012 word.indd 16
NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND REPORT 2012 Indicator # 31: Percentage of orphaned and vulnerable children aged 0 and less than 18 whose households received free basic external support in caring for the child (UNGASS (10), UA2) It is estimated that there are more than two million orphans and vulnerable children in Tanzania. The increasing number of these children has overwhelmed the available social welfare services provided by different stakeholders including the Government. The Department of Social Welfare receives only one per cent of the Ministry of Health and Social Welfare budget and there is a ratio of one social welfare offi cer for every 200,000 or more children (UNICEF Report, 2012). According to TOMSHA report (2012), the total number of OVC who benefi ted from various support was 127,385. The support included health care and supplies, emotional, psychosocial, food, nutrition and educational support. See details in the fi gure below:- Figure 8: Number of OVC who received support to mitigate HIV and AIDS impact in 2012 Source: TOMSHA Report 2012 Indicator # 45: Number of Income Generating Projects supported for vulnerable groups in the last 12 months Despite the fact that there were many initiatives to reduce rural poverty in Tanzania in the last ten years, rural poverty remains a critical economic problem and the rural incomes have not improved signifi cantly. Poverty is a predominantly rural phenomenon; more than 80% of Tanzania s poor live in rural areas, and the sale of food and cash crops is still the most important source of cash income for rural households (NBS, 2009). At the same time, REPOA report (2010) declared that majority of Tanzanians are confronted by limited access to adequate public services such as education, healthcare and safe drinking water. 17 NATIONAL RESPONSE REPORT 2012 word.indd 17
REPORT 2012 NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND According to fi ndings shared by Pact-Tanzania (2012), a total of 20,754 primary MVC Care givers were registered, whereby among them 17,468 (84%) were females and 3,286 (16%) were males (Pact, 2012). Furthermore, TOMSHA report (2012) showed that a total of 16,731 individuals had benefi ted from support provided by respective projects as outlined in the fi gure below: Figure 9: Number of beneficiaries who received support related to Income Generating Projects Source: TOMSHA report 2012 Indicator # 48: Number of PLHIVs receiving two or more support services There are about 1,600,000 PLHIVs in Tanzania Mainland (THMIS 2011-12). The Report from TOMSHA (2012) submitted by LGAs indicate that 28,012 PLHIV (1.7%) received two or more support services. In this context, households were considered vulnerable once they accommodate OVC, Elders, Widows, Widowers or any other vulnerable persons or groups. Information shared by the MoHSW (2012) shows that 894,519 OVC received two or more support services, whereby 474,095 (53 %) were females and 420,424 (47%) males. The TOMSHA report (2012) also revealed that 20,999 individuals from various vulnerable households received two or more support services. Indicator # 46: Number of Established PLHIV functional clusters According to TOMSHA report (2012) a total of 9,902 PLHIV support groups were established. NACOPHA in collaboration with other HIV and AIDS stakeholders managed to establish a total of 76 PLHIV functional clusters (54%) from 142 District Councils in Tanzania Mainland and 617 PLHIV support groups (NACOPHA Report, 2012). This is an addition of 39 clusters from previous 37 clusters reported in 2011. The increased advocacy on positive living among PLHIV has increased 18 NATIONAL RESPONSE REPORT 2012 word.indd 18
NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND REPORT 2012 the number of functioning PLHIV clusters which resulted into improved welfare services to the PLHIV particularly in terms of access to income generating activities and entrepreneurship training. The following were the challenges arising from the implementation of HIV and AIDS mitigation activities 5.3 Challenges Limited resources to support the affected and infected population including Vulnerable households Inadequate MVCs/OVCs data management system especially at the sub national level Limited interventions focused to support elderly caretakers and child headed Households Inadequate inclusion of MVCs/OVCs interventions into Councils Medium Term Expenditure Framework Inadequate village mechanisms for resource mobilisation to support PLHIV and MVC/ OVCs needs Lack of care taking skills by the elderly who are burdened with the responsibility to take care of PLHIV Weak coordination of interventions implemented by HIV and AIDS Stakeholders at various levels Most MVC committee formulated at village level are not well functioning. The Department of Social Welfare (DSW), the government agency charged with driving the National Costed Plan of Action for MVCC, is understaffed lacks the infl uence and resources needed to promote the Plan. 5.4 Recommendations In order to improve the HIV and AIDS Impact Mitigation interventions, the following recommendations are made: Scale up MVC/OVC identifi cation and services provision Improve MVC/OVC data management and reporting system as well as inclusion of the data on the elderly and people with disability at all levels Capacity building of MVC committees, elderly caretakers and people with disabilities The Central government should direct councils to integrate MVC interventions in the MTEF. Councils should strengthen coordination of HIV and AIDS implementers at the district level for rational and proper utilization of available resources. Councils in collaboration with stakeholders implementing the HIV and AIDS mitigation impact activities should reinforce the identifi cation process of the elderly caring for PLHIV, OVC and MVC Develop the human capacity necessary to implement the Plan by training district offi cials in their roles and responsibilities for MV children and helping them develop a government infrastructure to support MVCCs, coordinate NGOs and ensure their service delivery and response to MV children. 19 NATIONAL RESPONSE REPORT 2012 word.indd 19
REPORT 2012 NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND CHAPTER6 MANAGEMENT OF NATIONAL RESPONSE 6.0 Overview of the Management of National Response Tanzania Commission for AIDS is responsible for provision of multisectoral policy guidance and oversight of the National response to the HIV epidemic. Specifi cally, the Commission coordinates the National Multisectoral HIV and AIDS Strategic Framework with the key functions of policy development, resource mobilization, advocacy; and monitoring and evaluation. The public sector has well defi ned administrative structures for the national response to the epidemic. The structures are stretched from the national level through regional administration down to the Local Government Authorities as well as to the community level. The Planning, implementation and monitoring of the national response fall within the sectors which are also decentralized to the LGA levels. The roles and responsibilities of each of these levels in the National Response to HIV and AIDS are well defi ned. All partners supporting the national response to the epidemic work in collaboration with the public sector s defi ned administrative structures. 6.1 Status of Indicators for Management of National Response Indicator # 8: Domestic and international AIDS spending by categories, fi nancing sources and levels of government (UNGASS (1), UA7) Availability of adequate and sustainable fi nancial resources is very critical for the successful implementation of HIV and AIDS interventions. The Government of Tanzania recognizes the importance of fulfi lling global and regional commitments to health fi nancing and in this regard will continue to increase the level of funding, establish an HIV and AIDS Trust Fund and develop mechanisms to coordinate contributions from the private sector, CSOs and informal sector. During this reporting period, a total of 508.5 billion was estimated to have fi nanced HIV and AIDS, 98% of this came from Development Partners. See details below:- Table 6: Estimated amount of HIV and AIDS Funds Estimated amount of HIV and AIDS Funds, 2012/13 ( 000 shillings) Source of Fund Estimated amount of Fund GoT 11,265,104 Global Fund 102,900,000 Sweden Embassy 2,697,825 JICA 600,000 CIDA 11,000,000 DANIDA 8,760,000 Royal Netherlands Embassy 2,857,489 UNDP 9,627,187 UNFPA 612,000 USG 347,980,000 Germany 10,200,000 TOTAL 508,499,605 Source: Public Expenditure Review 2011, TACAIDS Financial report 2012 20 NATIONAL RESPONSE REPORT 2012 word.indd 20
NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND REPORT 2012 Indicator # 34: Percentage of implementers of HIV and AIDS interventions that have submitted TOMSHA forms on time in the last 12 months Community level HIV and AIDS implementers are trained on M&E and TOMSHA reporting. During this reporting period, a total of 1627 non medical HIV and AIDS implementers were trained on M&E and TOMSHA. The compliance of total number of trained implementers on TOMSHA reporting is at 42.0% (924/2200). The Government of Tanzania in collaboration with partners supporting the national response supplied computers to 133 LGAs and installed TOMSHA electronic database. 6.2 Support to the National Multisectoral Strategic Framework (NMSF II, 2008-12) The Government of Tanzania initiated NMSF Grant in 2006, this is a pooled fund to fi nance National Multi-sectoral Strategic Framework (NMSF) from 2008-2012. The NMSF Grant is currently fi nanced by the Governments of Canada and Denmark. The fund supports HIV and AIDS activities at the central and sub national levels through the Local Government Authorities. 6.3 Challenges The following are experienced challenges with the management of the national response Declining and inadequate funding of HIV and AIDS activities Weak coordination among implementers in private and informal sectors Poor harmonization of the fi nancial resources within sectors such as LGAs, MDAs and other public institutions HIV and AIDS committees at ward (WMACs) and village (VMACs) levels have inadequate capacity to supervise and coordinate HIV interventions at their respective areas hence fail to contribute effectively in national response. 6.4 Recommendations The Government of Tanzania should fast track the establishment of the AIDS Trust Fund TACAIDS and LGAs should strengthen coordination among implementers particularly with private, informal and FBOs LGAs through objective A, should allocate resources to train WMAC and CMAC to be able to carry out their mandate to coordinate and supervise HIV and AIDS related activities 21 NATIONAL RESPONSE REPORT 2012 word.indd 21
REPORT 2012 NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND 7 CHAPTER PARTNERSHIP IN HIV AND AIDS RESPONSE 7.0 Overview Partnership in HIV and AIDS Response Tanzania adopted a national multisectoral approach in responding to the HIV epidemic through strong partnership and collaboration with key International and National stakeholders. The partnership and collaboration are aligned and harmonized in order to ensure strong and participatory attainment of the national response strategic objectives. This chapter provides an overview on the Key Stakeholders efforts for HIV response in the country. 7.1 International Partnership Tanzania continued to participate and implement the International initiated Programs and strategies in the containment of the HIV epidemic. Various global initiatives where partnership and collaboration have been ratifi ed include MDG s, Paris Declaration, UNGASS, UA and the Beijing Platform of Action. Through partnership and collaboration of various development partners, the Government of Tanzania has managed to attract strong bilateral and multilateral collaboration through resource mobilization particularly the Global Fund, PEPFAR, Rapid Funding Envelope and Basket Funding. The country is now experiencing a diminished resource fl ow from partners due to several factors including the global economic recession, shift of development partners priority focus and internal socio-economic factors. 7.2 Regional Initiatives Tanzania has been an active member of the African Union since its inception. The African Union in its effort to contain the HIV epidemic has jointly formulated the Abuja declaration which Tanzania has ratifi ed. The country is involved in various regional HIV and AIDS initiatives including Lake Victoria Basin, Southern Africa Development Community (SADC), and the Great Lakes Initiatives on AIDS (GLIA), East Africa Community HIV and AIDS Initiative (EALVP/LVBC). These collaborations have joined efforts and strengthened the HIV and AIDS response across the African region. The Lake Victoria Basin Commission Project supported HIV and AIDS initiatives in fi shing communities across Lake Victoria, Migrant plantation workers and Universities communities. The SADC regional initiative works in 15 countries and aims at providing technical support, strengthening surveillance system, improving service delivery at cross-border and resource mobilization for the multi-regional response. GLIA was established as a collaborative partnership in responding to HIV and AIDS in the following countries; Burundi, Democratic Republic of Congo (DRC), Kenya, Rwanda, Tanzania and Uganda. The GLIA project had 4 components; (a) support to refugees, host communities, Internally Displaced Persons and returnees (b) support to HIV and AIDS networks (Long-distance truck drivers and PLHIVs) (c) support to health sector regional collaboration and (d) Management and Monitoring & Evaluation aspects. The activities implemented included support to national networks of PLHIV 22 NATIONAL RESPONSE REPORT 2012 word.indd 22
NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND REPORT 2012 (NACOPHA, Tanzania Drivers Association, and ZAPHA+ in Tanzania Mainland and Zanzibar Island respectively. The project also supported harmonization of health protocols and construction of four knowledge rooms along the central transport corridor at Mdaula, Kibaigwa, Kagongwa and Pemba- Zanzibar 7.3 National Partnership The Government of Tanzania in collaboration with the Development Partners has continued to support the implementation of HIV and AIDS activities at all levels. The Local Government Authority is central to the delivery of HIV and AIDS services in the communities. Therefore, investing and providing both technical and fi nancial support to this entity will always improve and sustain the achievements already gained. The fi nancial support of National Multi-sectoral Strategic Framework (NMSF) requires about 1 trillion Tanzanian shillings per year. Currently, the HIV and AIDS programs are being fi nanced by 50%; such that the public sector consumes about 25% of the total fi nancial resources. About 97% of the funding for HIV and AIDS programs is by DPs. The funding level indicates that 3% is by the government, Global Fund 20%; NMSF grant 4%; UN family 2% and USG 71%. The Government of Tanzania is making progress towards establishing AIDS Trust Fund (ATF), this fund is expected to fi ll the HIV and AIDS fi nancing gap. 7.4 Public Sector s response to the HIV Epidemic The coordination of HIV and AIDS interventions in the Public Sector is coordinated through Technical AIDS Committees, whereby each MDA has selected a Focal Person who is vested with responsibilities of ensuring there is a workplace program at the institution. The coordination at the regional level is done through the Regional Secretarial through Regional AIDS Management Team (RAT). The main responsibilities of this team are to provide technical support and guidance on the coordination of HIV and AIDS interventions in the LGAs. The RS have been supporting the LGAs by conducting supportive supervision and technical support that resulted into improved reporting at the LGA. The coordination of HIV and AIDS interventions at the LGA level is done through CMAC at the district level, WMAC at ward level and VMAC at village level. These coordination structures to a large extent have facilitated the provision of services to the benefi ciaries at the community level Private Sector s Response to the HIV Epidemic The Private sector in Tanzania is growing fast following an on going economic policy reforms adopted since early 1990s. The Government of Tanzania recognizes the importance of the private sector in development and therefore in the national response to the HIV epidemic. The AIDS Business Coalition (ABCT) was established to coordinate the response from this key sector. In June 2011, the private sector stakeholders selected the Association of Employers (ATE) to become the focal point for the Private sector and the Tanzania Private Sector foundation (TPSF) becoming the alternate focal point. ATE s main role has been that of advocacy and sensitization for HIV and AIDS workplace programs among its members; ATE with assistance from Engender health/champion Project, builds the 23 NATIONAL RESPONSE REPORT 2012 word.indd 23
REPORT 2012 NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND capacity of employers through monthly trainings on HIV and AIDS at workplace.this aims at enhancing employers capacity to protect their workforce from HIV infections and to deal with those that are already infected. ATE has been organizing yearly Employer of the Year Award (EYA) whereby one employer who excelled in the best practices in the response to the HIV epidemic in each category is awarded is a special award. ATE works in line with HIV and AIDS workplace Policy. The policy prohibits discrimination based on real or perceived HIV status and the policy covers both prevention and post-infection needs ATE looks at whether: The Workplace has a policy addressing HIV and AIDS and all employees have been sensitized on the same. The HIV and AIDS prevention and care initiatives are made available to employees and dependants within the workplace or readily accessible outside the workplace Adequate fi nancial and logistical resources made available to ensure that programs run effectively and effi ciently. Employees are involved at all levels and in all aspects of workplace responses to HIV and AIDS The effectiveness of HIV and AIDS initiatives are monitored and reviewed regularly HIV and AIDS related training Managers have been trained to address and respond to HIV and AIDS issues and concerns in the workplace Shop stewards/. The Labor union leaders have been trained to address and respond to HIV and AIDS issues and concerns in the workplace The workplace offers training; awareness and informational programs to workers and regular sensitization of employees on key HIV and AIDS issues using appropriate materials. The workplace offers programs reaching out to employees families (spouses/partners and children) The organization collaborates and networks with key HIV and AIDS stakeholders as a strategy to fi ght against HIV and AIDS The organization participates in HIV and AIDS-related community service There are HIV or reproductive health informational/educational materials Information provided routinely A company provides HIV counseling and testing; and treatment services or facilitates access to such clinical services for its workers including provision or facilitation for access to condoms Experience indicates that so far very little contribution has been realized from the private sector despite its rapid expansion over the past 10 years. Such low response from the private sector can be attributed to several factors including poor coordination and low/ineffective representation of the sector in HIV and AIDS coordination structures. 24 NATIONAL RESPONSE REPORT 2012 word.indd 24
NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND REPORT 2012 7.5 CSOs Response to HIV and AIDS The Civil society organizations play an important role in the HIV and AIDS national response. They have been recognized widely as champions in complimenting government efforts. Currently there are over 6,000 (six thousand) community and civil society organizations that provide HIV and AIDS services to communities in Tanzania. The services include prevention, care and support, impact mitigation and advocacy. National Steering Committee for CSOs TACAIDS has been collaborating with Civil Society Organizations in the implementation of HIV and AIDS interventions at all levels. Civil Society Organizations in collaboration with TACAIDS formed a National Steering Committee (NSC) to facilitate the coordination of these organizations so as to enable them to have a collective voice and networking in the national response against HIV and AIDS. NSC is made up of 10 civil society organizations under the Secretariat of the Tanzania AIDS Forum (TAF), an umbrella of organizations that engaged in HIV and AIDS activities in Tanzania. NSC has the leadership, the Constitution and a fi ve-year Strategic Plan that provides guidance for the implementation of HIV and AIDS interventions in the community through Civil Society Organizations. NSC has developed a one year plan for capacity-building for Civil Society Organizations in order to enable them to work more effectively and effi ciently. Tanzania Interfaith Forum (TAIFO) TACAIDS recognizes the contribution of the Religious and Faith Based Organization (FBO) in response to the HIV epidemic. TACAIDS in collaboration with religious/faith based organizations formed a Tanzania Interfaith Forum (TAIFO) to coordinate HIV and AIDS interventions by FBOs. This Forum is coordinated by Christian Social Services Commission (CSSC) and Tanzania Muslim Welfare Network (TMWN) to represent Christians and Muslims respectively. TAIFO brings together CSSC and TMWN as coordinating bodies for FBOs. TAIFO is currently under the coordination and chairmanship of CSSC; which is normally done on rotational basis. TAIFO has a 3-year Strategic Plan (2012-14) and has developed two guidelines (Christians and Muslims) to guide the provision of HIV and AIDS education to their followers. Informal Economic Network for AIDS Initiative-TIENAI The Government of Tanzania realizes the effects of leaving behind the Informal Sector Economy in the national response to the HIV epidemic. In conjunction with the leaders of TIENAI, has managed to establish an Informal Economic Network for AIDS Initiatives (TIENAI) for the purpose of managing and coordinating HIV and AIDS interventions in this sector (hawkers). TIENAI has developed a strategy of identifying these groups and resource mobilization is done to allow implementation to begin. 7.6 International Non Governmental Organizations The National Response is also supported by a number of International Non Governmental Organizations (INGOs). Many of these INGOs are supported by the Government of the United 25 NATIONAL RESPONSE REPORT 2012 word.indd 25
REPORT 2012 NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND States of America through the President s Emergency Plan for AIDS Relief (PEPFAR), USAID, US Department of Labor, CDC and US Department of Agriculture. Other support received included, the Global Fund to fi ght HIV and AIDS Tuberculosis and Malaria (GFATM), UNDAP, Basket Fund and DANIDA. These organizations have made signifi cant contribution to HIV care, treatment and support, HIV prevention initiatives and impact mitigation. 7.7 The HIV and AIDS Technical Working Committees Apart from specifi c partnership groups discussed above, there are six TWCs established to provide technical advice to the Government on National Multisectoral HIV and AIDS response in Tanzania Mainland. The composition of TWCs is Multisectoral in nature with representatives from the Government Ministries Department and Agencies (MDAs), the Development partners (DPGs), the Non Government Organizations (NGOs), the Faith Based Organizations (FBOs) and Community Based Organizations (CBOs). TACAIDS is the Secretariat of all TWCs except for Care, Treatment and Support TWC which is under the MoHSW. The TWCs meet once in every three months. In addition to quarterly meetings, the TWCs co-conveners may call adhoc meetings after consultation with stakeholders as the need arises. 7.8 Challenges Reduced resources for HIV and AIDS intervention from the global partners Inadequate funding to address regional initiatives such as SADC regional surveillance for drug resistance on TB/HIV Inadequate resources to provide for HIV and AIDS services cross boarder and transit routes Inadequate reporting compliance from INGOs Inadequate involvement of top management offi cials of the private companies in HIV and AIDS workplace interventions Few private companies implement HIV and AIDS workplace programs effectively Inadequate fi nancial resources limit the capacity of ABCT to play its role of coordinating the private sector s response Inadequate funds allocated for MDAs to implement HIV and AIDS interventions 7.9 Recommendations HIV and AIDS is still a major concern for the African region, therefore, support to all key stakeholders should be increased to respond to the HIV epidemic Reporting mechanisms for INGOs should be strengthened so as to increase reporting compliance The Government of Tanzania in collaboration with relevant stakeholders should ensure that private sector has effective WPP and reporting MDAs should allocate funds for HIV and AIDS inte rventions 26 NATIONAL RESPONSE REPORT 2012 word.indd 26
NATIONAL HIV AND AIDS RESPONSE REPORT 2012 TANZANIA MAINLAND REPORT 2012 CHAPTER 8 GENDER AND H IV and AIDSAND HIV &AIDS 8.0 GENDER AND HIV and AIDS STRATEGIC FOCUS Gender inequality and gender based violence (GBV) have been cited in various reports as contributing factors to HIV infections. The unequal power relations between men and women limit decision making for women and girls in negotiating for safe sex and condom use, and also increase the extent of violation of women s and girls rights. The most common forms of GBV are physical, sexual, psychological, and economic violence in terms of fi nancial deprivation and exploitation. The country continues to advocate for prevention of GBV and Violence against Children (VAC) community levels. The government has indicated commitment in achieving HIV Prevalence by Education gender equality in prevention Percent HIV-positive and access to HIV and AIDS services. The National Gender Operational Plan for HIV response in Tanzania Mainland 2010-2012 (GOP) has been disseminated to guide stakeholders in mainstreaming gender in all their HIV & AIDS interventions. The M & E Plan for GOP and data collection tools are being developed and the development of IEC materials and messages on Sexual and Reproductive Health (SRH) and BCC messages are ongoing. The process of developing a National Multi-sectoral program for HIV prevention, unintended pregnancy and violence has commenced. Strengthening of the Regional Capacity Building Teams (RCBT) and the National Coordination Structures including CMACs on GBV, child protection guidelines and VAC is in progress. Empowerment and HIV The government of Tanzania has made a fi rm political commitment to support various initiatives that are focused at alleviating gender inequalities and empowerment in economic, social and political areas. THMIS 2011-12 revealed that approximately 40% of women do not have the fi nal say in decisions regarding their own health, their children s health, or their own daily household expenditure. Only 15% of women can make decision on their own health care, the situation which increases HIV vulnerability. The Tanzania Women s Bank and other national and international institutions continue to provide small grants to women, men, boys and girls groups for income generation. 27 NATIONAL RESPONSE REPORT 2012 word.indd 27