5.3 A gender analysis of the HIV and AIDS programmes/policy of the ELCT Northern
5.3.2 Voluntary counselling and testing/ARVs/PMTCT
5.3.2.1 Voluntary counselling and testing (VCT)
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education, which the diocese is using in their programmes (without the C) is more harmful than helpful for women if employed in a gender-neutral way.
From the above, it is clear that whilst the participants noted the importance of the HIV and AIDS awareness programmes which disseminates facts to the congregants about various important relevant issues, my analysis has shown that the programme on HIV and AIDS awareness is deficient in at least two areas with regard to gender. In the next section, I will undertake a gendered analysis of three other programmes of the diocese which offer clinical services. These are voluntary counselling and testing (VCT), prevention of mother-to-child transmission of HIV (PMTCT), and the provision of antiretroviral drugs (ARVs).
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sentence,‟ due to the stigma attached to the pandemic,497 it has also been noted that there is a high demand for this service across the country498 where only a few VCT sites have been established. For instance, between 2002 and 2004 the country had only 527 VCT sites with 1201 trained counsellors.499 By the end of April 2009, VCT centres had increased to 2 134 as mentioned earlier. These centres which are established mainly in the urban and referral hospitals do not cater for the majority of the Tanzanians who are living in the rural areas.
Although the country is in financial crisis, comprehensive strategies need to be initiated to expand this essential service to the entire population. Public, private and religious hospitals offer this service, including the ELCT Northern Diocese hospitals which began to offer VCT in 2004. Individuals were required to pay 1 000 Tanzanian Shillings500 as a fee for this service (which is equivalent to 0.67 U$D) until mid 2007 when it became nationally sponsored.501 Addressing the public during the launch of a nationwide testing campaign on 14/07/2007, President Jakaya Kikwete who set an example by being tested together with his wife said: “It is possible to attain a zero HIV prevalence rate if people volunteer to know their health status.”502 The President‟s argument affirms that it is only through an HIV test that a person can know his or her status, and therefore take all the necessary precautions so as to avoid infection or infecting others.
The respondents explained that given the fact that HIV and AIDS is a new pandemic, all those involved in HIV and AIDS work (PHEP team members) had needed to attend various counselling training courses offered by the government, NGOs and the PHEP unit to equip them with counselling skills. Indicating the importance of counselling, one of the zonal educators who is also a health worker said:
497 The United Republic of Tanzania, National HIV/AIDS Communication and Advocacy Strategy, May 2006, p. 11.
498 TACAIDS, “Follow-up to the Declaration of Commitment of HIV/AIDS (UNGASS),”
<http://data.unaids.org/pub/report2006/2006_country_progress_report_tanzania_en.pdf>Accessed:
23/05/2009, p. 12.
499 TACAIDS, “Follow-up to the Declaration of Commitment on HIV/AIDS (UNGASS),” p. 12.
500 USAID/AMREF, “ANGAZA: Wataalam wa Ushauri Nasaha na Kupima,” ANGAZA Informational Brochure, p. 2.
501 PlusNews, “Tanzania: Government to set up ARV rollout and VCT,”
<http://plusnews.irinnews.org/Report.aspx?reportId=73298> Accessed: 04/08/2007. p.1.
502 PlusNews, “Tanzania: Government to step up ARV rollout and VCT,” p. 1.
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We offer pre-and-post counselling to facilitate voluntary HIV testing so that individuals are prepared to come to terms with the test results. Those who are diagnosed to be positive are treated either in public or church clinics/hospitals that are closer to their residence. We make a follow up to ensure that they attend the clinics and also take their medication as prescribed (CD- 4 on 23/01/2007).
Gender statistics of individuals who visited two of the diocesan‟s hospitals for VCT are illustrated in the tables below.
Table 1: VCT Machame Hospital 2004-07
Year No. of Males HIV+ Males No. of females HIV+ females
2004 206 6 141 9
2005 314 16 284 22
2006 670 14 865 53
2007 762 22 810 51
Total 1952 58 2100 135
Source: VCT – Angaza, Machame Hospital Records, 2008.
Table 2: VCT Marangu Hospital 2004-07
Year No. of Males HIV+ Males No. of females HIV+ females
2004 435 19 398 43
2005 759 46 721 64
2006 658 47 1090 139
2007 880 42 1060 132
Total 2297 135 2871 335
Source: VCT –Angaza, Marangu Hospital Records, 2008.
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An analysis of the two tables based on gender reveals that every year there is an increase in the number of those who volunteered to be tested as well as an increase in the incidence of HIV infection for both genders. However the increase among women is higher even though the numbers of men and women accessing the service are not equal. The question is: why are there more women than men, who are undergoing tests and who turn out to be HIV positive? On the one hand the best response to this question is taken from one of the female coordinators who is also one of the respondents. She stated that usually women feel obliged to take an HIV test because they are aware of the risky behaviour of their husbands (CD-3 on 05/03/07). In addition, according to Rao Gupta503 and other researchers 504 it is because of the subordination of women to men that more women are vulnerable to HIV infection. On the other hand although the tables show that more women than men are infected with the virus, UNAIDS has shown that more men are reluctant to seek treatment timeously, due to the ideology of masculinity that requires that they appear to be brave at all times,505 hence leading to the above mentioned statistics with regard to HIV testing.
Men‟s delay in accessing test and treatment results in the progression of the virus which then causes illness and premature death.
The second gendered aspect of the VCT service is connected to married couples. The issue here is whether one partner can access VCT with or without the knowledge of the other.
The majority of the implementers of the HIV programmes of the diocese indicated that a man or a woman is free to take the HIV test with or without prior consultation with their spouses. However, if a partner is diagnosed to be HIV positive, they counselled the person by showing them the importance of informing the other partner so that both can be tested and treated. Nevertheless, no one can be forced to disclose their status as one of the respondents said:
503Rao Gupta, “Gender, Sexuality, and HIV/AIDS,” p. 2.
504 Nicolson, AIDS: A Christian Response, p. 47. See also Nicolson, God in AIDS? p. 224, 225. Patricia Siplon, “AIDS and Patriarchy: Ideological Obstacles to Effective Policy Making,” in Amy .S. Patterson (ed), The African State and the AIDS Crisis, Aldershot: ASHGATE, 2005, p. 23. Usdin, The No-Nonsense guide to HIV/AIDS, p. 47.
505 UNAIDS, “Men and AIDS: A gendered Approach - 2000 World AIDS Campaign,”
<http://data.unaids.org.pub/report/2000/20000622_wac_men_en.pdf> Accessed: 19/07/2010, p. 3.
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if they refuse, we don‟t force them; rather we treat them according to their stages of infection, whether it is [an] opportunistic infection or [whether they] require ARVs (CD-4 on 23/01/2007).
This respondent said that health workers are governed by the National Policy on HIV and AIDS which urges medical practitioners to maintain confidentiality concerning HIV testing and results for their clients. The policy on HIV testing forbids health providers to disclose someone‟s HIV status to a third person without their consent, even if it is their spouse.506 The refusal to disclose their HIV positive status to their partners has been observed to occur among both males and females. However, women are particularly fearful due to the violence or rejection they may encounter from their husbands (CD-4 on 23/01/2007 & ZE- 8 on 30/01/2007). Although there is a tendency of both men and women to refuse to reveal their HIV positive status to their spouses, the reluctance of women is based on their subordinate position in society since the disclosure can result in violence or rejection as had been indicated by research conducted in other parts of the country.507 The respondents made it clear that those who refuse to inform their partners about their HIV status but continue to take their medication secretly, present a risk for both partners as they continue with unprotected sex, but indicated that this is beyond their control as it is a private affair.
However, those who test positive and agree to tell their partners are asked to come together with those partners to the clinic, and after thorough counselling the latter are informed and advised to be tested too. If both are infected then both are treated and advised to use preventive measures. If only one is infected, they are also advised to use preventive measures to safeguard the other from infection. For married couples who are both infected or of whom one is infected, male and female condoms are provided as treatment to minimize re-infection (CD-4 on 23/01/2007, ZE-8 on 30/01/2007 & CD-3 on 05/03/2007).
This is the only circumstance under which the programme of the diocese advises the use of condoms. The above response agrees with the clarification of the ELCT Managed Health Care Programme personnel who were interviewed by Paul Isaak in 2003. The personnel spelled out that condoms in church related health facilities are administered to married couples as a medical device in relation to HIV infection, after the infection of one or both
506 The United Republic of Tanzania, National Policy on HIV/AIDS, p. 24.
507 Usdin, The No-Nonsense guide to HIV/AIDS, p. 55.
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partners,508 and not as a prevention method. No condoms are given to unmarried people who are diagnosed to be HIV positive in the church related hospitals, since this is viewed as promoting immorality (CD-4 on 23/01/2007).
Thus, in this section, I have demonstrated two things: first, men and women have equal access to the service of VCT, although increasingly more women than men are going for testing. Hence, as I have indicated earlier, the women are becoming more aware that they are at risk from partners who are unfaithful even if they themselves are faithful. Second, both men and women are encouraged to disclose the results of their HIV status to each other. However, both men and women are reluctant to do so for gendered reasons as explained above. Therefore, this shows that while the VCT programme is important, the gendered factors, such as violence and masculinity need to be taken into consideration.
Next, we look at the second clinical service programme offered by the diocese namely ARV‟s.