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Urbanization in low and middle-income nations is characterized by economic and demographic shifts largely understood to be beneficial to women’s empowerment. These changes include increased education and wage-labor opportunities, a disruption of traditional patrilocal residence systems, and reductions in spousal age gap and fertility. However, such changes may drive a “violence backlash,” with men increasing intimate partner violence (IPV) in efforts to challenge women’s shifting status. To date, tests of this idea primarily relate to women’s changing economic status, with less known about the demographic correlates of IPV in urbanizing settings. Addressing this, we conducted a cross-sectional study of IPV behavior and attitudes in an urbanizing community in Mwanza, northern Tanzania ( n = 317). Consistent with a violence backlash, IPV was reported more often among women educated at higher levels than their husband, and women earning similar, rather than lower, wages to their husband were more likely to report that he condones IPV. These findings were independent of women’s absolute education and income. Furthermore, less frequent paternal kin contact, and relatively small spousal age gaps, generally understood to boost women’s empowerment, were associated with an increased risk of experiencing IPV. Less frequent paternal kin contact was also associated with an increased likelihood that a husband condones IPV. Contrary to our predictions, relatively lower fertility, generally linked to higher women’s empowerment, did not predict IPV behavior and women with high, rather than low, fertility were more likely to report that their husband condones IPV. Overall, our results support the notion of a violence backlash corresponding to economic changes for women that accompany urbanization. In contrast, demographic changes associated with urbanization have more variable relationships. Drawing on these results, we suggest future research avenues for better understanding the vulnerability of women to IPV in urbanizing settings.

Achieving gender equality fundamentally requires a transfer of power from men to women. Yet data on men's support for women's empowerment (WE) remains scant and limited by reliance on self-report methodologies. Here, we examine men's support for WE as a sexual conflict trait, both via direct surveys (n = 590) and indirectly by asking men's wives (n = 317) to speculate on their husband's views. Data come from a semi-urban community in Mwanza, Tanzania. Consistent with reduced resource competition and increased exposure to relatively egalitarian gender norms, higher socioeconomic status predicted greater support for WE. However, potential demographic indicators of sexual conflict (high fertility, polygyny, large spousal age gap) were largely unrelated to men's support for WE. Contrasting self- and wife-reported measures suggests that men frequently exaggerate their support for women in self-reported attitudes. Discrepancies were especially pronounced among men claiming the highest support for WE, but smallest among men who held a professional occupation and whose wife participated in wage labour, indicating that these factors predict genuine support for WE. We discuss the implications of these results for our understanding of both individual variation and patriarchal gender norms, emphasising the benefits of greater exchange between the evolutionary human sciences and global health research on these themes.

In Tanzania, unmet need for contraception is high, particularly in the postpartum period. Contraceptive counseling during routine antenatal HIV testing could reach 97 percent of pregnant women with much-needed information, but requires an understanding of postpartum contraceptive use and its relationship to antenatal intentions. We conducted a baseline survey of reproductive behavior among 5,284 antenatal clients in Northern Tanzania, followed by an intervention offering contraceptive counseling to half the respondents. A follow-up survey at 6-15 months postpartum examined patterns and determinants of postpartum contraceptive use, assessed their correspondence with antenatal intentions, and evaluated the impact of the intervention. Despite high loss to follow-up, our findings indicate that condoms and hormonal methods had particular and distinct roles in the postpartum period, based on understandings of postpartum fertility. Antenatal intentions were poor predictors of postpartum reproductive behavior. Antenatal counseling had an effect on postpartum contraceptive intentions, but not on use. Different antenatal/contraceptive service integration models should be tested to determine how and when antenatal counseling can be most effective.

To examine reproductive and contraceptive history and intentions by HIV status among women at antenatal clinics to help inform initiatives to integrate family planning into antenatal/preventing mother-to-child transmission services in Mwanza region, Tanzania.A questionnaire survey was carried out in antenatal clinics in Mwanza region, Tanzania in 2007-2008.: We interviewed 5284 pregnant women attending 15 antenatal clinics offering HIV testing in Mwanza City and Magu district, northern Tanzania. The questionnaires asked about reproductive and contraceptive history and intentions, and sexual behaviour. Subject to participants' consent, we collected blood to determine HIV status and linked these results to the questionnaire data through individual numbers.HIV prevalence was 8.9% overall, and family planning ever use was 26%. HIV-positive and HIV-negative women differed with respect to age, parity, length of last birth interval, child survival, childbearing intentions and intention to breastfeed. HIV-positive women were more likely to have used family planning, particularly hormonal methods. Patterns of family planning use and unmet need for contraception yielded useful information for the design of family planning counselling services at antenatal clinics.Our survey findings point to numerous potential benefits of offering family planning counselling as a part of antenatal services, particularly in clinics offering HIV testing. The differences in reproductive history and intentions between HIV-positive and HIV-negative women highlight the necessity of tailoring family planning counselling to their specific needs.

Objectives: To assess the feasibility of collecting sexual behaviour data during HIV surveillance in antenatal care (ANC) clinics, and to establish whether these data can provide information about the correlates of HIV infection in this population. Methods: Sexual behaviour surveys were conducted in the context of two HIV sentinel surveillance rounds in 11 ANC clinics in north west Tanzania between 2000 and 2002. Responses of individual women were anonymously linked to their HIV status. Three clinic catchment areas overlapped with a community based longitudinal study, which provided independent estimates of HIV prevalence and sexual behaviour. Changes between rounds and differentials between clinics were assessed and a two level logistic regression model used to identify behavioural and contextual correlates of HIV in 3689 women under 25 years of age. Results: Women attending clinics were willing to participate in the study. The sexual behaviour data obtained were internally consistent and tallied reasonably well with sexual behaviour data collected in the community overlapping the clinic catchment. Clear relations emerged between HIV infection and measures of sexual exposure: OR 1.20 (95% CL 1.12 to 1.28) for each year of premarital exposure and 1.09 (1.04 to 1.16) for each year after first marriage; background prevalence OR 1.15 (1.04 to 1.26) associated with each percentage point increase in background prevalence at the clinic; and certain partnership variables such as partner’s age OR 0.58 (0.45 to 0.76) if partner less than 10 years older. Conclusion: Conducting sexual behaviour surveys in the context of ANC clinics surveillance is feasible and yields useful data.

BACKGROUND: Verbal autopsy is currently the only option for obtaining cause of death information in most populations with a widespread HIV/AIDS epidemic. METHODS: With the use of a data-driven algorithm, a set of criteria for classifying AIDS mortality was trained. Data from two longitudinal community studies in Tanzania and Zimbabwe were used, both of which have collected information on the HIV status of the population over a prolonged period and maintained a demographic surveillance system that collects information on cause of death through verbal autopsy. The algorithm was then tested in different times (two phases of the Zimbabwe study) and different places (Tanzania and Zimbabwe). RESULTS: The trained algorithm, including nine signs and symptoms, performed consistently based on sensitivity and specificity on verbal autopsy data for deaths in 15-44-year-olds from Zimbabwe phase I (sensitivity 79%; specificity 79%), phase II (sensitivity 83%; specificity 75%) and Tanzania (sensitivity 75%; specificity 74%) studies. The sensitivity dropped markedly for classifying deaths in 45-59-year-olds. CONCLUSIONS: Verbal autopsy can consistently measure AIDS mortality with a set of nine criteria. Surveillance should focus on deaths that occur in the 15-44-year age group for which the method performs reliably. Addition of a handful of questions related to opportunistic infections would enable other widely used verbal autopsy tools to apply this validated method in areas for which HIV testing and hospital records are unavailable or incomplete.

Background: Persons with absent partners may be more vulnerable to risky sexual behavior and therefore HIV. Partner absence can be due to traveling (e.g., family visits or funerals) or to living apart (e.g., work-related or in polygamous marriages). We investigated to what extent partner absence leads to more risky sexual behavior in Tanzanian couples. Methods: We compared 95 men and 85 women living apart with 283 men and 331 women living together. Only persons who were still married were included, either living apart or cohabiting at the time of the interview. Subjects were classified into 4 groups: coresidents being either nonmobile or mobile, and people living apart either frequently or infrequently seeing each other. Results: Most people living apart were polygamously married. Men living apart did not report more extramarital sex than coresident men. However, among coresident men, extramarital sex was reported by 35 % of those being mobile compared with 15 % of those nonmobile. Among women, those living apart reported extramarital sex more often than coresidents (14% vs. 7%), and this was mainly due to women living apart who infrequently saw their husbands. Conclusions: Risky sexual behavior occurs more often in mobile coresident men, and in women living apart infrequently seeing their spouses. These groups are relatively easy to identify and need extra attention in HIV prevention campaigns.

Background Sentinel surveillance for HIV in ante-natal clinics (ANC) remains the primary method for collecting timely trend data on HIV prevalence in most of sub-Saharan Africa. We describe prevalence of HIV and syphilis infection and trends over time in HIV prevalence among women attending ante-natal clinics (ANC) in Magu district and Mwanza city, part of Mwanza region in Northern Tanzania. HIV prevalence from ANC surveys in 2000 and 2002 was 10.5% and 10.8% respectively. In previous rounds urban residence, residential mobility, the length of time sexually active before marriage, time since marriage and age of the partner were associated with HIV infection. Methods A third round of HIV sentinel surveillance was conducted at ante-natal clinics in Mwanza region, Tanzania during 2006. We interviewed women attending 27 ante-natal clinics. In 15 clinics we also anonymously tested women for syphilis and HIV infection and linked these results to the questionnaire data. Results HIV prevalence was 7.6% overall in 2006 and 7.4% at the 11 clinics used in previous rounds. Geographical variations in HIV prevalence, apparent in previous rounds, have largely disappeared but syphilis prevalence is still higher in rural clinics. HIV prevalence has declined in urban clinics and is stable in rural clinics. The correlates of HIV infection have changed over time. In this round older age, lower gravidity, remarriage, duration of marriage, sexual activity before marriage, long interval between last birth and pregnancy and child death were all associated with infection. Conclusions HIV prevalence trends concur with results from a community-based cohort in the region. Correlates of HIV infection have also changed and more proximate, individual level factors are now more important, in line with the changing epidemiology of infection in this population.

Background Despite the introduction of free antiretroviral therapy (ART), the use of voluntary counselling and testing (VCT) services remains persistently low in many African countries. This study investigates how prior experience of HIV and VCT, and knowledge about HIV and ART influence VCT use in rural Tanzania. Methods In 2006–7, VCT was offered to study participants during the fifth survey round of an HIV community cohort study that includes HIV testing for research purposes without results disclosure, and a questionnaire covering knowledge, attitudes and practices around HIV infection and HIV services. Categorical variables were created for HIV knowledge and ART knowledge, with “good” HIV and ART knowledge defined as correctly answering at least 4/6 and 5/7 questions about HIV and ART respectively. Experience of HIV was defined as knowing people living with HIV, or having died from AIDS. Logistic regression methods were used to assess how HIV and ART knowledge, and prior experiences of HIV and VCT were associated with VCT uptake, with adjustment for HIV status and socio-demographic confounders. Results 2,695/3,886 (69%) men and 2,708/5,575 women (49%) had “good” HIV knowledge, while 613/3,886 (16%) men and 585/5575 (10%) women had “good” ART knowledge. Misconceptions about HIV transmission were common, including through kissing (55% of women, 43% of men), or mosquito bites (42% of women, 34% of men). 19% of men and 16% of women used VCT during the survey. After controlling for HIV status and socio-demographic factors, the odds of VCT use were lower among those with poor HIV knowledge (aOR = 0.5; p = 0.01 for men and aOR = 0.6; p Conclusions Two years after the introduction of free ART in this setting, misconceptions regarding HIV transmission remain rife and knowledge regarding treatment is worryingly poor, especially among women and HIV-positive people. Further HIV-related information, education and communication activities are urgently needed to improve VCT uptake in rural Tanzania.