BASELINE STUDY TO DETERMINE CULTURAL CUSTOMS ACCELARATING HIV/AIDS RELATED STIGMA AND DISCRIMINATION, THAT HINDERING WOMEN AND

GIRLS TO HAVE ACCESS FOR HIV/AIDS PREVENTION AND MANAGEMENT ACKNOWLEDGEMENT This report reflected the challenges and problems accelerating HIV and AIDS related stigma and discrimination that restrict women and girls to have widely accepted prevention and management in Handeni district. We would like to thanks everyone who actively taken important chance during the baseline study and played an important role in accumulating the experiences, thus contributing to developing this document. This baseline Survey was made possible through profound participation and assistance of numerous individuals at all community levels. Special thanks go to District Executive Director through District Development Community Officer (DDOS) who currently saving as CHAC for his active support to make this exercise possible, also we would like extend our thanks to Community development officers namely Zawadi Ngwando, Amina Waziri, Asumin and Asumini Mkwizu, absolutely their closely collaboration and provision of important information has created enabling environment during our survey. Highly indebted goes to Wards and Villages chairpersons for showing enthusiastic and tolerance during the whole process of Baseline Survey, it was not easier for them as they were accountable to mobilize people for local government elections meanwhile placing some strategies against cholera epidemic in their areas. We are appreciating the participation of other key informant such as nurses, teachers, retired officers and other influential people in the surveyed villages. ACRONYMS
DAC TAWG HIV AIDS District Aids Coordinator for Health department Tanga Aids Working Group Human Immune Virus Acquired Immune Deficiency Syndrome

HBC SAHRiNGON VMAC NGOS CBOS FGD CMAC WMAC VMAC DDO

Home Based Care Southern African Human Rights NGOS Network Village Multsectoral HIV/AIDS committee Non Government Organizations Community Based Organizations Focused Group Discussion Council Multsectoral Aids committee Ward Multsectoral Aids Committee Village Multsectoral HIV/AIDS committee District Development Officer

TABLE OF CONTENTS
1. EXERCUTIVE SUMMARY ...3 2. BACKGROUND 5 2.1 The scope of Baseline Study ...8 2.2 Study Sample8 2.3 Objective of the study ..8 2.4 Specific objective..8 2.5 Methodologies...9 3. JUSTIFICATION OF BASELINE SURVEY 3.3.1 Overview of District Human Resources and other Social Services. 11 4. PRINCIPAL FINDINGS12-22 5. SELF EFFICACY QUESTIONS.. 24-26 6. SUMMARIZED VIEWS THROUGH FOCUSED GROUP DISCUSSION..27 7. RECCOMMENDATION ...28-29 4.2 SAMPLE QUESTIONARE 29-33

1.EXCUTIVE SUMMARY South Africa Human Rights Network (SAHRiNGON) Tanzania Chapter has funded a Baseline study to determine social culture factors accelerating HIV/AIDS related stigma that restricts women and girls to have widely access of preventive and Management in Tanga Region particular in Handeni District. Handeni is one amongst the ancient district located on the Eastern side of Tanga region which is just situated 274 kms from Dar es Salaam. It has 19 Wards and 112 registered villages and a total population of 249,572, with proportional of 123,581 males and 125, 991 females; there are 52,240 house holds according to 2002 National Census. The survey was carried out in 3 wards with the estimated population of 25,000 habitants. A simple conceptual questionnaire was developed in order to grasp and analyze the results. The survey used qualitative technique of data gathering, for example Focused Group discussion (FGD), in depth interviews of key informants, unstructured interview and observation. A total of 6 Focused group discussion sessions were conducted with proportional participants of 50 Females to 25 males, constituted (0.5%) of the sample population for study out of 16,500 habitants. 100 percent of interviewees have superficially knowledge on HIV/AIDS and widespread misconceptions, The level of knowledge was some how differ with regards to education level, for example 37percent of respondents, such as teachers and students were aware of all important issues around HIV and AIDS. The misconception about HIV and condom use is very high especially for elders, there are some people keeps on believing that mosquitoes can transmit HIV and condoms have been planted with viruses. Elders men have strong convincing power based on traditional culture and taboos experiences. Men have been granted with abundance power to dominate all families issues, women involvement in decision making either at families or community level is not highly prioritized and if at all they do their ideas gets influenced by men The discussion conducted through Focused group reveal that the village governments has weak connected structure outside the communities 95 percent of women regretted on the mechanism of AIDS committee in their village, they are less accountable and in some areas remained dormant. In all surveyed villages we found that inadequate insurance and inability to pay for health care has remained on the hand of women but it is men who decide the families

fate for treatment or information, i.e. 56 percent of women have said that the decision making on health care and health seeking information is under the control of men. 77 percent of interviewed women have commented to know nothing about reproductive health or life skills; girls are not well informed about their biological changes. It is prestige for a young woman to have a boy friend, that is to say we are starting sex very early out of knowledge, our mothers and grandmothers sometimes favor have been impressed with this behavior (Young girls at 15 16 years of age from Kwamasaka village explained). The baseline survey assessed the attitude and perceptions within the communities over women infected by HIV and 62 percent of respondents have shown negative attitude over women who contacting HIV regarding them as prostitutes. the survey provided insights into public attitudes about testing. Nearly 40 percent were sure they had not been tested for HIV. A majority (60 percent) of these respondents indicated that they did not need a test either because they "knew" they did not have HIV o The presence of cross sex behavior for older men having sex with younger women is just a picture portraying the community extra ordinary negative attitudes, which inspires our societies to extensive erosion of behavior. The survey carried out in all five villages has drawn the reality on the magnitude of the cross generation sex , 92 percent of interviewed young girls have agreed on the persisting in disciplinary actions in their villages and urban areas. r because they didn't think they needed to be tested. Unstructured interview was done to different men inquiring the reasons behind cross generation sex, 65 percent of respondents said that having sex with younger women is a prestige for men as it justify masculinity and boosting up the sexually highest orgasm, young girls knows how to play the game and always treats elders gently Lack of information among the young girls, poverty, low education level and limited income-earning opportunities often force girls into sex practice and exposing them to a high risk of HIV/STI infection. (Statement from Zawadi Gwando Community development Officer Handeni district Council). The baseline survey has found that 57 percent of women claimed to have no rights of negotiating sex and thus feels at risk of contacting HIV infection. Some risk behavior were identified as the possible factors contributing to the spread of HIV/AIDS in the community, the most significant was alcohol ( 19 percent ) mentioned by 15 informants and other members during the Focused Group Discussion, The survey revealed that 22 percent of women have accepted to be engaged in entrepreneurship and 78 percent of unmarried women and girls have no viable projects to supports their life. Some of them found themselves into trouble and keep on male dependence, transactional sex has been a common practice in order to fulfill their life essentials regardless the HIV/AIDS situation.

The baseline survey has found that 87 percent of women are not conversant with domestic or sexual violence laws and in most cases women believes that men have been granted with power to dominate and supporting women economically, in this manner the believe that it is so difficult for them to receive a favor or fair treatment. 77 percent of interviewed women regretted on the absence of special efforts in the rural setting to put in place the organs apart from judiciary power that may empower women on legal and inheritance rights, as a means of mitigating the negative impacts of HIV/AIDS in rural societies. Recommendations 1. 2. Increase interventions on Female-Focused HIV/AIDS Programs Governments and communities must take concrete steps to increase public knowledge about HIV/AIDS and to eradicate stigma and discrimination against HIV-positive women.. 3. The enactment, strengthening, and enforcement of legislation, regulations, and other measures to eliminate discrimination against people living with HIV/AIDS should be a top priority 4. Empowering women economically requires actions to reduce womens disadvantage in capabilities, opportunities and security with the actions implemented in such a way as to provide women with control over the resources provided and ability to participate in and make decision regarding their use. 5. The government reforms should not only change the legal structure affecting womens property rights but also support their claims to realize those rights by amending and harmonizing statutory and customary laws, promoting legal literacy, supporting Civil Societies Organization that helps women make land claims, increasing womens access to legal services and recording womens share of land or property.

2.0 BACKGROUND Tanga Aids Working Group (TAWG) is a Tanzanian Non-Governmental Organization (NGO) that has been running a multifaceted response to the HIV/AIDS pandemic in Tanga Region (North east of Tanzania) that acknowledges the need for treatment and care of people living with HIV/AIDS while also recognizes the need to organize intervention that are aimed at raising awareness and addressing behavior change relating to HIV/AIDS. South Africa Human Rights Network (SAHRiNGON) Tanzania Chapter has funded a Baseline study to determine social culture factors accelerating HIV/AIDS related stigma that restricts women and girls to have widely access of preventive and Management in Tanga Region particular in Handeni District.

The worldwide pandemic of HIV/AIDS is recognized as a major threat to every sphere of human society and is a leading obstacle to social development. It is widely recognized that men and women are affected in dramatically different ways by the epidemic because of gender inequality. Although the most widely respected UN documents explicitly state that men and women shall be equal in rights, rarely is that a fact of life in societies where male dominated traditions and roles continue. Commitment, political will and steadfast attention to the role gender inequality and its manifestations in the social, political, economic, cultural and religious spheres play for girls and women is essential to realistically confront this pandemic, and formulate enact action. Laws, policies, and strategies must be developed to ensure girls' and women's human rights are protected and supported by their communities. Treaties such as the Convention on the Elimination of all Forms of Discrimination against Women (CEDAW), and the Convention on the Rights of the Child, provide benchmarks for assessing compliance with these rights. Girls and women must be empowered to resist those practices and pressures that would hamper their efforts to protect themselves from HIV/AIDS. Special attention must be given to the needs of people living with HIV/AIDS, particularly girls and women, both in prevention and care programs to ensure the highest attainable standard of health and quality of life. Country hiv situational analysis According to Tanzania HIV Malaria Indicator Survey (THMIS) 2007/08 at least 90 % of people have heard of AIDS. Unfortunately, an indepth understanding of AIDS is less widespread. Only 40 % of women and 44 % of men have comprehensive knowledge about AIDS. comprehensive knowledge is defined as knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chances of getting HIV, knowing that a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about HIV transmission and prevention. Comprehensive knowledge increases with increasing level of education and wealth quintile. It is also considerably higher in urban areas than in rural areas. In Tanzania, 37 % of women and 27 % of men have been tested for HIV at some time and received the results. Fourteen % of women age 20-49 first had sexual intercourse before they were 15 and almost six in ten (59 %) had first sex before the age of 18.

Women are far less likely than men to report having had two or more sexual partners in the past 12 months. Only 3 % of women reported having had sex with more than one partner in the 12 months preceding the survey, compared with 18 % of men. In the context of this survey, higher-risk sex is defined as sex with a no marital, non cohabiting partner in the 12 months preceding the survey. Sixteen % of women and 29 % of men reported having sex in the 12 months before the survey with someone who was not a husband/ wife or cohabiting partner. 8% of men age 15-49 paid for sex in the 12 months before the survey and 60% of these men reported that they used a condom at their most recent paid sexual intercourse. Among young male respondents age 15-19, 5% paid for sex and more than half (56 %) used a condom at their last paid sexual intercourse. The HIV prevalence in Tanzania is 6 % for adults age 15-49 were infected with HIV. The prevalence of HIV is higher among women than men (7 % and 5 %, respectively). For both sexes, urban residents have higher levels of HIV infection than rural residents (9 and 5 %, respectively). HIV prevalence among urban women (11 %) is twice that of rural women (5 %). For men, the difference is not so large (6 % among urban men and 4 % among rural men) In all regions except Arusha, HIV prevalence is higher among women than men. Prevalence of HIV increases steadily as the number of lifetime partners increases. For women, HIV prevalence increases from 3 % among those who have had only one sexual partner to 22 % among women who have had 10 or more lifetime partners. The proportions for men are 1 % and 11 %, respectively. HIV prevalence among youth (women and men age 15-24) is 2 %, 3 % for Mainland and less than 1 % for Zanzibar.

District profile Handeni is one amongst the ancient district located on the Eastern side of Tanga region which is just situated 274 kms from Dar es Salaam. It has 19 Wards and 112 registered villages and a total population of 249,572, with proportional of 123,581 males and 125, 991 females; there are 52,240 house holds according to 2002 National Census. The

district has one government hospital (Handeni District Hospital) with 110 beds and a mission hospital (Kwamkono) with 70 beds. The main sources of anti-malarial medications are shops. These mostly treat mild malaria. Economic activities Economically Handeni habitants mainly depend on small scale farming and husbandry. The district gets two rainfall seasons per annually, however the long persisting drought has much affected the domestic and district annually income, people are very keen in micro business just to meet their daily essentials. The interaction of tribes is very high though Zigua remained the prominent one, others are Nguu, Sambaa, Maasai, Chaga, Bondei and Pare 2.1 THE SCOPE OF BASELINE SURVEY The Baseline study is a part of Tanga Aids Working Group efforts to support World wide goals on determining the current social cultural customs and practices that accelerating HIV/AIDS related stigma and discrimination that hampers women and girls respectively to have an access of widely preventable and management services. It was intended to generate information based on the situation and behavioral pattern of the target community, to examine and understand the relationships between the existing cultural and social practices that greatly predisposing woman to HIV infection. 2.2 STUDY SAMPLE The survey was carried out in 3 wards with the estimated population of 25,000 habitants. Majengo, Kwamkono, Vibaoni, Kwamasaka and Kivesa Street are the areas sampled for baseline survey. The selection assumption of the study areas was guided by the criteria of caste ethnicity, geographical severity of cultural problems and population aspects.

2.3 OBJECTIVE OF THE SURVEY Assess social culture factors accelerating HIV/AIDS related stigma that restricts women and girls to have widely access of preventive and Management in Handeni District, Tanga region. 2.4 SPECIFIC OBJECTIVE WERE AS FOLLOWS

Collect information on the knowledge, attitudes and practices hinders To identify the socially, economically and gender inequality factors

women and girls to have access of health and legal right related services. that hinders womens and girls opportunities in decision making at family and community levels To use the study in the development of solutions that will encourage the community and other civil societies organization to stand up and take actions against harmfully cultures and practices which are mainly stigmatize and discriminate women and girls to access prevention and management services

2.5 METHODOLOGIES Methods Participants Observation/ and natural Group discussion, Tasks Learning and understanding norms, attitudes in the community on HIV/AIDS related stigma and

discrimination that restricting women and girls to have widely access of preventable and management services. Community data collection Assessing enomically and gender inequality aspects which restricting women and girls to have the rights of decision making at families and community level. Collection of epidemiologically1 and social data related to the baseline study is a part of better understand how stigma and discrimination much affects the chance of women in relation to health information and treatment in the community

2.6 APPROACHES Participants Observation and Natural Group discussion Despite of being the cornerstone of the discipline of anthropology2, remains loosely defined method, Bernard (1995) defines participants observation as establishing rapport in a new community; learning to act so that people go about their business and usual when you show up; and removing yourself from culture immersion so that you can intellectualize what you have learned, put into perspective and write about it convincingly (137). Perhaps the potentiality of defining the process is identifying the types of results that can be achieved through participants observation research.3 Finding from participants also contribute to a more holistic or integrated understanding of the research setting as the researcher inters and interacts in multiple domain of social life in the study settings
1

The study of the distribution, effects and causes of diseases in populations, and the means by which they may be treated or prevented, 2 The multidisciplinary study and analysis of the origins and characteristics of human beings and their societies, customs and beliefs. 3 Pelto and Pelto 1978 suggest that data from participants observation can guide development of other methods of data collection and serve as more general check of information collected through specialized research methods.

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Conceptual questionnaire used for gathering data and analysis results A simple conceptual questionnaire was developed in order to grasp and analyze the factors hinders women and girls to have reliable health and HIV/AIDS preventable services through glimpsing the community general knowledge and perception over HIV and AIDS, common social cultural and practices that predisposing HIV transmission, the chances for women and girls empowerment, impediments around women and girls to access legal rights, political will and commitments in addressing HIV/AIDS. Data collection technique Data were collected in Handeni District. The survey used qualitative technique of data gathering, for example Focused Group discussion (FGD), in depth interviews of key informants, unstructured interview and observation. A total of 6 Focused group discussion sessions were conducted with proportional participants of 50 Females to 25 males, constituted (0.5%) of the sample population for study out of 16,500 habitants. The study involved community affiliation of 15 key informants, such as nurses, village leaders, social development workers, political leaders, teachers and retired officers were interviewed. Also the focus for interview went to public authority in the district administration.

3. JUSTIFICATION OF BASELINE SURVEY This Survey has brought about to light information of a sensitive issues on the factors that accelerating HIV/AIDS related stigma and discrimination that hampers women and girls respectively to have an access of widely preventable and management services. 3.3.1 Overview of human resources and other social services

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Likewise other districts in Tanzania, the problem of inadequate manpower is still high despite of all efforts to centralizing services in rural settings. This situation creates a great setback to enabling community needs of acquiring quality social services. The provision of social services especially water in both, urban and rural areas is still intermittent, people depends on natural wells which do not fulfill the domestic needs of getting adequate and wholesome water. Health facilities are not friendly used as people have to access the service far away from their locality, however inadequate staffing for both health and education sector has remained as an acute problem intimidating millennium development goals.

4. PRINCIPAL FINDINGS The study generated number of findings as analyzed hereunder 4.4.1 SUPERFICIALLY HIV/AIDS UNDERSTANDING 100 percent of interviewees have superficially knowledge on HIV/AIDS and widespread misconceptions, 48 percent of respondents claimed to hear about HIV and AIDS through radio, meetings, reading books and banners and through peoples discussion. The level of knowledge was some how differ with regards to education level, for example 37percent of respondents, such as teachers and students were aware of all important issues around HIV and AIDS. The misconception about HIV and condom use is very high especially for elders, there are some people keeps on believing that mosquitoes can transmit HIV and condoms have been planted with viruses. At Kibaoni the youth believes that the most effective way of reducing HIV/AIDS for youth is through condom use, but this voice mix with others (female headed households) who argue that abstention is the best strategy when choice are to be male. The argument from other youth at Kwamasaka and Kivesa emerged a great challenge on the questioning whether condoms are being properly used; the availability of condoms may in fact lead to increased promiscuity. Some women believe that condom are urged to increase loose of behavior among the youth in their villages. 4.4. 2 WOMENS DECISION MAKING

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Elders men have strong convincing power based on traditional culture and taboos experiences. Men have been granted with abundance power to dominate all families issues, women involvement in decision making either at families or community level is not highly prioritized and if at all they do their ideas gets influenced by men. My husband is like a king, whatever he want to do no one can urge, some days ago I attempted to question him on why was decided to take a married without informing me, things was very tough he broke into anger and was about to kill me, he chased me with my small baby back to my parents, it was such a cruel treatment and injustice practice never experienced before. I claimed my divorce certificate but pompously said that he know how to take a marriage and not divorced. My parents did not stand on my side they fiercely forced me to return back to my husband as the culture does not allow the marriage woman to flee her husband without a permit. I had no any options rather than obeying the order to return back to my husband. It is absolutely true that a man has all responsibility on familys daily issues but here in the village things are quite opposite, you have to depend upon yourself, working hard in the farms and taking care of children, having a husband is just a prestige and if you flee from him someone else can immediate held the chance, our elders women warns us to respect the husband, as they were borne to be a leaders. (Disappointed story from Ridhia Mwenjuma (40) years old, living at Kwamkono Village) The interview brought about the linkage between village communities and individuals and decision making structures outside the village community. The discussion conducted through Focused group also makes it clear that the village governments has weak connected structure outside the communities 95 percent of women regretted on the mechanism of AIDS committee in their village, they are less accountable and in some areas remained dormant. Diffuse accountability The national policy as regards HIV/AIDS is being implemented during these years. Related process is also efforts of decentralizing. However there is a bigger emphasis currently on treatment that on preventive measure. This implies that strong policies of reaching out to communities as regards preventive efforts have partially been institutionalized by CMAC, WMAC, and VMAC and CSOS which are normally based

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in urban settings. The interview revealed that there were different as to how well these institutional structures were established and how well they performed, most of them it seemed had difficulties in performing for lack of funding and absence of clear roles and responsibilities. For the communities to engage with this structure or for individuals or groups some clarification of responsibilities is highly needed and some resources have to be made available if the structure is to perform. 4.4.3 WOMEN ACCESS TO HEALTH CARE AND DECISION MAKING Despite targeted programs and policies helping women lead healthier lives, significant gender-based health disparities remained. Community lack of education, employment opportunities, and economic stability are significant barriers preventing women from accessing information and quality basic healthcare. In all surveyed villages we found that inadequate insurance and inability to pay for health care has remained on the hand of women but it is men who decide the families fate for treatment or information, i.e. 56 percent of women have said that the decision making on health care and health seeking information is under the control of men. Governments must implement policies to increase women's access to healthcare. These policies need to take into account women's disproportionately lower incomes, as well as their unique health needs and their role in negotiating. (As the WHOS commission on Macroeconomics and Health (2001) has established, health as prerequisite for economic development, just as much as it is an outcome. For women, health information particularly HIV/AIDS and reproductive health is a pre condition for access to economic assets and resources and the opportunities to use them effectively for themselves and their families).

4.4.4 CHANCE OF WOMEN AND GIRLS TO ACCESS REPRODUCTIVE HEALTH, HIV/AIDS AND OTHER HEALTH RELATED INFORMATION The women and girls chance to access HIV/AIDS, reproductive health information or life skills studies has been so limited due to women low education level and inadequate

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plan to ensure the studies are mainstreamed in schools and out of schools. 77 percent of interviewed women have commented to know nothing about reproductive health or life skills; girls are not well informed about their biological changes. When girl is about to mature is forced to go to their grandmother for guidance on how to control menses period. It is prestige for a young woman to have a boy friend, that is to say we are starting sex very early out of knowledge, our mothers and grandmothers sometimes favor have been impressed with this behavior (Young girls at 15 16 years of age from Kwamasaka village explained). 23 percent have shown slightly knowledge pertaining to reproduction health as they have acquired it through antenatal clinics. Empowerment, gender power, and womens health What is the process of empowerment4 that emerged from the interview? Firstly the prevailing situation is one of disempowerment, i.e. restricted and confined process of change. The situation as it prevails in these poor communities is one of lack of confidence in institutionalizing change and one where resource constraints are integral in every situation or event Health and gender power over womens life as was explored in all five Villages
Health Life stage Gender Power Relations

Power biased health care nutrition Poor nutrition/ health care menstrual disorders, unsafe abortions, unprepared, unprotected sex, early childbearing, high risk pregnancies

Girl

Poor access to education, gender biased in work burden and poor esteems High work burden, low education, early marriage, low autonomy regarding sexuality, low knowledge regarding body/sex and dowry violence

Adolescent girl

Empowerment is defined as a process by which the powerless gain greater control over circumstances of their lives. It includes both control over resources (physical human, intellectual, financial) over ideology beliefs, values and attitudes (Batliwa, 1994). It means not only greater extrinsic control but a growing intrinsic capability greater self confidence and an inner transformation of ones consciousness that enables one to overcome external barriers to accessing resources or changing traditional ideology.

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Maternal depletion, malnutrition, STI, unsafe abortion, poor service to manager birth, high risk of maternal morbidity. Women Work/ income insecurity, exploitation in labour and other market, heavy work burdens, domestic violence, low decision making sexuality and poor knowledge regarding body. Meno pause Older women Widow hood destitution

Increase Women's Rights, Empowerment and Involvement in Leadership Ensuring women's and girls' rights and empowerment at all levels of society are crucial to eradicating HIV/AIDS and should be a top priority for local government. National HIV/AIDS strategies should include components that seek to enhance women's economic status, secure women's property and inheritance rights, promote gender equality and the human rights of women, ensure education and economic security, and increase women's meaningful participation in civil society and governmental decision making at all levels. All of these factors are essential to ending the vulnerability of HIV/AIDS pandemic for women. 4.4.5 THE COMMUNITY PERCEPTION AND ATTITUDES OVER WOMEN INFECTED BY HIV IN THE COMMUNITY

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Women with HIV/AIDS may suffer greater stigma than men. For example, they may be blamed as carriers, either as prostitutes infecting men or mothers infecting their infants. Furthermore, there are multiple biological, social, economic, and environmental risk factors that increase women's likelihood of contracting HIV. The physiology of the female genital tract makes women inherently more vulnerable to HIV than men. The baseline survey assessed the attitude and perceptions within the communities, 62 percent of respondents have shown negative attitude over women who contacting AIDS. Some of people say, those who have been infected with HIV were promiscuity, others think that living with AIDS patients can easier cause infection for others. The repercussions of stigma and discrimination in the villages greatly hampers the efforts of addressing HIV/AIDS epidemic, people are getting fear of disclosing their HIV sero status after undergo HIV testing. The way to combat HIV/AIDS stigma is to make HIV testing routine, and the survey provided insights into public attitudes about testing. Nearly 40 percent were sure they had not been tested for HIV. A majority (60 percent) of these respondents indicated that they did not need a test either because they "knew" they did not have HIV or because they didn't think they needed to be tested. 4.4.6 CROSS GENERATION SEXUALLY BEHAVIOR AND RIGHTS OF WOMEN TO NEGOTIATE ABOUT SEX PROTECTION AND PREVENTION The presence of cross sex behavior for older men having sex with younger women is just a picture portraying the community extra ordinary negative attitudes, which inspires our societies to extensive erosion of behavior. The survey carried out in all five villages has drawn the reality on the magnitude of this problem, 92 percent of interviewed young girls have agreed on the persisting in disciplinary actions in their villages and urban areas. The study explored the situation in the community and it become big as it was reported by Secondary students and primary pupils from Kwamkono village, in details they tried to express their feeling over the on going temptations, they said that the problem of cross generation sex with elders men could not be escaped due to nature of familys lives. People are living below the poverty line and so long life becomes tough, it is absolutely difficulty to manage all life expenses

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if your father is only affording to give you 10,000/- shillings per month and 20 kgs of maize, still you have to pay for house rent at least 3000/- how can you manage to meet your essentials? You have to accept the conditions even though sound terrific for you, we are women and sometimes we need something special they said. Unstructured interview was done to different men inquiring the reasons behind cross generation sex, 65 percent of respondents said that having sex with younger women is a prestige for men as it justify masculinity and boosting up the sexually highest orgasm, young girls knows how to play the game and always treats elders gently 25 percent have agreed to practice sex with younger girls, they briefly said that girls are cheap than elderly women, and love for them is like part of their life. The events of elders men engaged in sex with younger girls is at threatened point especially for secondary students, nowadays they have changed styles by offering anal sex, they are afraiding of getting pregnant Lack of information among the young girls, poverty, low education level and limited income-earning opportunities often force girls into sex practice and exposing them to a high risk of HIV/STI infection. (Statement from Zawadi Gwando Community development Officer Handeni district Council). Worldwide, approximately as many women as men are living with HIV, but there are important differences between women and men in the underlying mechanisms of HIV infection and in its social and economic consequences. These stem from biology, sexual behavior, and socially constructed gender differences between women and men in roles and responsibilities, access to resources, and decision-making power. Women are more susceptible than men to infection from HIV in heterosexual encounters, because of the greater area of mucous membrane exposed in women during sex; the greater amount of fluids transferred from men to women; the higher viral content in male sexual fluids; and the micro-tears that can occur in vaginal (or rectal) tissue from sexual penetration. The focused group discussion conducted at Kwamkono and Kwamasaka villages snapped shot the reality about gender norms that influence women's vulnerability to

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HIV. These norms allow men to have more sexual partners than women and encourage older men to have sexual relations with much younger women. This contributes to higher infection rates among young women compared with young men. Women may want their partners to use condoms (or to abstain from sex altogether), but often lack the power to make them do so. The baseline survey has found that 57 percent of women claimed to have no rights of negotiating sex and thus feels at risk of contacting HIV infection. The violence (physical, sexual, and emotional) that many women experience at some point in their lives increases their HIV/AIDS vulnerability in several ways:

Forced sex can contribute to HIV transmission because of the tears and lacerations that can be caused by the use of force. Violence and fear of violence can prevent women from negotiating safer sex and getting treatment. Fear of violence can prevent women from learning their HIV status or disclosing a positive test result.

Women generally assume the major share of caretaking in the family, including for those living with HIV. The widespread assumption that caretaking is women's "natural" role also adds to their burden. 4.4.7 KNOWLEDGE ON HIV/AIDS Another theme among the statement by interviewees during the discussion was that, people do not understand about prevention measures, it was suggested during the discussion that youth sharing needle and razor bladder without regards of sterilization, sometime people handling dead body without protective gear, informant ( nurses from (Kwamkono) said that in our community it is not only sex that predispose people to HIV infection but also caring of the AIDS patients and washing the deceased bodies , traditionally love and belonging forced women to have fully responsibility and commitment of caring their patients, in this manner it is hard to stigmatize your son or daughter, we have witnessed some of the women in our village trying to providing nursing for their children but subsequently they ended up to death, when this occurs

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they tends to hide the fact around death, you may hear people within the families say, people are very wizards they have killed our brother and so on 4.4.8 RISK FACTORS CAUSED BY SOCIAL CULTURAL BEHAVIOR Some risk behavior were identified as the possible factors contributing to the spread of HIV/AIDS in the community, the most significant was alcohol ( 19 percent ) mentioned by 15 informants and other members during the Focused Group Discussion, drinking alcohol was thought to encourage unproductive sex encounter with new partners. Like wise drinking alcohol may placing people in the venue where such behavior considered more permissible, another risk identified was traveling to urban areas for seeking business or informal employment this problem was mostly reported at (Kwamkono village) There some people who migrant to town or cities in search of job, they leave their wives here then they may get AIDS, once they return back to their households they transmit to their wives and even more worse after their husband have gone again to town/cities wives starts to move sexually with other men in the villages. They do so simply because they want to get money to help themselves and their children, in so doing the disease increased. Story by Hamad Athuman a street government chairperson) Multiple partner with carried (26 percent) was also mention by informants as a risk behavior factors for AIDS transmission, it is a prestige and proves masculinity to encounter sexually with more than one partner Youth said during the discussion 17% of respondents commented that traditional night dances especially during the harvesting seasons and other ceremonies have played great roles in HIV transmission in the rural communities, respondents said that religious ceremonies such as Maulidi, X mas and National Torch ( Mwenge) has destructive effects too, men and women takes the privilege of this annually events to meet with their spouses sexually and un protective. The concern for people who not knowing their HIV sero status Blood tested for HIV is the recently phenomenon in the community. In some aspects it was believed that testing for HIV us a potential answer to the AIDS problem. Many

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people have a little knowledge about pre and post testing steps and some of them do not exactly think testing is the solution against HIV transmission

4.4.9 INCOME AND ECONOMIC ACTIVITIES Our baseline survey has found that women are more likely than men to spend their small income that they control on food, education and health care for their children. Beyond income, womens unpaid work saves expenditure and in time of economic crisis replaces income. In rural households which provide most of their own subsistence needs, womens unpaid work is critical to households survival, however the economic status of women in the villages is not reliable due to combined many factors than they counter party in urban areas, for example the long persist drought has greatly affect the rate of production and life has became so unreliable. Women in the villages relay on informal very small scale business such as selling of tomatoes, vegetable, some of them are keen to preparing their farms. The survey revealed that 22 percent of women have accepted to be engaged in entrepreneurship and 78 percent of unmarried women and girls have no viable projects to supports their life. Some of them found themselves into trouble and keep on male dependence, transactional sex has been a common practice in order to fulfill their life essentials regardless the HIV/AIDS situation. 4.4.10 THE COMMUNITY EFFECTIVE WAYS OF MOBILIZING WOMEN AFFECTED BY HIV/AIDS TO STRENGTHEN THEIR PROPERTY AND INHERITANCE RIGHTS The baseline indicator was to see number of women and children accessing justice either through formal or informal systems Property and Inheritance Rights Women who own or control economic assets particularly land and housing are better positioned to improve their lives and cope, by owning their home and land, women directly gain from such benefits as use of the land and high incomes, as well as secure

21

place to live (Agarwal 2002). The survey has found that individuals who own land generate higher rural non farm income from self employment than people without land, women can also use a house or land as collateral for credit during financial crisis or to invest in small business or other income generating venture. Assets control has also proved to give women greater bargaining power within households and protect against the risk of violence. For all of these reasons, property and inheritance rights create the enabling condition to empower women. Womens lack of property ownership can have grave consequences in areas where AIDS and hunger are prevalent. There id anecdotal evidence to suggest that women who are less secure economically and dependent on their male partner are less likely to be able to negotiate protection against HIV infection. There is documented evidence; however of the negative results of lack of property ownership for women whose husbands die of AIDS (Drimie 2002; FAO 2003). Without ownership of the house and land, a husbands death could mean a loss of land, house and tools assets that could otherwise have helped the surviving widow and her children economically cope with the tragedy. Current information Women may seek redress as indicated above, but so far cases of sexual abuse or violation of rights, have not been taken to informal courts. Women at Kwamkono, Kwamasaka and Vibaoni village expressed a kind of powerlessness. They said that they can seek help with volunteers or relatives, but they question whether they can raise cases to the police. There are no indications in all surveyed village which shows orphans or widowers have mandate to access justice through formal or informal courts, all issues have been deflected at families traditionally by older men unjustly. The baseline survey has found that 87 percent of women in Majengo , Vibaoni, Kwamasaka, Kwamkono and Kivesa are not conversant with domestic or sexual violence laws and in most cases women believes that men have been granted with power to dominate and supporting women economically, in this manner the believe that it is so difficulty for them to receive a favor or fair treatment, Sometimes women loose tolerance to proceed with the case due to prolonged time and other accompanied

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court expenses, ultimately they leave the issue on Gods hands for judgment we have experienced such a problem in our village when one of our sister forced to leave his house following the death of her husband, it was injustice and ungodly action as they took all assets together with two farms they have possessed and shared among themselves, they claimed to have a control over deceased properties in order to raise the left two children and funny enough no one stood to support our sister, she had no option rather than returning back to home and currently she is living with us ( Ridhia Mwenjuma 40 years old) . 77 percent of interviewed women regretted on the absence of special efforts in the rural setting to put in place the organs apart from judiciary power that may empower women on legal and inheritance rights, as a means of mitigating the negative impacts of HIV/AIDS in rural societies. More effort has been done in the urban settings whereby a vast number of NGOS and government Institutions play a great role to support and promoting women rights Statement from the Village chairperson, Vibaoni Street.

PATH WAY TO WOMEN EMPOWEMENT

DEVELOPMENT GOALS Reduce poverty Economic growth Decreased inequalities

HIV/AIDS AND REPRODUCTIVE HEALTH OUTCOME Increase access to HIV/AIDS information Increase access to Reproductive health Improved quality care

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WOMEN EMPOWERMENT Reduced violence Increased legal rights literacy Increased decision making and political participation Changed marriage family, social norms for women

Table 1 5. SELF EFFICACY QUESTIONS 1. Women with knowledge on HIV/AIDS Have you ever heard about HIV/AIDS High 48% Low 37% Moderate 15%

2. Mode of HIV transmission and prevention measures Unsafe sex Transfusion of infected blood Sharing of sharp instruments Other means (caring of AIDS patient washing of dead body 35% 18% 31% 15%

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3. Knowledge on preventive measures against HIV Practicing safer Avoiding sharing of sharp instruments Condom use Others 19% 29% 30% 22%

4. Presence of social culture carried in the area which pre disposing to HIV/AIDS Widow inheritance Polygamous Alcoholism Multiple Night dances & ceremonies 10% 28% 19% 26% 17%

5. Social culture practices in the areas which affects much women and young girl to HIV transmission Widow inheritance Polygamous Night dances and ceremonies 10% 31% 28%

6. Presence of economical viable projects for Girls and Unmarried women to support their life. Yes No 22% 78%

7. Low income and economical insecurity is a predisposing factor for women to be engaged in transaction sex Yes 95%

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No 8. Awareness on reproductive health information to women and girls Existing Not existing

5%

23% 77%

9. Presence of effective legal rights for women affected by HIV/AIDS Yes No 22 77%

10. Chance for women and girls to discuss and plan for HIV/AIDS intervention No chance Present 67% 33%

11. Decision making on Health care and Health information seeking Present Not 46% 54%

12. Women rights on sexually protection and decision making against HIV/AIDS Yes No 43% 57%

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13. Presence of cross generation sex for older people having sex with younger girls Present Not present 92% 8%

14. Community stigma to positive living women Existing Not existing 42% 18%

15. The government efforts against all social culture and practice which accelerate HIV/AIDS related stigma and hindering women to access preventable services. Interventions done Interventions not done 68% 32%

16. Women involvement in decision making to the local government and HIV/AIDS committees. (CMAC, WMAC & VMAC) Involved Some how Not involved At family level Involved Some how Not involved 15% 27% 58% 27% 20% 53%

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6.

SUMMARIZED VIEWS THROUGH FOCUSED GROUP DISCUSSION HIV/AIDS Gender roles and empowerment of women Underlying social cultural factors Division of work and responsibility based on sex where women assume the burden of households responsibility Women given less value compared to men Decision making power within the family resting with male Male involvement in HIV/AIDS and Reproduction Health There is a limited involvement of men in HIV/AIDS & RH because of cultural beliefs

HIV/AIDS is related to peoples sexually and reproduction behavior and it is Mult faceted issues

Social culture behavior factors affecting HIV transmission Socially taboos surrounding sex and sexuality preventing people from seeking information, silence on reporting sexually related problems HIV/AIDS as a behavior problems related to culture construction about masculinity HIV/AIDS as a consequence of existing problem of poverty

Households assets and resume are under the control of men

Age gender hierarchy gives young women less of voice

Under socially cultural factors Perception of HIV/AIDS as a female problem Culture of silence surrounding RH & HIV/AIDS in men Tendency of project/ programs to ignore men in RH/AIDS Tendency of project/program to ignore gender inequality, support limited involvement of men in RH

7. RECOMMENDATIONS BASED ON STUDIES. 7.7.1 Increase interventions on Female-Focused HIV/AIDS Programs

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Current HIV/AIDS programs often ignore the biological differences and the social, economic, and cultural inequities that make women more vulnerable to HIV/AIDS. Sex differences must be examined in the design, implementation, and evaluation of biomedical and behavioral studies. Existing HIV/AIDS prevention, care, and treatment programs should be re-evaluated to ensure that they address the needs of women and include outcome measures that can accurately capture female-specific data. Additionally, all HIV/AIDS prevention initiatives should include components focusing on women's educational and economic empowerment, as well as increase access to health services and comprehensive, evidence-based HIV information 7.7.2 Increase Public Knowledge and Decrease Stigma and Discrimination Governments and communities must take concrete steps to increase public knowledge about HIV/AIDS and to eradicate stigma and discrimination against HIV-positive women. Greater investment is needed in educational campaigns that not only provide the public with accurate information about the transmission and prevention of HIV, but that also address all aspects of HIV stigma. These awareness campaigns should promote a more supportive and empowering environment for women living with HIV/AIDS by countering stigma and discriminatory attitudes. In addition, governments and communities must also work toward eliminating the cultural, institutional, and structural conditions that fuel stigma and discrimination. The enactment, strengthening, and enforcement of legislation, regulations, and other measures to eliminate discrimination against people living with HIV/AIDS should be a top priority 7.7.3. Ways to empower women economically Empowering women economically requires actions to reduce womens disadvantage in capabilities, opportunities and security with the actions implemented in such a way as to provide women with control over the resources provided and ability to participate in and make decision regarding their use. At the local government level the village should strength the opportunities for pro primary education for girls while meeting commitment Guarantee sexual and reproductive health education and rights for girls and women

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Eliminate gender inequality in employment The government and other institutions which providing grants or simple conditioned loans should work closely with community and translate their policy so as to enabling women in micro project.

7.7.4

Action to promote womens property and inheritance rights The government reforms should not only change the legal structure affecting womens property rights but also support their claims to realize those rights by amending and harmonizing statutory and customary laws, promoting legal literacy, supporting Civil Societies Organization that helps women make land claims, increasing womens access to legal services and recording womens share of land or property. Joint titling to land so that women are protected against dispossession in case of widowhood, divorce or abandonment

QUESTIONAIRE FOR GCAP BASELINE SURVEY QUESTIONAIRE Name of Interviewer (Initials) Name of interviewer. Village.. Ward Age: ( ) Sex: M ( ) ) F ( Date / /2009

District... Education level: Primary ( ) others ( ) Secondary ( ) Religion: Christian ( ) College ( ) Muslim ( ) Non educated ( )

Occupation: .

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Marital Status: Married ( Cohabited ( )

) Unmarried (

) Divorced (

) Separated (

1. Have you heard about HIV and AIDS in this area a. Yes ( If yes ) b. No ( )

How?.......................................................................................................... 2. .................................. area . . . 3. Can you mention the common mode of HIV transmission in this

b c d How can you prevent yourself against HIV infection? .........................

........................................... 4.

predispose to HIV transmission? . . .

Which are Social cultural issues carried out in this area and a b c

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..

5. Among the mentioned above social cultural factors which do you think it affect much women and young girls? . .. 6. a b c Do unmarried women/girls have economically viable ) b. No ( )

project to support themselves? 7. a. Yes (

Do you think low income and economic insecurity is a ) b. No ( )

predisposing factor for women to be engaged in transactional sex? a. Yes ( 8. Do you think Women and girls are well informed ) b. No ( )

about reproductive health? a. Yes ( 9.

Do you think the community has effective ways of

mobilizing women affected by HIV and AIDS to strengthen their property and inheritance rights? a. Yes ( ) b. No ( )

10. I there any legal rights that allows women and girls to claim and defend their properties and rights as a means of mitigating the impact of HIV and AIDS? 11. violence laws? a. Yes ( ) b. No (

Are women conversant with domestic or sexually

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a. Yes (

12. Do women and girls given chance to discuss and plan for interventions against HIV and AIDS in this area? a. Yes ( ) If No, Why? b. No ( )

b. No (

........................................................................ ........................... 13. Do you think women have enough power to decide on a. Yes ( )

health care and health information seeking? b. ( )

14.

Do you think cross generation sexually behavior for in this

older man having sex with younger women is a problem area? a. Yes ( ) b. No ( )

If yes why it

so 15. Do you think women and girls have the rights to negotiate /AIDS infection ) Why...

about sex and protect themselves against HIV a. Yes ( If No!

b. No (

16. Which group is at most risk of contacting HIV in the

village?..................................................................................................... ............................................... Why this group is at most risk?

. 17. What is the community attitude towards HIV positive women? 33

a b c....................

...................................................................

18. Does the Village Government puts any efforts against all social hindering women to access preventable services? a. Yes ( ) 19. Do women participating in decision making at? a. VMAC & WMAC; Yes ( ) c. Some how ( ) level Yes ( ) No (

culture or practices which accelerate HIV/AIDS related stigma and b. No ( ) No ( ) ) b. Family

20. What challenges hampers the community to fight against destructive social cultural customs and practices?

FOCUSED GROUP DISCUSSION

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