Communicating with the people about HIV infection risk as a basis for planning interventions: Lessons from the Kagera region of Tanzania

In order to deepen the understanding of risk factors associated with HIV infection in the Kagera region of Tanzania and to investigate the potentials of communicating with the people in planning for interventions, two studies were performed in the districts of Bukoba Urban, Bukoba Rural and Muleba in 1989. The HIV prevalence of these areas ranged between 4.5% and 24.2% according to the prevalence study performed earlier in 1987. The studies involved the community in ward meetings on the one hand, and previously studied individuals on the other hand. The studies aimed both at conveying to the people the results of a previously performed study and at collecting new data using a combination of quantitative and qualitative methods in order to better understand the associated risk factors, perceived or real, and what suggestions the community could offer for reducing HIV transmission in the region. From the initial study, awareness about AIDS was found to be universal. Change of sexual partners and infection with syphilis were found to be the major risk factors for HIV-1 infection. From the ward meetings people suggested a variety of solutions for interventions which we have categorized as either "hard" or "soft". The "hard" solutions involved suggestions such as isolation, imprisonment, castration and killing of AIDS victims, while the "soft" solutions involved sympathetic handling of the sick and educating the people about the modes of transmission and how best to prevent infection. There was a greater tendency for the low HIV prevalence rural communities to suggest the "hard" solutions than the high HIV prevalence urban ones which tended to suggest the "soft" solutions. However, with the changing dynamics of HIV infection in the region towards higher HIV prevalence in rural areas, it is likely that the "soft" solutions will gain acceptance and become adopted for interventions throughout the region. The information obtained from these studies has provided lessons that can be used for rational counselling as well as for guiding the implementation of IEC activities geared at interventions. It is also suggested that there should be further research into new strategies or their combinations which could be crucial in prevention such as those of community participation, empowerment of women and solidarity in AIDS intervention work.