1. AFRICA LOCAL GOVERNMENT ACTION FORUM (ALGAF) PHASE IV LOCAL GOVERNMENT RESPONSES TO HIV AIDS DAR ES SALAAM – TANZANIA BETTY MUZE TEMEKE MUNICIPAL AIDS CORD.

2. Importance of HIV AIDS for Local Government Introduction Central government has undergone reforms, where by a Ministry of Regional Administration and Local Government was established. Basing on this approach, districts are characterised into Councils and Municipalities depending on the population and infrastructure status.

3. Introduction Cont. Health facility based data (HMIS), community based data (AMMP annual booklet, and burden of diseases analysis) indicates that the major health problems include; 1. HIV/AIDS, 2.Tuberculosis, 3. Uncomplicated 4.Severe Malaria, 5.Hypertensive disorders & stroke, 6.Anaemia, 7. Unintentional injuries and 8.Pregnancy complication. (HMIS, AMMP report 2001).

4. Economic Activities: Informal and formal sectors E.g. Heavy business men and women, industrial workers, government civil servants, small- scale business e.g. carpentry, fishing, farming, as well as labourers, non governmental organisation and parastatal workers.

5. Health and development Municipal development projects depend on the revenue collection from various productive areas. Production and income generation depends on the health status of the individual and indeed the entire community

6. Epidemiology of HIVAIDS HIV /AIDS is the second leading cause of adults mortality after malaria. Community data indicates that HIV/AIDS is the leading cause of death.in Dar es Salaam. HIV/AIDS reported cases Tanzania are 1.5 mil. and DSM is 2,574. (MoH 2000 - 2002). Prevalence rate is 8.3% in 2000 and 18.8% by the year 2001 for male blood donors (MoH 2000/2001).

7. Epidemiology Cont. Overall ANC HIV prevalence in Tanzania 2001- 2002 is 9.6% with a range of 5.6% to 16.0% and in Dar es Salaam in particular is 12.8%. Prevalence of HIV amongst blood donors Municipalities: Temeke is 26%, Ilala 15% and Kinondoni 33% (MOH 2001). Affected age group is 15 to 49 years they are most sexually active, reproductive and productive group.

8. Epidemiology Cont. Mode of transmission. Heterosexual relationship, which accounts to about 80%. Mother to child transmission, which is around 5%. Other modes of transmission like IDU, use of unsterile instruments and MSM, are insignificant. (UNAIDS /WHO 2002.)

9. Effect of HIV/AIDS on production. Councils are basically responsible in offering social services to their communities e.g. education, health services, water, and infrastructures like construction of feeder roads To contribute to revenue collection people need to be healthy, amongst other factors. Most of the services are provided by specific professionals, e.g. teachers, health service providers, engineers, technicians etc,

10. Effects of HIV AIDS on production cont. HIV/AIDS has a long course of illness leads to sick leave, absenteeism,long hospitalisation. High treatments cost Premature death (Life year loss). Burial costs. Family facing drainage of resources Unmanageable number of orphans Increase of street children Vicious cycle of, crime, drug users, bandits, sexual abuse, poverty, and ultimately increase of HIV infections.

11. Obstacles facing the local government;  Inadequate access to anti retral virals,  Limited means of information especially media coverage at the rural areas.  Community is less informed on HIV /AIDS to the grass route level due to rural urban migration.  Social stigmatisation  No local government news media.

12. Opportunities: Appropriate use of VCT centres. Local media coverage e.g. radios, TV etc. Meetings held at different levels including full council Vehicle labelling on HIV/AIDS messages. Advertisement billboards. Alliances of Mayors initiatives on HIV/AIDS. TACAIDS will respond to HIV/AIDS prevention proposals to the councils. Working with NGOs.

13. Challenges People are changing behaviour very slowly e.g. STI, unwanted pregnancies etc. Factors that influence HIV transmission are difficult to tackle e.g. sex for money, constraints or life hardships. Volunteering for testing is limited due; to distant from testing sites and rural areas are much under served. People’s optimism following the results of testing (what next after testing). Commitment in addressing HIV/AIDS issues in meetings. Commitments in employing competent staff in handling HIV AIDS issues.

14. Appropriate responses to HIV /AIDS for Local government. STI control and case management Advocacy Fighting stigma and indiscrimination. Condom promotion and distribution. Voluntary HIV Counselling and testing. Prevention of mother to child transmission of HIV. School based prevention for primary and secondary level. Work place intervention. Blood safety. Care and support community based. Treatment of common opportunistic infections

15. Inputs required to mounting an effective LGHIV/AIDS strategy To ensure that all leaders are well knowledgeable on updates HIV/AIDS issues. HIV/AIDS committees should be well informed on HIV/AIDS issues to educate others in their respective areas. To be creative and able to design means of educating their communities in acceptable cultures and taboos. Innovation of evaluation of effectiveness of the ongoing interventions. Billboards for HIV /AIDS messages should bear a clearer meaning and easy to understand.

16. Thank you very much for listening. Bye Bye and Welcome to Dar Es salaam Tanzania.