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Adolescents’ Communication with Parents, Other Adult Family Members and Teachers on Sexuality: Effects of School-Based Interventions in South Africa and Tanzania
(AIDS and Behavior, 2015) Kilonzo, Gad P.
Cluster-randomized controlled trials were carried out to examine effects on sexual practices of school-based interventions among adolescents in three sites in sub-Saharan Africa. In this publication, effects on communication about sexuality with significant adults (including parents) and such communication as a mediator of other outcomes were examined. Belonging to the intervention group was significantly associated with fewer reported sexual debuts in Dar es Salaam only (OR 0.648). Effects on communication with adults about sexuality issues were stronger for Dar es Salaam than for the other sites. In Dar, increase in communication with adults proved to partially mediate associations between intervention and a number of social cognition outcomes. The hypothesized mediational effect of communication on sexual debut was not confirmed. Promoting intergenerational communication on sexuality issues is associated with several positive outcomes and therefore important. Future research should search for mediating factors influencing behavior beyond those examined in the present study.
Asthma at Muhimbili: a clinical and laboratory study of pattern of presentation, provoking and aggravating agents, and complicating factors.
(Diss. University of Dar es Salaam, 1977) Kilonzo, Gad P.
The purpose of this study was to examine asthma patients presenting at Muhimbili Hospital with the view to: 1. Describe social and psychological features associated with asthma patient presenting at Muhimbili. 2. Describe the pattern of the disease here and compare this with that described in other parts of the worlds, with paticular emphasis on atopic disease. 3. Find out what agents provoke and influence severity of illness. 4. Determine the clinical status of these patients 5. Find out what complications accompany the disease with special attention paid to the cardiopulmanary system.50 asthma patients and a group of 44 non-asthmatic control patients presenting at Muhimbili were studied. Asthma patients referred to Muhimbili casualty department and those admitted through medical outpatient clinics during September, October and November 1976 were included. Cases were taken consecutively as far as possible. They were interviewed, examined and investigated. The methods included (i) Personal interview with the patient using a check list. (ii) General physical examination with emphasis placed on cardio-resperatory system, and in particular noting signs of chronic chest hyper-inflamation due to chronic airway obstruction. (iii) Investigations were done to asthmatic patients. Only those investigations which required to be controlled were done to control patients, mainly stool examination, and serum estimation for IgE. The results showed late onset of asthma more marked among the females with crippling social and psychological stresses which accompany the disease. Accompanying a topic illnesses were high resembling the picture seen in temperate countries, and unlike that reported in several tropical countries. History was not a good indicator of offending allergens, and skin testing is suggested as a better method of identifying sensitizing allergens. Asthma in Muhimbili resembled other tropical countries in having a high eosinophil count, but this count was not higher than that of control patients. Asthma patients also have lower intestinal parasite load than a group of control patients. Patients with severe asthma have significant dehydration at the time of hospital admission. Chest radiographic changes were similar to the observations of other clinical workers in tropical countries and consisted of signs of chronic hyperinflation and tuberculosis reactivation. Results of skin testing identified two major allergens, house dust mites and mixed threshings. House dust mites and their secretions in dust were more important. Implications for management and therapy include the following: (a) Severe asthma patients should be rehydrated with at least 2 litres of fluid. This may be given as a vehicle for bronchodilators. (b) Asthma patients on corticosteraids whether continuous or intermittent should receive prophylactic anti-tuberculous therapy or followed closely with chest radiographs and sputum culture. (c) On the basis of sensitivity pattern tetracycline is the drug of choice at the first instance in cases of asthma complicated by infection before culture and sensitivity are available. The author concludes that major clinical conditions accompanying asthma are few, and complications of asthma are dehydration, reactivated tuberculosis, and chest deformities.
The cultural perspective of therapeutic relationship ‐ a viewpoint from Africa
(Acta Psychiatrica Scandinavica, 1985) Kilonzo, Gad P.
Therapeutic relationship has been considered an important ingredient of all psychotherapies. In communities in which no familiar conventions of such a relationship are available, the therapeutic encounter poses very different problems from those in the West, where such conventions freely prevail. This study has been carried out by five therapists representing three widely disparate cultures, but all working together in Tanzania. It brings together their perceptions of these problems and the strategies they employed to resolve them while working with African patients. In their view, in spite of great disparity between the world view behind Western psychotherapy and that of African communities, it is not impossible to forge a therapeutic relationship if empathic understanding and cultural sensitivity are added to the attitude of acceptance. After all, the therapist must attract and keep the patient before he can expect anything from him. The authors describe how this can be done with African patients.
Determination of appropriate clomipramine dosage among depressed African outpatients in Dar es Salaam, Tanzania
(The Central African Journal of Medicine, 1994) Kilonzo, Gad P.
In an open clomipramine dose finding study, 33 depressed indigenous African outpatients were randomly assigned to two regimens of treatment with 125 mg and 75 mg oral medications daily. At the end of eight weeks of treatment, 16 patients (48,5 pc) were on the 75 mg regime, and 17 (54,8 pc) were on 125 mg. 178 Analysis of depression scores cm the Beck-Rafaelsen scale indicated improvements of depression in both regimes of equal magnitude. Analysis of variance showed no statistically significant difference on dose response between the two regimes. The higher doses, however, were associated with more drowsiness and tremulousness. It is suggested that Black African patients respond to tricyclic antidepressants in much lower doses than those recommended in Western textbooks. It is also apparent that side effects of tricyclic antidepressants, which have been implicated in non-compliance to medication, could be avoided without compromising treatment outcome
Development of mental health services in Tanzania: A reappraisal for the future
(Social science & medicine, 1998) Kilonzo, Gad P.
The article traces the historical development of mental health services in Tanzania from traditional practices through custodial institutions during the colonial period, efforts towards decentralization, including the development of innovative agricultural rehabilitation villages during the 60s and the introduction of primary mental health care during the 80s right up to the present. Available resources in Tanzania, including the traditional healing system, the family and ample arable land were examined as to how these might be used in the care of mental patients and the promotion of mental health in general. The article points to real opportunities and a possible course of action for the future.
Disentangling HIV and AIDS stigma in Ethiopia, Tanzania and Zambia
(LSHTM Research Online, 2003) Kilonzo, Gad P.
The International Center for Research on Women (ICRW), in partnership with organizations in Ethiopia,Tanzania, and Zambia, led a study of HIV and AIDS-related stigma and discrimination in these three countries.This project, conducted from April 2001 to September 2003, unraveled the complexities around stigma by investigating the causes, manifestations and consequences of HIV and AIDS-related stigma and discrimination in sub-Saharan Africa. It then uses this analysis to suggest program interventions. Structured text analysis of 730 qualitative transcripts (650 interviews and 80 focus group discussions) and quantitative analysis of 400 survey respondents from rural and urban areas in these countries revealed the following main insights about the causes, context, experience and consequences of stigma: 1. The main causes of stigma relate to incomplete knowledge, fears of death and disease, sexual norms and a lack of recognition of stigma. Insufficient and inaccurate knowledge combines with fears of death and disease to perpetuate beliefs in casual transmission and, thereby, avoidance of those with HIV.The knowledge that HIV can be transmitted sexually combines with an association of HIV with socially“improper”sex, such that people with HIV are stigmatized for their perceived immoral behavior. Finally, people often do not recognize that their words or actions are stigmatizing. 2. Socio-economic status, age and gender all influence the experience of stigma.The poor are blamed less for their infection than the rich, yet they face greater stigma because they have fewer resources to hide an HIV-positive status. Youth are blamed in all three countries for spreading HIV through what is perceived as their highly risky sexual behavior.While both men and women are stigmatized for breaking sexual norms, gender-based power results in women being blamed more easily. At the same time, the consequences of HIV infection, disclosure, stigma and the burden of care are higher for women than for men. 3. People living with HIV and AIDS face physical and social isolation from family, friends, and community; gossip, name-calling and voyeurism; and a loss of rights, decision-making power and access to resources and livelihoods. People with HIV internalize these experiences and consequently feel guilty, ashamed and inferior.They may, as a result, isolate themselves and lose hope.Those associated with people with HIV and AIDS, especially family members, friends and caregivers, face many of these same experiences in the form of secondary stigma. 4. People living with HIV and AIDS and their families develop various strategies to cope with stigma. Decisions around disclosure depend on whether or not disclosing would help to cope (through care) or make the situation worse (through added stigma). Some cope by participating in networks of people with HIV and actively working in the field of HIV or by confronting stigma in their communities. Others look for alternative explanations for HIV besides sexual transmission and seek comfort, often turning to religion to do so. 5. Stigma impedes various programmatic efforts. Testing, disclosure, prevention and care and support for people with HIV are advocated, but are impeded by stigma.Testing and disclosure are recognized as difficult because of stigma, and prevention is hampered because preventive methods such as condom use or discussing safe sex are considered indications of HIV infection or immoral behaviors and are thus stigmatized. Available care and support are accompanied by judgmental attitudes and isolating behavior, which can result in people with HIV delaying care until absolutely necessary. 6. There are also many positive aspects of the way people deal with HIV and stigma. People express good intentions to not stigmatize those with HIV. Many recognize that their limited knowledge has a role in perpetuating stigma and are keen to learn more. Families, religious organizations and communities provide care, empathy and support for people with HIV and AIDS. Finally, people with HIV themselves overcome the stigma they face to challenge stigmatizing social norms. Our study points to five critical elements that programs aiming to tackle stigma need to address: - Create greater recognition of stigma and discrimination - Foster in-depth, applied knowledge about all aspects of HIV and AIDS through a participatory and interactive process - Provide safe spaces to discuss the values and beliefs about sex, morality and death that underlie stigma - Find common language to talk about stigma - Ensure a central, contextually-appropriate and ethically-responsible role for people with HIV and AIDS While all individuals and groups have a role in reducing stigma, policymakers and programmers can start with certain key groups that our study suggests are a priority: - Families caring for people living with HIV and AIDS: programs can help families both to cope with the burden of care and also to recognize and modify their own stigmatizing behavior - NGOs and other community-based organizations: NGOs can train their own staff to recognize and deal with stigma, incorporate ways to reduce stigma in all activities, and critically examine their communication methods and materials - Religious and faith-based organizations: these can be supportive of people living with HIV and AIDS in their role as religious leaders and can incorporate ways to reduce stigma in their community service activities - Health care institutions: medical training can include issues of stigma for both new and experienced providers, while at the same time, risks faced by providers need to be acknowledged and minimized - Media: media professionals can examine and modify their language to be non-stigmatizing, provide accurate, up-to-date information on HIV, and limit misperceptions and incorrect information about HIV and people living with HIV and AIDS The complexity of stigma means that these and other approaches to reduce stigma and discrimination will face many challenges, but, at the same time, there exist many entry points and strong, positive foundations for change that interventions can immediately build on.
Drug trafficking, use, and HIV risk: the need for comprehensive interventions
(SAHARA-J: Journal of Social Aspects of HIV/AIDS, 2012) Kilonzo, Gad P.
The rapid increase in communication and transportation between Africa and other continents as well as the erosion of social fabric attended by poverty, ethnic conflicts, and civil wars has led to increased trafficking and consumption of illicit drugs. Cannabis dominates illicit trade and accounts for as much as 40% of global interdiction. Due to escalating seizures in recent years, the illicit trade in heroin and cocaine has become a concern that has quickly spread from West Africa to include Eastern and Southern Africa in the past 10 years. All regions of Africa are characterized by the use of cannabis, reflecting its entrenched status all over Africa. Most alarming though is the use of heroin, which is now being injected frequently and threatens to reverse the gain made in the prevention of HIV/AIDS. The prevalence of HIV infection and other blood-borne diseases among injection drug users is five to six times that among the general population, calling for urgent intervention among this group. Programs that aim to reduce the drug trafficking in Africa and needle syringe programs as well as medication-assisted treatment (MAT) of heroin dependence while still in their infancy in Africa show promise and need to be scaled up.
Engendering health sector responses to sexual violence and HIV in Kenya: Results of a qualitative study
(AIDS care, 2008) Kilonzo, Gad P.
In Kenya many people who have been affected by sexual violence turn to the health sector for clinical treatment and preventive therapies. This interface provides a vital opportunity to impact on the dual epidemics of HIV and sexual violence. Despite this, the uptake of post-rape care services in health facilities as low and health care providers felt ill-prepared to deal with the consequences of sexual violence. A qualitative study was conducted to better understand the reasons for the low uptake of services and to establish perceptions of sexual violence in Kenya. Thirty-four key informants were interviewed and sixteen focus group discussions with women and men were held in three districts in Kenya. Blurred boundaries between forced and consensual sex emerged. Important implications for the delivery of HIV post exposure prophylaxis (PEP) after sexual violence include the need for gender-aware patient-centred training for health providers and for HIV PEP interventions to strengthen on-going HIV-prevention counselling efforts. Further research needs to determine the feasibility of on-going risk reduction measures in the context of PEP delivery.
Factors affecting HIV counselling and testing among adults in Muheza District, Tanzania.
(Tanzania journal of health research, 2014) Kilonzo, Gad P.
HIV/AIDS is one of the major public health problems affecting people worldwide. Counselling and testing is a process by which an individual undergoes confidential counselling to enable him/her to make an informed choice about his or her HIV status and to take appropriate actions. The objective of this study was to assess factors affecting HIV counselling and testing (HCT) among adults in Muheza district in north-eastern Tanzania. A total of 394 adults were interviewed using a standardized questionnaire. The majority of the study participants were females (N=213; 54.1%). Most of the respondents were either in or have completed secondary education. Almost two thirds of the study population (262) was not married. Seventy one percent of all participants viewed HCT positively. A significant proportion of married (17.7%) and un-married (16.5%) participants judged HCT as not essential as it would not change the test result. Sixty-eight percent of the respondents did not consider themselves at risk and most of them (71%) were married. Importantly, 26% reported being scared of discrimination. In conclusion our study results demonstrate that only half of the study population had adequate knowledge of HCT. Being married was considered as a ‘protective’ factor in terms HIV risk which indicates a misconception. These findings underscore the importance of proper HIV counselling and testing in this community so as to bridge the knowledge gap. It further demonstrates the need to address in detail misconceptions during HIV counselling and testing.
The family and substance abuse in the United Republic of Tanzania
(Bulletin on narcotics, 1994) Kilonzo, Gad P.
The family in the United Republic of Tanzania has traditionally been a paramount institution invested with important functions of socialization. It provided spiritual guidance, emotional and social support systems, security and education, and defined the moral and ethical system in which the community was intricately bound together. The institution is weakening under the impact of modernization at a pace that far exceeds the pace at which newer institutions are emerging to assume those responsibilities. Drug abuse is becoming an unwelcome guest under those circumstances. It is proposed that active measures should be taken at the community and national policy level to strengthen and employ the family for the purpose of promoting a drug-free lifestyle.
Flashblood: blood sharing among female injecting drug users in Tanzania
(Addiction, 2010) Kilonzo, Gad P.
Aims This study examined the association between the blood‐sharing practice of ‘flashblood’ use and demographic factors, human immunodeficiency virus (HIV) status and variables associated with risky sex and drug behaviors among female injecting drug users. Flashblood is a syringe‐full of blood passed from someone who has just injected heroin to someone else who injects it in lieu of heroin. Design A cross‐sectional study. Setting Dar es Salaam, Tanzania. Participants One hundred and sixty‐nine female injecting drug users (IDUs) were recruited using purposive sampling for hard‐to‐reach populations. Measurements The association between flashblood use, demographic and personal characteristics and risky sex and drug use variables was analyzed by t‐test and χ2 test. The association between flashblood use and residential neighborhood was mapped. Findings Flashblood users were more likely to: be married (P = 0.05), have lived in the current housing situation for a shorter time (P < 0.000), have been forced as a child to have sex by a family member (P = 0.007), inject heroin more in the last 30 days (P = 0.005), smoke marijuana at an earlier age (P = 0.04), use contaminated rinse‐water (P < 0.03), pool money for drugs (P < 0.03) and share drugs (P = 0.000). Non‐flashblood users were more likely to live with their parents (P = 0.003). Neighborhood flashblood use was highest near downtown and in the next two adjoining suburbs and lowest in the most distant suburbs. Conclusions These data indicate that more vulnerable women who are heavy users and living in shorter‐term housing are injecting flashblood. The practice of flashblood appears to be spreading from the inner city to the suburbs.
Harm reduction in Tanzania: An urgent need for multisectoral intervention
(The International journal on drug policy, 2007) Kilonzo, Gad P.
The Tanzanian ‘war on drugs’ From mid-November 2006 to early February 2007, the Tanzanian media regularly covered their government’s “War on Drugs”. Another November 2006 editorial cartoon enti-tled “War on Drugs” featured a boa constrictor squeezing a man to death. The boa’s head, symbolically shaped as a marijuana leaf, was preparing to swallow the drug user it had crushed (Kinya, 2006). Governmental response to trafficking includes destroying farms and plots producing marijuana. In another editorial cartoon focused on heroin trafficking, a young Member of Parliament, Amina Chifupa, is featured sitting on a bomb labelled ‘drug dealers. She is lighting a match as if preparing to light the bomb’s fuse and is thinking, “Give me a chance, I”ll blow that!” (Danny, 2006). During mid-November, Ms Chifupa had called upon members of Parliament to talk genuinely about the problem of heroin trafficking and reveal the names of drug barons (Kulekana, 2006). She was hounded by the press for days with both positive and negative stories written about her activities and relationships. By December, the media began focusing reports and edi-torials on a list of 200+ names of high-level business and government leaders that they reported had been circulated to high levels of the government. Media announcements that these individuals were being watched for their involvement in drug trafficking dominated the news. Editorials warned of blacklisting and a December 3rd editorial cartoon showed a businessman and a young associate sitting at a table drinking beers. The younger man is saying, “Boss, your name is in the drug dealers’ list, you should quit the business!” The boss replies, “Don’t worry, lists of names are always there, nothing can be done!” (Abeid, 2006). Media reports, editorials, pictures and the parliamentary debate about outing suspected drug barons heightened the general public’s understanding that Tanzania was part of an international trafficking network and that heroin had joined the ranks of marijuana, khat, and “gongo” as illicit substances consumed locally. The lengths to which drug traffickers go to move theirproduct and the extent to which Tanzanian youths are involved in the trade was revealed to the public in late December. During the 2006 Christmas holidays several young Tanzanian men were arrested for transporting a corpse of a colleague containing 59 pellets of heroin (This Day, 2007). The idea that Tanzanians would use a friend’s or anybody to transport heroin was a shocking realization for many. Popular music and slang reveal that these arrests were not an isolated incident. A Swahili pop song’s tongue-in- cheek lyric about an IDU’s ‘friend’s’ suggestion to plead guilty and go to prison where he would enjoy free room and board notes the reality IDUs in Tanzania experience (Maembe, n.d.). After injecting heroin became popular during 2001 and cheap pure heroin began to dominate the local market during 2003, Tanzanian police and security officials focused on both drug trafficking and local consumption. During the latter half of 2006, the Tanzanian government’s largely successful efforts to reduce heroin trafficking at the international airports led traffickers to focus on land routes. Escalated bursts of police activities have resulted in roundups of sellers and users. © 2007 Elsevier B.V. All rights reserved. doi:10.1016/j.drugpo.2007.05.001
Heroin and HIV risk in Dar es Salaam, Tanzania: youth hangouts, mageto and injecting practices
(AIDS care, 2005) Kilonzo, Gad P.
HIV risk through needle sharing is now an emerging phenomenon in Africa. This article describes the practices that heroin users are producing as they establish the rules and organization surrounding their drug use. Their practices and interactions reveal the ways that they become initiated into its use, how they progress to injecting, and the important role of local neighborhood hangouts in facilitating this process. Their practices, interactions and narratives also provide insights into what may be the most appropriate HIV-prevention interventions. Semi-structured interviews were conducted during the months of February and July 2003 with 51 male and female injectors residing in 8 neighborhoods in the Dar es Salaam, Tanzania. Interviews were content coded and codes were collapsed into emergent themes around hangout places, initiation of heroin use, and progression to injecting. Interviews reveal that Dar es Salaam injectors begin smoking heroin in hangout areas with their friends, either because of peer pressure, desire, or trickery. One hangout place in particular, referred to as the ‘geto’ (ghetto) is the main place where the organization and rules governing heroin use are produced. Three main types of heroin ‘ghettoes’ are operating in Dar es Salaam. As users build a tolerance for the drug they move along a continuum of practices until they begin to inject. Injecting heroin is a comparatively recent practice in Africa and coincides with: (1) Tanzania transitioning to becoming a heroin consuming community; (2) the growing importance of youth culture; (3) the technical innovation of injecting practices and the introduction and ease of use of white heroin; and (4) heroin smokers, sniffers, and inhalers perceived need to escalate their use through a more effective and satisfying form of heroin ingestion.
High Rates and Positive Outcomes of HIV-Serostatus Disclosure to Sexual Partners: Reasons for Cautious Optimism from a Voluntary Counseling and Testing Clinic in Dar es Salaam, Tanzania
(AIDS and Behavior, 2003) Kilonzo, Gad P.
The rates, barriers, and outcomes of HIV serostatus disclosure to sexual partners are described for 245 female voluntary counseling and testing (VCT) clients in Dar es Salaam, Tanzania. VCT clients were surveyed 3 months after HIV testing to describe their HIV-serostatus disclosure experiences. Sixty-four percent of HIV-positive women and 79.5% of HIV-negative women (p = 0.028) reported that they had shared HIV test results with their partners. Among women who did not disclose, 52% reported the reason as fear of their partner's reaction. Both 81.9% of HIV-negative women and 48.9% of HIV-positive women reported that their partner reacted supportively to disclosure (p < 0.001). Less than 5% of women reported any negative reactions following disclosure. VCT should continue to be widely promoted. However, intervention approaches such as development of screening tools and new counseling approaches are important to ensure the safety of women who want to safely disclose HIV serostatus to their sexual partners.
HIV and Partner Violence: Implications for HIV Voluntary Counseling and Testing Programs in Dar es Salaam, Tanzania
(2001) Kilonzo, Gad P.
This study explored the links between HIV infection, serostatus disclosure, and partner violence among women attending a VCT clinic in Dar es Salaam, Tanzania. Men and women both perceive HIV testing as a way to plan for the future but are motivated to undergo testing by a number of different individual, relationship, and environmental factors. The women in our study described more barriers to HIV testing than did men, and women who have communicated with their partners about VCT before seeking services are significantly more likely to share their HIV test results than those who have not talked with their partners. Findings from this study led to a number of recommendations that could reduce the barriers women face in getting tested for HIV and in disclosing their serostatus to their partners, as well as reduce levels of partner violence. These recommendations pertain to VCT services as well as to the wider community and policy environment.
HIV risk behaviors in Sub-Saharan Africa and Northern Thailand: baseline behavioral data from project accept
(Journal of acquired immune deficiency syndromes, 2008) Kilonzo, Gad P.
Background—Of 2.5 million new HIV infections worldwide in 2007, most occurred in Sub Saharan Africa and Southeast Asia. We present the baseline data on HIV risk behaviors and HIV testing in Sub-Saharan Africa and northern Thailand from Project Accept, a community-randomized controlled trial of community mobilization, mobile voluntary counseling and testing Methods—A random household probability sample of individuals aged 18–32 years yielded a sample of 14,657 with response rates ranging from 84–94% across the five sites Zimbabwe, Tanzania and two in South Africa Results—In multivariate analysis, females, married individuals, less educated with one sexual partner in the past 6 months were more likely to have had unprotected intercourse in the previous 6 months. Rates of lifetime HIV testing ranged from5.4%among males in Zimbabwe to 52.6%among females in Soweto Conclusion—Significant risk of HIV acquisition in Project Accept communities exists despite two decades of prevention efforts. Low levels of recent HIV testing suggest that increasing awareness of HIV status through accessible VCT services may reduce HIV transmission.
HIV-positive women report more lifetime partner violence: findings from a voluntary counseling and testing Clinic in Dar Es Salaam, Tanzania
(American journal of public health, 2002) Kilonzo, Gad P.
Objectives: Experiences of partner violence were compared between HIV-positive and HIV-negative women. Methods: Of 340 women enrolled 245 (72%) were followed and interviewed 3 months after HIV testing to estimate the prevalence and identify the correlates of violence. Results: The odds of reporting at least 1 violent event was significantly higher among HIV-positive women than among HIV-negative women (physical violence odds ratio [OR] = 2.63; 95% confidence interval [CI] = 1.23, 5.63; sexual violence OR = 2.39; 95% CI = 1.21, 4.73). Odds of reporting partner violence was 10 times higher among younger (< 30 years) HIV-positive women than among younger HIV-negative women (OR = 9.99; 95% CI = 2.67, 37.37). Conclusions: Violence is a risk factor for HIV infection that must be addressed through multilevel prevention approaches.
HIV/AIDS and injection drug use in the neighborhoods of Dar es Salaam, Tanzania
(Drug and Alcohol Dependence, 2006) Kilonzo, Gad P.
This study examines the intersection between needle-sharing practices and HIV recovered from used syringes collected from 73 heroin injection drug users (IDUs) in Dar es Salaam, Tanzania, between October 2003 and January 2004. To extract blood residue, syringes were flushed and 10 microliters of solution mixed with 120 microliters of a latex solution was placed on a Capillus HIV-1/2 slide. Thirty-five (57%) of the useable syringes tested positive for HIV antibodies. Results varied significantly: 90% of syringes tested HIV positive in a mixed-income neighborhood 2 kilometers from the city center: 0% of syringes tested HIV positive in the outlying areas. In addition, semistructured interviews were conducted with 51 IDUs. The interviews were content coded and codes were collapsed into emergent themes regarding syringe-use practices. Injecting is a recent practice, particularly among heroin users in neighborhoods far from the city center. Sharing syringes has resulted in a high proportion of used syringes containing HIV-positive blood residue. Geographic distance is an indicator of recent adoption of IDU in neighborhoods and correlates strongly with the distribution of syringes containing HIV-positive blood residue. Keywords." Heroin; Injection; Needle sharing; HIV risk; Africa; Urban
Ingredients and contaminants of traditional alcoholic beverages in Tanzania
(Transactions of the Royal Society of Tropical Medicine and Hygiene, 1991) Kilonzo, Gad P.
Abstract Home-made but commercially available alcoholic beverages were collected in Dar es Salaam, Tanzania and analysed for their congener alcohol, additive, aflatoxin and heavy metal contents. Ethanol concen- trations of the 15 brewed samples ranged from 2.2 to 8.5% w/v whilst the 2 distilled samples contained ethanol 24.2 and 29.3% w/v. Aflatoxin Bl was found in 9 brewed beverages, suggesting the use of con- taminated grain or fruit for their production. The amount of zinc in 4 samples was double the World Health Organization recommended maximum for drinking water (5 mg/litre). One brewed beverage contained toxic amount of manganese (12.8 mg/litre). Both distilled spirits were rich in fuse1 alcohols and one was fortified by caffeine. The results suggested that impurities and contaminants possibly associated with severe health risks, including carcinogens, are often found in traditional alcoholic beverages. Con- tinuous daily drinking of these beverages is certain to increase health risks. Contaminated grain or fruit rejected from foodstuff production should not be used for the production of alcoholic beverages.
Is care and support associated with preventive behaviour among people with HIV?
(AIDS care, 1999) Kilonzo, Gad P.
Care and support should play a critical role in assisting people who are HIV-positive to understand the need for prevention and to enable them to protect others. Differences in sexual risk reduction among 154 newly diagnosed HIV-positive individuals from semi-urban Tanzania were examined using a randomized control design, which assigned a control group to regular health services and an experimental group to enhanced care and support. Data were collected at baseline, three months and six months on self-reported sexual risk behaviours, disclosure of serostatus, reproductive health and psychosocial support. Over the six-month period, significant risk reduction occurred among both groups, with most of the behaviour change occurring during the first three months, e.g. 86 respondents (56%) reported condom use at last intercourse at 3 months compared with 24(16%) at baseline (p = 0.05). Extra care and support did not lead to increased risk reduction among the experimental group. The study population as a whole significantly changed their behaviour, suggesting that in the short term, learning one is HIV-positive has an impact on risk reduction.

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