Lugalla Joe, Emmelin Maria, Mutembei Aldin, Sima Mwiru, Kwesigabo Gideon, Killewo Japhet, Dahlgren Lars
Department of Anthropology, University of New Hampshire, 316 Huddleston Hall, Durham, NH 03824, USA.
Soc Sci Med. 2004 Jul;59(1):185-98. doi: 10.1016/j.socscimed.2003.10.033.
This paper is a follow-up of earlier findings by the Kagera AIDS Research Project (KARP), which documented declining trends in the prevalence and incidence of HIV infection in the Kagera region of Tanzania. The paper examines socio-cultural and sexual behavioral changes as possible determinants of the observed declining trends in Bukoba, the largest urban area of the region. The study used in-depth interviews, focus group discussions, field observations and ethnographic assessments to collect the required data. The findings suggest that since the initial years of the epidemic there have been significant changes in sexual behaviors, norms, values, and customs that are considered high-risk for HIV transmission. The findings show an increase in condom use, abstinence, zero grazing (sticking to one sexual partner) and uptake of voluntary HIV testing while traditional practices such as polygamy, widow inheritance, excessive alcohol consumption, and sexual networking are declining. We suggest that these changes are partly a result of the severity of the epidemic itself in the study area, and interventions that have been carried out in this area since 1987. The major interventions have included health education, the distribution of condoms, AIDS education in schools, voluntary HIV counseling and testing. These are encouraging findings that give hope and we believe that other places within Tanzania and other countries experiencing a severe AIDS crisis have much to learn from this experience. However, changes in norms and behavior are vulnerable; people in Kagera are still at risk and there is a need for continued intervention together with monitoring of the direction of the epidemic.
本文是对卡盖拉艾滋病研究项目（KARP）早期研究结果的跟进，该项目记录了坦桑尼亚卡盖拉地区艾滋病毒感染率和发病率呈下降趋势。本文考察了社会文化和性行为变化，将其作为该地区最大城市布科巴观察到的下降趋势的可能决定因素。该研究采用深入访谈、焦点小组讨论、实地观察和人种学评估来收集所需数据。研究结果表明，自疫情初期以来，被认为存在艾滋病毒传播高风险的性行为、规范、价值观和习俗发生了重大变化。研究结果显示，避孕套使用、禁欲、“零放牧”（坚持单一性伴侣）以及自愿接受艾滋病毒检测的情况有所增加，而一夫多妻制、寡妇继承、过度饮酒和性网络等传统习俗则在减少。我们认为，这些变化部分是由于研究地区疫情本身的严重程度，以及自1987年以来在该地区开展的干预措施所致。主要干预措施包括健康教育、避孕套发放、学校艾滋病教育、自愿艾滋病毒咨询和检测。这些都是令人鼓舞的发现，带来了希望，我们相信坦桑尼亚其他地区以及其他经历严重艾滋病危机的国家可以从这一经验中学到很多。然而，规范和行为的变化很脆弱；卡盖拉的人们仍然面临风险，需要持续进行干预并监测疫情的发展方向。
