Strategic Assessment to Define a Comprehensive Response to HIV in Iringa, Tanzania Research Brief

This elevated HIV prevalence is not fully understood, and the response to HIV in Iringa has been insufficient to match the need. The Iringa strategic assessment was designed to inform the development of comprehensive HIV prevention interventions that respond to key factors linked to HIV-related risk in Iringa, Tanzania. Descriptive statistics from the 2007/8 Tanzania HIV/AIDS and Malaria Indicator Survey (THMIS) and other sources provide a preliminary starting point for understanding HIV risk in Iringa. However, to date, there has not been a comprehensive analysis of these data beyond descriptive statistics that examine risk factors for HIV in Iringa and the rest of Tanzania. This study performs robust statistical analyses using the 2007/8 THMIS data, including multivariate logistic regression, to examine the drivers of HIV in Iringa, Tanzania. The study used data from the 2007/2008 THMIS to assess risk factors for HIV infection in the Iringa region relative to the rest of Tanzania. The THMIS survey utilizes a conventional two-stage cluster sample representative of both urban and rural areas at the national level. In the first stage, 120 clusters of households were identified, and an average of 25 households were then randomly sampled from each cluster, resulting in an overall sample of approximately 3,000 households. The study found that HIV prevalence in the Iringa region is almost twice as high in urban areas (30%) relative to rural areas (16%) and is also higher among women (18%) relative to men (12%). Estimates from the 2007/8 THMIS showed that HIV prevalence in the region among youth ages 15-24 years was twice as high in young women compared to young men (8.2% vs. 4.8%). When examining modes of transmission in the Iringa region, 85% of HIV transmission occurs through heterosexual contact and only 6% is attributed to mother-to-child transmission of HIV. The study also found that higher levels of risk factors and lower levels of protective factors exist in the Iringa region relative to other regions. For example, the prevalence of HIV knowledge as measured by the THMIS is lower in Iringa for women (18.7%) and men (32.4%) compared to the national prevalence of 39.6% and 44.3%, respectively. Migration and mobility are also common in the region, and recent data triangulation efforts indicate that mobility may play an important role in the region's high prevalence. The majority (61.4%) of men and women in Iringa reported traveling in the past year, and among those who had traveled, slightly over one-third (37%) spent more than a month away from home. Other factors such as low prevalence of male circumcision, late initiation of HIV-infected individuals into clinical care and antiretroviral therapy (ART), and structural vulnerabilities for young women and girls also appear to contribute to ongoing HIV transmission. Only 30% of men in Iringa report being circumcised, compared to 67% of men nationally. The percentages of adults ever tested for HIV in Iringa are 51.8% of women and 34.1% of men, compared to 40.9% of women and 29.2% of men nationally. Although HIV care and treatment data are not available for Iringa specifically, in Tanzania, an estimated 22% of those eligible for ART are receiving it. The study's findings provide a better understanding of the reasons behind the high HIV prevalence in the Iringa region and help to identify and tailor an appropriate set of interventions to address it. The results can be used to inform the development of more effective HIV prevention programs in this region.