Browsing by Author "Mbwambo, Jessie"

Now showing 1 - 6 of 6
  • Thumbnail Image
    Item
    The Application of Intervention Mapping In Developing and Implementing School-Based Sexuality and HIV/AIDS Education in a Developing Country Context: The Case of Tanzania
    (Scandinavian Journal of Public Health, 2009) Mkumbo, Kitila A. K.; Schaalma, Herman; Kaaya, Sylvia; Leerlooijer, Joanne; Mbwambo, Jessie; Kilonzo, Gad
    Aims: Effective sexuality and HIV/AIDS education programmes are needed to protect young people against HIV/AIDS and teenage pregnancy in Tanzania and other Sub-Saharan African countries. Using a theory- and evidence-based approach and adapting the programmes to local contexts, increases the effectiveness of these programmes. This paper describes and discusses the challenges and opportunities concerning the application of Intervention Mapping (IM) in the development and implementation of a sexuality and HIV/AIDS education programme targeting young people aged 12–14 in Tanzania. Methods: The sexuality and HIV/AIDS programme was designed in a participatory manner, involving researchers, curriculum developers and teachers’ and students’ panels. The programme comprised five lessons, organized around 23 sessions with the aim of delaying the onset of sexual intercourse and increase correct and consistent condom use among young people. The programme was delivered by trained teachers as an extracurricular lesson. Conclusions: The IM protocol facilitated the development of a comprehensive sexuality and HIV/AIDS education programme relevant and appropriate to the social cultural context and the needs of learners in Tanzania. The paper has demonstrated that, although the IM was developed in the Western context, it can be used in a flexible manner to adapt to local contexts such as those in Sub-Saharan Africa
  • Thumbnail Image
    Item
    Depression and HIV Risk Among Men Who Have Sex with Men in Tanzania
    (Taylor and Francis, 2016) Ahaneku, Hycienth; Ross, Michael W.; Nyoni, Joyce E.; Selwyn, Beatrice J.; Troisi, Catherine; Mbwambo, Jessie; Adeboye, Adeniyi; Mccurdy, Sheryl
    Studies have shown high rates of depression among men who have sex with men (MSM) in developed countries. Studies have also shown association between depression and HIV risk among MSM. However, very little research has been done on depression among African MSM. We assessed depression and HIV risk among a sample of MSM in Tanzania. We reviewed data on 205 MSM who were recruited from two Tanzanian cities using the respondent driven sampling method. Demographic and behavioral data were collected using a structured questionnaire. HIV and sexually transmitted infections data were determined from biological tests. Depression scores were assessed using the Patient Health Questionnaire (PHQ-9). For the analysis, depression scores were dichotomized as depressed (PHQ > 4) and not depressed (PHQ ≤ 4). Bivariate and multivariable Poisson regression analyses were conducted to assess factors associated with depression. The prevalence of depression in the sample was 46.3%. The mean (±SD) age of the sample was 25 (±5) years. In bivariate analysis, depression was associated with self-identifying as gay (p = .001), being HIV positive (p < .001: <8% of MSM knew they were HIV infected) and having a high number of sexual partners in the last 6 months (p = .001). Depression was also associated with sexual (p = .007), physical (p = .003) and verbal (p < .001) abuse. In the Poisson regression analysis, depression was associated with verbal abuse (APR = 1.91, CI = 1.30–2.81). Depression rates were high among MSM in Tanzania. It is also associated with abuse, HIV and HIV risk behaviors. Thus, reducing the risk of depression may be helpful in reducing the risk of HIV among MSM in Africa. We recommend the colocation of mental health and HIV preventive services as a cost-effective means of addressing both depression and HIV risk among MSM in Africa.
  • Thumbnail Image
    Item
    Health Care in a Homophobic Climate: The SPEND Model for Providing Sexual Health Services to Men Who Have Sex with Men Where Their Health and Human Rights are Compromised
    (Co-Action, 2015-03) Ross, Michael W.; Nyoni, Joyce E.; Larsson, Markus; Mbwambo, Jessie; Agardh, Anette; Kashiha, John J.; Mccurdy, Sheryl A.
    We present a model for developing health services for men who have sex with men (MSM) in sub-Saharan Africa and other places where MSM are heavily stigmatized and marginalized. The processes of the SPEND model include Safe treatment for sexually transmissible infections (STIs) and HIV; Pharmacy sites for treatment of STIs in countries where pharmacies and drug stores are the source of medical advice and treatment; Education in sexual health issues for health professionals to reduce discrimination against MSM patients; Navigation for patients who have HIV and are rejected or discriminated against for treatment; and Discrimination reduction through educating potential leaders in tertiary education in issues of human sexuality. Supporting empirical evidence from qualitative and quantitative studies is summarized, and barriers to implementation are discussed. Health care for MSM is one of the casualties of anti-homosexual social and legal climates. There is no amnesty for MSM in health care settings, where the stigma and discrimination that they face in the rest of society is replicated. Such conditions, however, make it necessary to consider ways of providing access to health care for MSM, especially where rates of HIV and STIs in MSM populations are high, and stigma and discrimination encourages high proportions of MSM to marry. This in itself enhances the status of MSM as an important bridge population for STIs including HIV. Where anti-homosexual laws encourage, or are believed to encourage, the reporting of MSM to authorities, health care may be seen as an agent of authority rather than an agency for care.
  • Thumbnail Image
    Item
    High HIV Seroprevalence, Rectal STIs and Risky Sexual Behaviour in Men Who Have Sex with Men in Dar es Salaam and Tanga, Tanzania
    (2014) Ross, Michael W.; Nyoni, Joyce E.; Ahaneku, Hycienth; Mbwambo, Jessie; Mcclelland, Raymond S.; Mccurdy, Sheryl A.
    Objectives: To assess HIV and sexually transmitted infection (STI) prevalence and associated risk factors in men who have sex with men (MSM) in two cities in mainland Tanzania. Methods: We conducted respondent-driven sampling of 300 MSM in Dar es Salaam and Tanga. Results: In Dar es Salaam, 172 (86%) men (median age 23, IQR 21–28) consented to HIV/STI testing, and 30.2% were HIV seropositive. Only five reported a previous positive HIV test: >90% were new HIV detections. 2.5% were syphilis-exposed and none hepatitis B positive, but 21.4% had a curable STI. Over 90% of the gonorrhoea and chlamydia was rectal. In Tanga, 11.1% of MSM were HIV seropositive, 8% hepatitis B positive and 0% were syphilis-exposed, with 4.4% having a curable STI. Predictors of HIV infection were number of MSM known, city, identifying as gay and having first sex with a man. Predictors for STIs were recent unprotected receptive anal intercourse, and number of MSM seen in the last month. 30% of the sample reported that they sold sex. There was no significant association between HIV and STI infection. Conclusions: HIV and STI rates were substantially lower in MSM in a provincial city than in a large metropolis and rates appear to depend on larger numbers of MSM known. Most HIV detected were new cases, and there was a high burden of asymptomatic curable rectal STIs (>1 in 5 MSM). Owing to stigma, MSM may not report homosexuality and thus not have rectal STIs treated. High need for tailored HIV testing and STI screening and treatment of MSM in Tanzania is apparent.
  • Thumbnail Image
    Item
    Lubricant Use and Condom Use during Anal Sex in Men Who Have Sex with Men in Tanzania
    (2015) Romijnders, Kim A.; Nyoni, Joyce E.; Ross, Michael W.; Mccurdy, Sheryl; Mbwambo, Jessie; Kok, Gerjo; Crutzen, Rik
    The lack of data on condom and lubricant use among African men who have sex with men hinders prevention efforts. We describe use, knowledge, and access to lubricants in Dar es Salaam and Tanga, Tanzania. Data were collected in 2012 and 2013 from a cross-sectional survey of 200 men who have sex with men in Dar es Salaam and 100 men who have sex with men in Tanga, Tanzania. The most common reason for not using condoms was dislike of condoms. Two-thirds of the men reported always using a lubricant for anal sex. Fewer men who have sex with both men and women know about lubricants, more gay men look for, have difficulty finding, and find lubricants to be expensive; and men who have sex with men use lubricants to facilitate penetration. Men who have sex with both men and women commonly receive their lubricants from their sexual partner, while gay men got them from friends and pharmacies. HIV-negative men who have sex with men used lubricants to facilitate penetration and reduce pain. HIV-positive men who have sex with men are likely to get their lubricants from pharmacies or friends. Men who have sex with men and women use Vaseline® significantly more than gay men as a lubricant. Results suggest that HIV prevention knowledge among gay men is greater; HIV prevention efforts should emphasise carrying water-based lubricant among men who have sex with men and women. Consequently, there is an opportunity to co-market condoms and water-based lubricants.
  • Thumbnail Image
    Item
    Sexual Motivation, Sexual Transactions and Sexual Risk Behaviors in Men who have Sex with Men in Dar es Salaam, Tanzania
    (2014) Bui, Thanh C.; Nyoni, Joyce E.; Ross, Michael W.; Mbwambo, Jessie; Markham, Christine M.; Mccurdy, Sheryl A.
    Understanding the associations between sexual motivation and sexual risk behaviors of men who have sex with men (MSM) is critical for developing effective HIV prevention interventions. To examine these associations, we employed data from a survey of 200 MSM in Dar es Salaam, Tanzania, recruited through respondent driven sampling. Results showed that 44.5% of surveyed participants most often looked for love/affection when having sex, and 36.5% most often looked for money. Money-motivated MSM were more likely to identify themselves as bisexual, more likely to have anal sex, and had significantly higher numbers of partners of both sexes. Those who most often looked for love/affection were less likely to ask for condom use, to actually use a condom, and to use lubrication in anal sex. MSM with different sexual motivations had dissimilar sexual risk behaviors. Tailored health interventions for each group to reduce these sexual risks for STIs/HIV prevention are needed.