1. 1 Family context and dynamics of rural women’s sexual relationships : transactional sex and experience of sexual violence in relation to HIV/AIDS in North Western Tanzania By Joyce Wamoyi Centre for AIDS Research, School of medicine, PhD research proposal Supervisor: Dr. Will Stones

2. 2 Context: family in Tanzania The basic family structure is mainly extended Nuclear families now becoming common in urban areas due to the pressures on economic resources & modernisation Traditional family system where parents & close relatives had strong influence on children’s upbringing now diminishing

3. 3 Context: Sexual relationships in Tanzania (1) Median age at first marriage:18.6 years for women & 24.4 years for the men 65% of women are married by the age 20 Marital status (15-49 years): -never married (23% F,38%M), -currently in unions (67%F, 57%M), -divorced/separated/widowed (10%F, 5%M) Women & men who are separated, divorced or widowed have a significantly higher prevalence of HIV than currently or the never married: -divorced/separated/widowed (19.8% F, 15.0% M) -currently married/in union (6.9% F, 7.8M) -never in married (3.8% F, 3.0% M)

4. 4 Context: sexual relationships in Tanzania (2) Mainly controlled by the male partners -women powerless to negotiate/use protection Emphasis in relationships is for male sexual pleasure Age mixing/sexual networks -males older than females -young women preferred

5. 5 Transactional sex (1) Women from disadvantaged backgrounds use sex as a means of economic gain Exchange range from money to gifts Usually from a man to woman Gift (money/presents) and countergift (sex) may happen on different occasions Gifts/money in exchange for sex may have symbolic value Engage in risky sexual practices such as anal and dry sex

6. 6 Transactional sex(2) Transactional sex exacerbates risk of HIV transmission  Reduces a woman’s ability to negotiate for safer sex  Provides dynamic for partner change  Makes people with money to be attractive as sexual partners and this may be older & high risk in most cases

7. 7 Sexual violence (1) Relationship between women’s HIV status & experiences of partner violence HIV+ young women attending a HIV VCT centre in Dar were 10 times more likely to report experience of physical violence with a current partner than the HIV- Overall, HIV+ women reported significantly more sexual violence in their relationships, greater no. of physically violent partners in their lifetime. Transactional sex exacerbates sexual and physical violence

8. 8 Sexual violence (2) Sexual violence exacerbates risk of HIV transmission:  Violence limits a woman’s ability to negotiate condom use  Coercive sex poses direct biological risk for HIV infection resulting from vaginal trauma, lacerations  Relationships with riskier/older men

9. 9 Other factors that increase women’s risk (1) Physiological differences in the genital tract Sexually Transmitted infections -greater burden of STI among women owing to under-treatment as less symptomatic Gender inequalities -Cultural norms encourage subordination -Unequal access to education & lack inheritance rights

10. 10 Gap Unexplored role of the family context in determining how women form and dissolve relationships and how this may influence their decision to transact sex and experience sexual violence Focus has been on high risk groups (sex workers), but little has been done to understand and prevent women entering/being into sex work or relationships that are violent Much has been done on how AIDS has impacted on families, but little on the how the family context can increase or reduce vulnerability to HIV

11. 11 Aim To study the role of rural women’s family contexts in determining how they form and dissolve sexual relationships.

12. 12 Objectives 1.To study how sexual relationships are formed in different family contexts 2.To study how sexual relationships are dissolved in different family contexts 3.To understand how family context influences women’s experience of transactional sex 4. To understand how family context influences women’s experience of sexual violence 5.To study how formation and dissolution of relationships is linked to HIV status

13. 13 Research methods (1) Qualitative data collection using:  In-depth interviews  Focus group discussion  Participant observation Focus on: -Understanding meaning of family from participants point of view, fluidity of families, family context e.g. economic & social support, transactional sex, experience of sexual violence, beliefs about HIV & their own vulnerability, love/emotional attachment.

14. 14 Research methods (2) Secondary data:  DSS data will be helpful on status of relationships (specifically during sampling) -set up in 1994 -data on adult mortality & fertility in the general population by HIV status -provides information on households composition & marital status  Epidemiological sero-survey data on HIV status of the participants -data on the current magnitude, patterns and trends of the HIV/AIDS epidemic

15. 15 The study country: Tanzania Population:35 million Education: 74% f & 89%m have primary education Maternal mortality:1500 per 100,000 live births (WHO 2004) HIV/AIDS in Tanzania  National adult prevalence is 7% (7.3% f & 6.3% m)  1.6 Million people infected (840,000 F, 660,000 M & 140,000 Children)  Life expectancy 45.6 years, expected to drop to 35.3 years by 2010 mainly due to AIDS

16. 16 Map of study site: Kisesa ward,

17. 17 Description of Kisesa ward (1) Population: 30,000 people –95% are from Sukuma ethnic group – 74% Christians, 23% traditional religions, 3% muslims –a total of 4500 households with mean size of 6.4 individuals –about 80% of adults have primary education -but, only 5% of men and 2% of women have secondary education or higher Total fertility rate is 6.2

18. 18 Description of Kisesa ward (2) Marital relationships: -median age at first marriage (19 yrs F, 23 yrs M) -mainly monogamous -5% of men and 15% of women are in polygamous unions -among women in polygamous union, 92.5% were cohabiting with their partners Economy –per capita income below $120 per year –farming is main source of income, petty trading common Health : four public and three private health centers

19. 19 Description of Kisesa ward (3) HIV prevalence has been increasing -1994-1995 – 5.8% (m 4.8%, f 6.7%) -1996-1997 – 6.4% (m 4.9%, f 7.6%) -1999-2000 – 7.4% (m 6.8%, f 9.3%) - 2003-2004 – 7.9% (m 7.6%, f 8.2%)

20. 20 Conclusion It is important to understand the role of the family context in determining how women form or dissolve relationships some of which may increase their risk for HIV

21. 21 Thank you Comments/feedback