PWID) In , Tanzania National AIDS Control Programme (NACP) A study of people who use drugs in the northwestern city of Mwanza found that % of In , Tanzania's sustained anti-gay crackdown was part of a broader health by giving people trusted, up-to date information.
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- 2. Current and future challenges and opportunities in Tanzania
- AIDS > Get Involved > Take part > The Amsterdam Affirmation
- Telephones of Homosexual
- The Amsterdam Affirmation: People, Politics, Power
Most women talked about HAS being linked with difficulties women experience during childbirth due to weakened anal muscles. FSWs talked about this in the following:. It has consequences. You get severe pains during delivery. Instead of delivering the child from the front vagina the baby is delivered from the back anus. Majority of women linked faecal incontinence with weakened anal muscles. Women from the general population said:.
When you do it anal sex is a must that you get problems because the faeces will be coming out uncontrollably. Because all the sites are open, when you laugh or do anything it is a must that the faeces will come out, [FGD, females, general population, years]. If you get used to fucking at the back it has consequences.
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You can suffer in old age, You will have a blocked bladder. It gets blocked. There is dirt that blocks the urinary tract, [FGD, fishermen, years]. Some young women from the general population described how other people talked about HAS causing sperms to accumulate in the anal:. Almost all participants were well aware of the protective effect of condoms against HIV infection. However, condoms available on the market were thought to be only suitable for vaginal sex and not inappropriate for HAS. Some talked about beliefs that if condoms were used during HAS they were likely to burst due to the tightness of the anus and hence there was no need for them.
One woman said:. Even when a man decides to use a condom during anal sex, still you will get infection… in the anus whatever you do, it may not work. Both men and women talked about people using lubricants for the reasons of easing penetration and not to avoid diseases. Examples of substances that were used as lubricants across the study populations were: petroleum jelly, saliva, K-Y Jelly, vaginal fluids, cooking oils, soaps, lotion and honey.
A female from the general population talked about her experience in the following:. However, some women from the general population talked about lubricants being beneficial for men than women:.
2. Current and future challenges and opportunities in Tanzania
Even if he [man] will apply oil, it will help him to enter [his penis] easily but you [woman] will still get bruises and tear your anus, [FGD, females, general population, years,]. This study delineates six discourses that were used by participants from the general population and selected key population groups to talk about HAS. The discourses were simultaneously available to participants across the populations although some discourses were more common in certain sub-groups than others.
The discourses in which participants positioned themselves changed as several participants drew on different discourses at different stages of the interview and discussion. It has been noted that whatever the discourse through which people might understand their behaviour, different discourses could be drawn on in a conversation as socially appropriate [ 11 , 13 ].
Therefore, when negotiating a sexual encounter, men may use different discourses from those they might use when discussing HAS with fellow men. The terms used to describe HAS reflected the contexts within which participants lived. The symbols used by the cellular telephone companies in Tanzania seemed to influence the selection of metaphors for the practice. Tigo , vodacom and Zain telephone companies have a national reach and are represented by a circular shape. Even though participants talked about HAS with ease, on the contrary, terms used to describe the practice were intended to hide it from other people outside their group.
The ease with which many participants talked about HAS may imply that the practice could be explored further in surveys since this is something people may talk about when asked to. The use of diverse terms may imply a need to include multiple terms to describe HAS when measuring the magnitude of the practice. Hence, most participants reporting that other groups of people outside their category, practised HAS but not themselves.
Moreover, some of the terms e. Linking HAS with MSM and the perception that it is others unrelated to them who engaged in HAS may further stigmatise the practice and make it difficult to understand personal experiences. The stigmatization of certain behaviours limits access to sexual and reproductive health services [ 29 - 31 ] as people may feel that it is others who are at risk and not them. Such stigma has also been linked to under reporting of risky sexual behaviours [ 32 , 33 ] for fear of rebuke and discrimination. There is need for further research to explore the extent of this belief that it is others unrelated to them who engaged in certain high-risk sexual practices.
Gender was important in determining how participants talked about HAS. While men described HAS using crude terms, women were more careful in their selection of terms and overall description of the practice. This observation could reflect social norms around masculinity and femininity in these communities that may tolerate male expression of ideas [ 34 , 35 ]. Accounts of men using HAS to punish women whom they had exchanged sex with money or those who had concurrent sexual partners could be indicative of the existence of sexual assault in some of the relationships.
Studies have linked sexual violence with increased risk of HIV [ 36 - 38 ] and hence accounts of men about using anal sex to punish women could increase their HIV risk. Further research needs to be done to explore the extent to which some of the anal sexual encounters may be considered assault and how sexual assault in relationships is associated with increased risk of HIV.
Young women were in support of the practice as indicated in the way they talked about HAS as trendy. Similar findings about young people adopting behaviours that they considered trendy in a desire to move away from what they considered old-fashioned behaviours has been noted in other studies [ 34 , 39 , 40 ].
AIDS > Get Involved > Take part > The Amsterdam Affirmation
Although this discourse encourages HAS among young women, it offers important avenues to channel interventions aimed at reducing risks related to HAS. For instance, interventions, could consider ways of incorporating messages on condom use as trendy and acceptable for HAS. The materiality discourse is a key driver for HAS among women. Similar findings have been noted in another study in Tanzania [ 21 ]. Interventions could take advantage of the negotiations for money during HAS to encourage negotiations for condoms as well.
However, this awareness did not discourage them from having unprotected HAS. As noted elsewhere, knowing the risk does not necessarily translate into adopting safer sex behaviours [ 41 ]. Participants discussed the type of condoms currently available on the market as not suitable for HAS and hence, using them during HAS was considered not effective against HIV infections.
Structural factors, in particular economic circumstances and social norms influenced the discourses participants drew on. The positions men and women took in the discourses were shaped by norms on masculinity for men [ 33 ] while for both men and women by socio-economic contexts of their communities [ 42 ]. The masculinity and secrecy discourses may have been influenced by the social norms stipulating what is appropriate behaviour for men [ 33 ]. On the other hand, the public health discourse was shaped by HIV prevention interventions that participants previously had access to [ 43 , 44 ].
The key strengths of this formative study is the inclusion of general and key population groups, involving multiple sites in various parts of Tanzania and the utilisation of different methods allowing for the exploration of multiple dimensions of HAS. Despite these strengths, the following limitations of our study should be considered.
First, it is difficult to establish whether the discourse used in the discussions to describe HAS behaviour was the same as that through which the behaviour was understood at the time of data collection. Second and more fundamental, is the difficulty in clarifying whether the discourse within which one positioned themselves prompted certain actions or whether having acted in a particular way, the person adopted a particular discourse through which to interpret their actions.
Although our data does not suggest that relationship between discourse and practice, we are confident that practices could affect discourses that specific populations draw upon.
Telephones of Homosexual
Therefore, being part of a population such as FSW, fishermen or truck drivers or age group made certain discourse positions more available and legitimate than others. These discourses have implications for the magnitude of the practice, decisions on the practice of safer sex, and ultimately HIV prevention. Since discourses are more than language, but organise meaning into action, it is important for interventions aimed at reducing risks related to HAS to consider competing discourses when addressing HAS risks.
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The Amsterdam Affirmation: People, Politics, Power
Prevalence and determinants of reproductive tract infections among women. J Commun Dis. Wight D, Macmillan. In: Adlcins L, Merchant V, editors. Sexualising the Social: Power and the Organisation of Sexuality. Foucault M. The history of sexuality vol.