1	Life and HIV in East Africa Summer 2005 Dr. John Kowalczyk University of Minnesota Duluth
2	Swahali Language
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5	Arusha, Tanzania
6	Tanzanian Demographics There are 192 countries in the world…….. Tanzania is the 5^th poorest country in the entire world!! Average life expectancy of local people is 40 years of age, comparable to 78 years of age for USA Average median income is only $200 per year!!
7	History of Tanzania Formerly known as Tanganyika 1961 gained independence from UK- British rule for 40 years 1964 revolution with Zanzibar (Unguja) as it was its own country Eventually “annexed” with the mainland “Tan”= Tanganyika “Zan”= Zanzibar Tan + Zan + “ia” = Tanzania
8	Tanzania Demographics- cont’d Population of country is 34.6 million Approximately 10 % of population is HIV infected Over 800,000 reported cases to date but most don’t get reported HIV prevalence higher in urban areas (12%) and only 4% in rural areas 1.1 million children are orphans from one or both parents dead from AIDS
9	Africa is Diversity of Life!
10	Africa is the people…..
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18	Africa is the natural beauty…
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40	Africa is the poverty and simplicity…
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53	The Project with Global Service Corps…
54	Global Service Corps An NGO (non-government organization) based out of San Francisco, California Founded by Richard Lathrup, Executive Director In existence for 10 years in Tanzania; sister program also in Thailand
55	Global Service Corps- cont’d Volunteers serve short term- 4-6 weeks or long term up to six months Work in Arusha, Tanzania with HIV education program Programs also in Sustainable Agriculture (farming) and a new initiative in HIV & Nutrition (2005)
56	Local Staff & Volunteers
57	GSC Programs in Tanzania HIV Day Camp 3 week summer camp to teach secondary school peer educators about HIV prevention 200 teenagers participate in program
58	GSC Programs Cont’d HIV Prevention Education Work with community groups 4 day, 16 hour program HIV prevention, transmission, HIV biology, condom use, myths
59	Dr. Kowalczyk’s Work in Tanzania HIV Prevention & Health Education HIV & Nutrition Development and Training Job shadowing with local medical doctors in hospital and clinic- preventive medicine & patient care
60	HIV Statistics & Research 20 million people worldwide have died of AIDS so far! 40 million people currently living with HIV/AIDS worldwide! 95% PLWHA reside in low income (Third World) countries! HIV leading cause of death worldwide among ages 15-59! Worldwide, most people living with HIV are unaware of their HIV status!
61	HIV in Tanzania & East Africa Sub-Sahara Africa- 30 million PLWHA This is 10% of their population compared to only .6% of American population PLWHA 58% of HIV+ infections are women 87% HIV transmission is heterosexual; 6% mother to child transmission Majority HIV+ cases are 25-34 year old category People do not believe in condom usage!
62	Cultural Myths that Contribute to HIV in Tanzania When a woman’s husband dies, deceased husband’s brother ‘inherits’ the widow & children. Brother-in-law required to have sex with his sister-in-law (widow) within 4-5 days after funeral to ward off evil omens in the house! An HIV+ man can be cured of AIDS. He only has to have sex with a virgin girl, the younger the better! Men don’t believe in condoms- they are “infected” with the virus or holes poked in by Western manufacturers! If a woman does not produce children within 3 years of the marriage, the man can divorce his wife and go find another woman to produce offspring! If a man pays a big dowry to woman’s family, man has full power and control over his wife! Polygamy is still recognized and practiced in Tanzania, particularly among the Muslims Huge stigma about HIV status; therefore people don’t get tested because they don’t want to know! Woman cannot refuse sex with her husband, even if she suspects unfaithfulness or STDs! Women’s role is to work and produce babies- sex is ‘work’ and not for pleasure!
63	HIV Prevention Education Transmission of HIV virus ABCs of Prevention Immune System and Biology Prevention of infection Condom Demonstration Myths & Gender roles HIV & Nutrition
64	HIV Prevention Education-cont’d Format is 4 days, 16 hrs Interactive, demonstrations, group discussions, role play Feed participants lunch each day! Award/certificate ceremony on last day People have NO concept of time in showing up!
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66	HIV & Nutrition Program New initiative GSC started in Summer 2005 with Dr. Kowalczyk developing a HIV & Nutrition Program A 3-day ‘train the trainer’ program was conducted to 17 GSC volunteers and local community workers who in turn then went out into the community to put on HIV-Nutrition classes Premise developed from WHO & UN research showing that the only affordable way to extend ‘quality’ of life for HIV+ people is through a better nutrition program, as ARVs are too expensive and not readily available to the general population
67	HIV & Nutrition Program- cont’d Research materials from U.S. Aid (FANTA- Food and Nutrition Technical Assistance Project), World Food Programme (WHO), and other agencies were used to develop this program for GSC Theme I developed was “Chakula ni Dawa”- Food is Medicine Originates from Hippocrates’ famous quote: “Let thy food be thy medicine, and let thy medicine be thy food” Therefore→ “Food is First Medicine for AIDS”
68	Food is First Medicine for AIDS Research is clear: HIV families must have good nutrition to delay symptoms and to live longer Good nutrition improves immune system Half of all Africans who die of AIDS die from starvation! For many African HIV patients, FOOD is ONLY medicine for their survival!
69	Tanzanian Diet Malnutrition and malabsorption big problems with PLWHA Diet heavy in Carbohydrates- rice, ugali (corn meal), pasta, plantains, cassava, white bread Diet average in Protein- peanut butter, beans, ground nuts Diet poor in Fats (too poor to buy meat)- goat, chicken, some beef Diet practically non-existent in vitamins and minerals, yet greatest source of fruits and vegetables are in abundance!!
70	Special Eating Needs for PLWHA Immune Enhancement Diet- (Dr. J. Kaiser: ‘Healing HIV- How to Rebuild Immune System; 1999) Eat nutritious breakfast everyday Increase consumption of vegetables and fruits Increase consumption of whole grains Get abundant protein in diet Limit dairy consumption to 10% of diet Micronutrient Deficiencies in TZ Vitamin A- 2,000-4,000 children go blind every year from vit A deficiency! Iron deficiency anemia- most widespread nutritional disorder; 32% population with 45% of children and 85% pregnant women Iodine deficiency disorder- single most preventable cause of intellectual impairment in the world! Goiter/thyroid disease in women
71	Coping with Complications of HIV/AIDS Lack of appetite Sores in mouth; loss of taste buds Diarrhea Nausea or vomiting Fever, influenza-like symptoms Body wasting/body weight loss
72	Nutrition Training Nutrition teaching pedagogy Nutrient-based messages Community-based education Active learning Cooking demonstrations, free food samples, etc.
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75	Health Care in Tanzania “Health-seeking behavior is not common in Africa” Top 10 most common diseases in Tanzania (1997) Malaria Upper respiratory Diarrhea Eye diseases Pneumonia Skin diseases Intestinal worms Anemia Accidents HIV
76	Health & Medical Care in Tanzania Number one leading cause of death in Tanzania is Malaria! Number two leading cause of death is AIDS In top 10 most common diseases, 8 are infectious type Cancer and heart disease are unheard of in Tanzania! Some hypertension and diabetes just starting to be reported and recognized Prevention & education badly needed for malaria control There is no such thing as routine physical exams or preventive health maintenance- everything is crisis situations with health care. People do not have health insurance
77	Local Life & Culture
78	Local Life and Culture
79	Africa is the beauty of Life
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93	Is there Hope for the African Future? Senior citizen population in Tanzania is only 1% of overall population, compared to >33% of American population! Where and what will be the next Generation of Tanzania? Once people are infected with HIV virus, AIDS comes in about 7 years! In US, an HIV person will be HIV+ for 15-20 yrs before AIDS kicks in! Women need to be empowered to take more control in their sexual relationship This will take time → this is a Major shift !!
94	Only time will tell for the African nation of Tanzania…..
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