Purpose: Immediate initiation of antiretroviral treatment following HIV infection is a cornerstone of the current HIV ‘universal test and treat’ approach. Delayed progress along the HIV care... Show morePurpose: Immediate initiation of antiretroviral treatment following HIV infection is a cornerstone of the current HIV ‘universal test and treat’ approach. Delayed progress along the HIV care continuum is thus framed as a major stumbling block in effective HIV epidemic control. Through examining the HIV care trajectories of people diagnosed with HIV in Shinyanga Region, Tanzania, we offer a critical interrogation of the HIV care continuum. Methods: Data are drawn from a social science study on the uptake of a ‘treat all’ model of HIV prevention and care conducted from 2018 to 2019. Methods included interviews with participants who tested positive (n = 30) and interviews (n = 25) with health staff involved in the testing campaigns.Findings: Exploring individuals’ care trajectories, we found that most participants followed pathways to care that do not easily align with the current emphasis on rapid, linear progress from testing to treatment initiation. Instead, participants’ trajectories from diagnosis to treatment happened on a different, non-linear time scale mediated through social relations and diverse communities of care. We thus conceptualize five pathways of linkage to care - virtuous/immediate, delayed testing, repeat testing, negotiated, and ‘failed’.Conclusion: Based on our findings we propose a community-centered HIV care continuum that exposes moments of potential connection with or rupture from the health system and centers the importance of social support structures and forms of relational labor involving broader communities of care. Show less
When nongovernmental organizations (NGOs) encounter state resistance to human rights accountability, how do NGOs use international courts for their human rights advocacy strategies? Considering the... Show moreWhen nongovernmental organizations (NGOs) encounter state resistance to human rights accountability, how do NGOs use international courts for their human rights advocacy strategies? Considering the overlapping phenomena of shrinking civic space within authoritarian, hybrid, and democratically backsliding regimes, and state backlash against international courts, NGOs navigate two potential levels of state backlash against human rights accountability. Building on the interdisciplinary scholarship on legal mobilization, we develop an integrated framework for explaining how states' two-level (domestic and international) backlash tactics can both promote and deter NGOs' strategic litigation at international human rights courts (IHRCs). States' backlash tactics can influence NGOs' opportunities, capacities, and goals for their human rights advocacy, and thus affect whether and how they pursue strategic litigation at IHRCs. We elucidate the value of this framework through case studies of NGOs' litigation against Tanzania at the African Court on Human and Peoples' Rights, an understudied IHRC. Drawing on an original data set, interviews, and documentation, we process-trace how Tanzania's various backlash tactics influenced whether and how NGOs litigated at the Court. Our framework and analysis show how state backlash against human rights accountability affects NGOs' mobilization at IHRCs and, relatedly, IHRCs' opportunities for influence. Show less
Nowadays, urban-rural connections are accelerating in sub-Saharan Africa resulting in agricultural transformations, which in turn lead to the transformation of rural livelihoods. This paper... Show moreNowadays, urban-rural connections are accelerating in sub-Saharan Africa resulting in agricultural transformations, which in turn lead to the transformation of rural livelihoods. This paper examines agricultural transformations in the Dodoma Region, Tanzania, and their impact on local rural livelihoods. Triggered by transportation development and rising demand for agricultural produce on the national and international level, the transformation of rural livelihoods on the village level entails: the application of more advanced methods and organisation of agricultural production; the increased use wage-labour; considerably higher agricultural revenues; a distinct rise of livelihoods partly or exclusively based on small-scale industry, petty trade and other businesses; and a distinctively higher level of incomes and consumption. Show less
The article is a plea for sustaining the indigenous languages of Tanzania and Kenya. These languages display an impressive richness in diversity which is diminishing currently. It is important to... Show moreThe article is a plea for sustaining the indigenous languages of Tanzania and Kenya. These languages display an impressive richness in diversity which is diminishing currently. It is important to appreciate the value of the current linguistic diversity and that of multilingualism. The article is based on a presentation at a conferenceof the Languages of Tanzania project and hence is biased towards the Tanzanian situation. I argue that the success of the language policy of promoting Kiswahili now opens the ways to support the local languagesthat pose no threat to national unity. Given that this article is a plea and one making ample use of my personal experiences of linguistic research in Tanzania and Kenya the style is more personal and lacks the usual detachment of academic papers. Show less
The paper provides an overview of blessings and curses in verbal art and in daily life among the Iraqw (Cushitic) of Tanzania. Blessings and curses are common in the verbal art and these seem to be... Show moreThe paper provides an overview of blessings and curses in verbal art and in daily life among the Iraqw (Cushitic) of Tanzania. Blessings and curses are common in the verbal art and these seem to be formally different from how traditionally in daily life people would intentionally bless and curse.The fiiro traditional prayer (literally requesting) is interspersed with blessings/curses or strong wishes which are clearly set apart from by a high speed of speech, high pitch and loud voice for a whole sentence upon which the audience waves the hands in the air or towards the ground. The slufay poetry which follows the fiiro can be seen as one long blessing, using subordinate verb forms and other archais elements but not containing these formally marked utterances of the fiiro (Beck and Mous 2014).In daily life cursing is done sometimes standing on a hillock wishing bad fortune on ones opponent but the actual words nor the way they are performed seem to be essential (Kamera 1986). Lifting the curse is a major event however. This can easily take up a whole day of discussing, singing, drinking and eating and the ceremony needs to be performed with the families of the two opponents and other people from the area present and with text emphasizing peace, good wishes and community spirit. The anthropological literature discusses the societal functions of curses (Hagborg 2001, Lawi 2000, Rekdal 1999, Snyder 2005, Thornton 1980).Blessing is often done by putting a piece of grass, barsi, above the door of the house between the cross bar above thr door opening and the roof. This can but need not be accompanied with speech. Show less
Okere, N.E.; Meta, J.; Maokola, W.; Martelli, G.; Praag, E. van; Naniche, D.; ... ; Hermans, S. 2022
Background: Differentiated service delivery (DSD) offers benefits to people living with HIV (improved access, peer support), and the health system (clinic decongestion, efficient service delivery).... Show moreBackground: Differentiated service delivery (DSD) offers benefits to people living with HIV (improved access, peer support), and the health system (clinic decongestion, efficient service delivery). ART clubs, 15–30 clients who usually meet within the community, are one of the most common DSD options. However, evidence about the quality of care (QoC) delivered in ART clubs is still limited.Materials and methods: We conducted a concurrent triangulation mixed-methods study as part of the Test & Treat project in northwest Tanzania. We surveyed QoC among stable clients and health care workers (HCW) comparing between clinics and clubs. Using a Donabedian framework we structured the analysis into three levels of assessment: structure (staff, equipment, supplies, venue), processes (time-spent, screenings, information, HCW-attitude), and outcomes (viral load, CD4 count, retention, self-worth).Results: We surveyed 629 clients (40% in club) and conducted eight focus group discussions, while 24 HCW (25% in club) were surveyed and 22 individual interviews were conducted. Quantitative results revealed that in terms of structure, clubs fared better than clinics except for perceived adequacy of service delivery venue (94.4% vs 50.0%, p = 0.013). For processes, time spent receiving care was significantly more in clinics than clubs (119.9 vs 49.9 minutes). Regarding outcomes, retention was higher in the clubs (97.6% vs 100%), while the proportion of clients with recent viral load <50 copies/ml was higher in clinics (100% vs 94.4%). Qualitative results indicated that quality care was perceived similarly among clients in clinics and clubs but for different reasons. Clinics were generally perceived as places with expertise and clubs as efficient places with peer support and empathy. In describing QoC, HCW emphasized structure-related attributes while clients focused on processes. Outcomes-related themes such as improved client health status, self-worth, and confidentiality were similarly perceived across clients and HCW.Conclusion: We found better structure and process of care in clubs than clinics with comparable outcomes. While QoC was perceived similarly in clinics and clubs, its meaning was understood differently between clients. DSD catered to the individual needs of clients, either technical care in the clinic or proximate and social care in the club. Our findings highlight that both clinic and DSD care are required as many elements of QoC were individually perceived. Show less
Using materials from three relevant archives, this article explores the 1967 Nationalisation of the banking industry in Tanzania with particular focus on the three British banks that dominated the... Show moreUsing materials from three relevant archives, this article explores the 1967 Nationalisation of the banking industry in Tanzania with particular focus on the three British banks that dominated the sector. Although it is widely agreed that prompt, adequate, and effective compensation should be paid for such nationalisations, studies in this arena have rarely focused on the contestations that impact on the definition and operationalisation of what constitutes fair compensation. This article explores the above dynamics using the Obsolescing Bargaining Power Theory. Evidence in this article suggests that the bargaining position of foreign multinational banks is stronger when they are net exporters of capital from their host countries. Also, the negotiating position of the British banks was further strengthened by the overt and covert support they received from the British Government. Show less
Schistosome infection is recognized as a potentially modifiable risk factor for HIV in women by the World Health Organization. Alterations in cervicovaginal bacteria have been associated with HIV... Show moreSchistosome infection is recognized as a potentially modifiable risk factor for HIV in women by the World Health Organization. Alterations in cervicovaginal bacteria have been associated with HIV acquisition and have not been studied in schistosome infection. We collected cervical swabs from Tanzanian women with and without S. mansoni and S. haematobium to determine effects on cervicovaginal microbiota. Infected women were treated, and follow-up swabs were collected after 3 months. 16S rRNA sequencing was performed on DNA extracted from swabs. We compared 39 women with S. mansoni with 52 uninfected controls, and 16 with S. haematobium with 27 controls. S. mansoni-infected women had increased abundance of Peptostreptococcus (p = 0.026) and presence of Prevotella timonesis (p = 0.048) compared to controls. High-intensity S. haematobium infection was associated with more diverse cervicovaginal bacterial communities than uninfected controls (p = 0.0159). High-intensity S. mansoni infection showed a similar trend (p = 0.154). At follow-up, we observed increased alpha diversity in S. mansoni (2.53 vs. 1.72, p = 0.022) and S. haematobium (2.05 vs. 1.12, p = 0.066) infection groups compared to controls. Modifications in cervicovaginal microbiota, particularly increased diversity and abundance of taxa associated with bacterial vaginosis and HIV (Peptostreptococcus, Prevotella), were associated with schistosome infection. Show less
Objectives To quantify the burden of HIV, syphilis and schistosome infection and associated risk factors among adults living in seven fishing communities of Lake Victoria in northwest Tanzania... Show moreObjectives To quantify the burden of HIV, syphilis and schistosome infection and associated risk factors among adults living in seven fishing communities of Lake Victoria in northwest Tanzania.Methods Cross-sectional study conducted between 2015 and 2016 in the selected communities. In each community, we randomly selected a sample of adults from the general population and from three putative risk groups including the following: (i) fishermen, (ii) fish processors and traders, and (iii) women working in the recreational facilities. Participants were interviewed to obtain information about potential risk factors, and venous blood was collected for detection of HIV, syphilis and schistosome infections. We used logistic regression models to quantify the associations between potential risk factors and HIV, and also between schistosome infection and HIV.Results We enrolled 1128 people from selected fishing communities. The overall prevalence of HIV, syphilis and schistosome infection was 14.2%, 15.6% and 83.1%, respectively. Female recreational facility workers had the highest prevalence of HIV (30.4%) and syphilis (24%). The odds of being HIV infected were generally higher in all age categories. Transactional sex was commonly reported and especially receiving gifts for sex was found to be strongly associated with HIV (adjusted OR = 2.50; 95% CI: 1.44-4.34, P = 0.008). Confirmed serological syphilis was associated with increased odds of having HIV infection. HIV was not associated with schistosome infection in a combined dataset and when we examined this separately for men and women alone.Conclusions We observed a high burden of HIV, syphilis and schistosome infections in the fishing communities. Targeted efforts to treat and control infections have the potential to improve health among their residents. Show less
An estimated 6 million individuals are co-infected with HIV and schistosomiasis. This thesis seeks to add to the comprehension of the epidemiology of HIV and schistosome co-infections in Tanzania,... Show moreAn estimated 6 million individuals are co-infected with HIV and schistosomiasis. This thesis seeks to add to the comprehension of the epidemiology of HIV and schistosome co-infections in Tanzania, by Lake Victoria. It first evaluates Tanzania’s progress regarding HIV care and defines the study population and the challenges it faces in the fight against co-infections. It then explores the impact of Schistosoma infection on HIV outcomes and transmission. One of the main findings is that people who were infected with Schistosoma when they also acquired HIV infection, on average survive longer and have slower decline in CD4 counts than those who were not infected with Schistosoma in the first place. This thesis also shows that individuals with HIV and Schistosoma spp. co-infections have lower viral loads than those with HIV alone, when accounting for time infected with HIV, and estimates the first hazard rate of HIV transmission from co-infected partners. Finally, this thesis explores the impact of HIV infection on the detection of Schistosoma in co-infected people and concludes that co-infected individuals and women are less likely to excrete parasite eggs. Both local and systemic interactions are discussed in light of those results. Show less
This paper presents a comparative study on conceptualizations of the poorly understood nodding syndrome (NS) in Uganda and Tanzania. NS has been constructed as a biomedical category to serve global... Show moreThis paper presents a comparative study on conceptualizations of the poorly understood nodding syndrome (NS) in Uganda and Tanzania. NS has been constructed as a biomedical category to serve global health discourse as well as national contexts of managing the condition. The paper looks into the shifting meanings and conceptualizations of NS in the affected areas of Kitgum (UG) and Mahenge (TZ) district. The perceived universality of biomedical classifications is problematized as conflicting with the specific contexts of lucluc and kifafa cha kusinzia. Reconciliation proves to be challenging, poignantly evoking the cultural construction as such of any medical condition. Show less
