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Religious practices and quality of life in palliative care: insights from Tanzania
(BMJ Supportive & Palliative Care, 2025-02-23) Kilonzo,Gad P.; Ahmed,Nadia
Abstract Objective To explore the role of religious practices in palliative care and their impact on the quality of life among inpatients at Ocean Road Cancer Institute. Methods A quantitative cross-sectional study was conducted, using structured surveys to gather data from 150 inpatients receiving palliative care. The WHO Quality of Life-BREF (WHOQOL-BREF) tool was used to measure quality of life, alongside data on the usage of religious practices. Results The findings reveal that most of the participants (90%) expressed a need for religious practices, predominantly prayer. Notably, access to these practices positively correlated with improved perceptions of well-being, despite a considerable portion of patients reporting a poor quality of life (84.7%). Conclusion The study’s findings highlight the importance of incorporating religious practices into palliative care, particularly in low-resource settings like Tanzania, to provide culturally sensitive, holistic support for patients with cancer.
Prevalence, sub-types, and associated factors of anemia among inpatients at a tertiary psychiatric hospital in Tanzania: a cross-sectional study
(BMC psychiatry, 2025-02-26) Morawej,Zahra.
Background Anemia has been linked to psychiatric disorders including depression, bipolar disorder, and schizophrenia. Studies have demonstrated an association between anemia and worsening clinical presentation and treatment outcomes of these disorders. This study aimed to assess the prevalence and factors associated with anemia among adult patients admitted at Mirembe National Mental Health Hospital (MNMH) in Dodoma, Tanzania. Methods A cross-sectional analytical study was conducted at MNMH among 265 adults admitted at the hospital. Socio-demographic and clinical variables were collected using a closed-ended questionnaire, and anemia and other hematological indices were assessed via complete blood count (CBC). Data were entered into an Open Data Kit (ODK) app and analyzed using SAS version 9.4. Chi-squared test was used initially to assess association between individual exposures and the outcome, anemia. Variables with a p-value < 0.20 from the chi squared analysis were fitted into a logistic regression model to determine their odds of association with anemia. Odds ratios from adjusted regression analysis were used to identify factors independently associated with anemia. Significance level was set at p value < 0.05. Results The prevalence of anemia among adult patients admitted at MNMH was 44% (CI 38.08, 50.36). The majority of participants had mild anemia (74.36%). Microcytic hypochromic and normocytic normochromic were the common types of anemia (47% and 46% respectively). Being male, institutionalization, and using Olanzapine was associated with anemia among participants at bivariate analysis, however, only institutionalization remained as a statistically significant factor associated with anemia at multivariable analysis (AOR:5.742, 95% CI 2.048, 16.105). Conclusions Comprehensive care strategies addressing anemia among psychiatric inpatients are crucial, extending beyond psychiatric symptoms to address factors related to prolonged admission, such as nutritional considerations. It is recommended that regular screening for anemia be implemented among psychiatric inpatients and efforts should be made to investigate and address the underlying causes of anemia among this population.
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
Psychiatric co-morbidity in medical patients with aids: some considerations for clinicians and counselors in Tanzania June 1997
(Tanzania Med J, 1997) Kilonzo, Gad P.
Clinical experience indicates that psychiatric patient populations are being neglected in HIV preventive work and furthermore the psychiatric problems of persons with AIDS are often undetected and under reported. This paper explores the reasons for this observation and discusses the implications for clinicians and counselors. This review focuses on two issues: the urgent need for preventive efforts geared to the psychiatric patient population; and for the early detection of psychiatric problems in HIV positive medical patients by primary care physicians and counselors.
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.
Social networks' influence on tobacco use among students in Dar es Salaam, Tanzania
(Promotion & Education, 2005) Kilonzo, Gad P.
Introduction Tobacco use is a major cause of preventable morbidity and mortality in both developing and developed countries (WHO, 1995). Tobacco use has increased dramatically in developing countries over the last 25 years, and it is estimated that by 2030, seven out of ten tobacco-attributable deaths will occur in developing countries (WHO, 2002). Numerous studies worldwide have focused on the correlates, predictors, and risk factors associated with the initiation of cigarette smoking during childhood and adolescence (Zhu et al., 1992; Flay et al., 1998; Shamshudin et al., 2000; Zhang et al., 2000). These studies completed in developed countries have shown an association between the smoking habits of parents and their children's smoking behaviors. In addition, experimentation with the use of cigarettes at a younger age is a predictor of future regular use of a tobacco products as well as experimentation with a wider range of other substance abuse (Soueif et al., 1990). Generally, school based studies in developing nations show the prevalence of ever smoking to vary considerably.According to data from the Global Youth Tobacco Survey, 37.6% of South African adolescents reported ever smoking in 2002, and over half of the smokers reporting having parents who smoke (WHO, 2002). The occurrence of adolescent ever smoking in Mali was 39.8% in 2001, in Mauritania 31.8%, and in Kenya 14.9% (WHO, 2001) Peer influences (Kwamanga, Odhiambo,& Amukoye, 2003; Maassen, Kremers,;1------.Mudde & Joof, 2004) and family members have also been found to be important determinants of cigarette smoking among children in African countries. A school- based study conducted in Zimbabwe among secondary school children showed that more fathers (25.5%) than mothers (8.7%) were tobacco users (Aare et al., 2000). Adelekan et al. (1993) completed a study in Nigeria among college age students that indicated siblings had a greater influence on smoking behavior than parents
New injecting practice increases HIV risk among drug users in Tanzania
(British Medical Journal, 2005) Kilonzo, Gad P.
Editor— Female sex workers who inject heroin in Dar es Salaam, Tanzania, have created a new needle sharing practice they call “flash blood.” This entails drawing the first blood back in a syringe until the barrel is full and then passing the needle and syringe to a female companion. Women believe that about 4 cm 3 of such blood contains enough heroin to help them escape the pains of withdrawal. They developed this practice in mid-2005 in an altruistic attempt to help one another. Male injectors are unaware of this practice. These data are based on ongoing interviews with 63 injecting drug users. Research on the relation between drug injection and HIV transmission has long focused on the serial use of syringes or needles, practices such as “back loading,” and reuse of paraphernalia before injecting. 1–3 Flash blood is a new phenomenon that is, in a sense, a dangerous exaggeration of needle sharing that magnifies HIV transmission risk. If the first injector is infected with HIV or hepatitis C virus the amount of virus directly transmitted into the bloodstream by the second injector could be quite large. The rationale for the practice may be the price and quality of heroin. Since 2003 the price of heroin has doubled. Once pure, it is now reportedly adulterated. Now a kete costs $1, and injectors reportedly need two to get high. Most female injectors are sex workers, and the more successful are helping the more desperate with flash blood. The women who accept flash blood are also the most likely to agree to clients’ frequent requests to forgo condoms. Injection drug use emerged in East Africa during the past five to six years, and it is spreading rapidly throughout the region. 4 5 If flash blood spreads to other cities in East Africa, its impact on the rate of trans mission of HIV and hepatitis C virus could be substantial.
Marital Conflicts and the Psychosocial Status of Children and Adolescents: A case study of Kinondoni District, Tanzania
(The Winnower, 2015) Kilonzo, Gad P.
Consistent with Blumer’s Symbolic Interactionism (1969), this study explored a child and adolescent’s experiences of marital conflicts and their outcomes on their psychosocial wellbeing. It specifically focused on examining the links on how marital conflicts negatively influence the psychosocial wellbeing of children and adolescents. The study involved children of ages 7-12(middle childhood) and adolescents of ages 13-19 (early adolescence) respectively. The data were collected by administering children and adolescent’s self-report measures using non-participant observation and in-depth interview methods. With the use of an exploratory design, ideas, insights and experiences of children and adolescents towards marital conflicts were captured and analyzed using content analysis technique, and presented in narratives along the study’s objectives. Findings indicated that marital conflicts predicted a child’s and adolescent’s psychosocial distress in terms of their distorted relationship with parents and peers, lowered self-esteem, signs to psychological disorders such as anxiety and depression, and development of externalizing and internalizing behaviors respectively. The study recommends a longitudinal study on the subject matter and more practical studies for the services needed for these affected children and their distressed parents.
Socio‐economic and partner relationship factors associated with antenatal depressive morbidity among pregnant women in Dar es Salaam, Tanzania
(Tanzania journal of health research, 2010) Kilonzo, Gad P.
Depression during pregnancy may negatively influence social functioning, birth outcomes and postnatal mental health. A cross-sectional analysis of the baseline survey of a prospective study was undertaken with an objective of determining the prevalence and socio-demographic factors associated with depressive morbidity during pregnancy in a Tanzanian peri-urban setting. Seven hundred and eighty seven second to third trimester pregnant women were recruited at booking for antenatal care at two primary health care clinics. Prenatal structured interviews assessed socio-economic, quality of partner relationships and selected physical health measures. Depressive symptoms were measured at recruitment and three and eight months postpartum using the Kiswahili version of the Hopkins Symptom Checklist. Completed antenatal measures available for 76.2% participants, showed a 39.5% prevalence of depression. Having a previous depressive episode (OR 4.35, P<0.01), low (OR 2.18, P<0.01) or moderate (OR 1.86, P=0.04) satisfaction with ability to access basic needs, conflicts with the current partner (OR 1.89, P<0.01), or booking earlier for antenatal care (OR 1.87, P=0.02) were independent predictors of antenatal depression in the logistic regression model; together explaining 21% of variance in depression scores. Attenuation of strength of multivariate associations suggests confounding between the independent risk factors and socio-demographic and economic measures. In conclusion, clinically significant depressive symptoms are common in mid and late trimester antenatal clinic attendees. Interventions for early recognition of depression should target women with a history of previous depressive episodes or low satisfaction with ability to access basic needs, conflict in partner relationships and relatively earlier booking for antenatal care. Findings support a recommendation that antenatal services consider integrating screening for depression in routine antenatal care.
Parents' and Teachers' Communication About HIV and Sex in Relation to the Timing of Sexual Initiation Among Young Adolescents in Tanzania
(Scandinavian Journal of Public Health, 2008) Kilonzo, Gad P.
Aims: Early sexual debut is associated with increased HIV risk among young adolescents in sub-Saharan Africa. Our study examines parents' and teachers' communication about sexual matters in relation to the timing of sexual initiation among students aged 12—14 years old in Dar es Salaam, Tanzania. Methods: Virgin primary school students were followed prospectively for 6 months to assess sexual initiation. Socio-demographic, psychosocial, and behavioural factors were assessed with a structured questionnaire. Univariate and multivariate logistic regression analyses were performed. Results: Of 2477 adolescents, 26.9% of students reported communicating about HIV and sex with parents and 35.6% communicated with teachers. Communication with teachers about HIV and sex was associated with delayed sexual initiation among adolescents after adjusting for potential confounding factors (OR=0.59, 95%CI=0.40—0.89, p=0.01). However, parental communication was not associated with the timing of sexual initiation. The perception that most peers are sexually active was a significant predictor of early sexual debut (test for linear trend, p=0.002). Students who do not live with a biological mother were marginally more likely to initiate sex compared to those who live with a biological mother (OR=1.39, 95%CI=0.97—1.99, p=0.08). Conclusions: Teachers can play an effective role in discussing HIV and sex with young adolescents. Our study highlights the necessity of responsible adults discussing sexual matters with young adolescents in sub-Saharan Africa. More research is required to better understand the role of parental communication about sexual matters and strategies for improving the quality of parental communication.
Knowledge, Attitude, and Practice Toward Epilepsy Among Rural Tanzanian Residents
(Epilepsia, 1993) Kilonzo, Gad P.
Before a health education program can be established, one must first know what the target population believes and does with respect to the disease in question. Therefore, we performed a study among Tanzanian rural inhabitants to identify their knowledge, attitude, and practice (KAP) toward epilepsy: 3,256 heads of households (mean age 40.2 years, range 15–90 years; M/F ratio 1:1) were interviewed. Of the respondents, 32.9% said they had never seen a seizure; 67.7% said they did not know the cause of epilepsy; 33.3% mentioned various causes including heredity, witchcraft, infection of the spinal cord, hernia; 40.6% believed epilepsy was infectious through physical contact, flatus, breath, excretions, sharing food; 36.8% believed epilepsy could not be cured and 17.1% believed it could not even be controlled; 45.3% believed epilepsy could be treated by traditional healers, and only 50.8% believed hospital drugs were of any use; and 62.7% of the respondents would not allow an epileptic child to go to school for various reasons, including mental sub normality (54.0%), fear of the child falling while alone (65.9%), and fear that the epileptic child would infect other children (11.2%). Concerning what is to be done when a seizure occurs, 33.5% of the respondents would keep away and not touch the person; 16.5% would take some potentially harmful measure such as forcing a mouth gag or forcing a drink such as water (1 even mentioned urine); 5.2% would take unnecessary measures such as rushing the patient to a hospital. Only 35.7% of respondents would perform at least some of the currently recommended first‐aid measures. Therefore, there is a need for health education on epilepsy in Tanzania, and these results are forming the base for design and execution of a health education and a primary health care program in epilepsy control.
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.
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.
Lessons from Tanzania on the integration of HIV and tuberculosis treatments into methadone assisted treatment
(International Journal of Drug Policy, 2014) Kilonzo, Gad P.
To successfully address HIV and TB in the world, we must address the healthcare needs of key populations, such as drug users, and we must do this urgently. Currently in Tanzania, as in many countries, the care for these medical disorders is separated into disease specific clinical environments. Our consortium began working to integrate HIV and TB clinical services into the methadone program in Dar es Salaam, Tanzania. We present the key lessons learned in this process of integration and the importance of integrating HIV/TB into the methadone program, which serves as a critical anchor for adherence to clinical services. Integrated healthcare for people who use drugs is clearly a long-term goal and different health systems will progress upon this continuum at different rates. What is clear is that every health system that interacts with drug users must aspire to achieve some level of integrated healthcare if the incidence rates of HIV and TB are to decline.
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.
Medication assisted therapy (MAT) and substance use disorders in Tanzania
(International Journal of Human Rights in Healthcare, 2011) Kilonzo, Gad P.
Purpose – Substance use is among the risk factors associated with both HIV/AIDS and non communicable diseases (NCDs). The aim of this paper is to describe the development of the medication assisted therapy (MAT) in the treatment of substance use disorders and opportunities for further interventions in Tanzania. Design/methodology/approach – A review of MAT pilot project documentation, existing published and grey literature on substance misuse in Tanzania was used to describe the scope of this paper. MATas a program focuses on the treatment of opiod dependent individuals using methadone in a national hospital in Tanzania. It is delivered by a team of trained interprofessionals coordinating with community partners. Findings – The findings indicate an uptake of pharmacotherapy in the treatment of substance use disorders as an adjunct to traditional counseling approaches in low resource settings. Program acceptability and reach within a short period of time by the opiod dependent individuals is shown. Practical implications – National buy-in is critical for developments of new interventions. Given adequate resources, it is feasible to integrate MAT for the treatment of substance use disorders within health care systems in poor resource settings. To ensure the success of the program, sustainable efforts and scaling up to include alcohol and tobacco dependence treatment is crucial. The local capacity building is required including a need for designing appropriate policies to address alcohol and tobacco use in Tanzania. Originality/value – The intervention is the only one in sub-Saharan Africa. MAT may serve as a practice model for other countries in the region. Keywords Substance use, Addiction treatment, HIV, Methadone, Africa, Non-communicable diseases, Tanzania, Nicotine, Alcohol, Heroin, Drug addiction, Tanzania Paper type General review
Responsibility as a dimension of HIV prevention normative beliefs: measurement in three drug-using samples
(AIDS care, 2007) Kilonzo, Gad P.
The concept of responsibility was derived originally from principles of morality, as part of a network of rights, duties and obligations. HIV risk-related studies have suggested that a sense of responsibility for condom use to protect a partner is a potentially important predictor of condom use in drug-using populations. We created a four-item scale measuring Self responsibility to use condoms and Partner's responsibility to use condoms. Data were collected from three drug-using samples: crack smokers, HIV seropositive crack smokers in an intervention study in Houston, Texas, and Tanzanian heroin users in Dar es Salaam. Data indicated that the four responsibility items had high alpha coefficients in each sample, and that there were moderate to high intercorrelations between equivalent self and partner responsibility items. There were significant differences in scale scores between the crack smokers and the HIV positive crack smokers and the Tanzanian samples, but no significant differences between the HIV positive and Tanzanian samples. Comparing within the first crack-smoker sample those who were HIV positive and negative showed significant differences in the direction of higher beliefs in responsibility to use condoms in the HIV positive group. These data suggest that responsibility is measurable, holds similar psychometric properties across three samples differing in culture and HIV serostatus, and that condom use responsibility is conceptualized as a measure of general responsibility rather than as a reciprocal self/partner responsibility.
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.
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.
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.

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