HIV prevalence here has remained below one percent for three decades, and some recent studies (DHS- 2016/2017), suggest that the prevalence has gone further down to less than 0.4 percent.
Thanks to multiple interventions to control the spread of the disease.
The interventions include increased public awareness; voluntary testing and treatment (ARV), prevention of mother to child transmission; and promoting ABC: Abstinence from sex before marriage, Be faithful to partner or marriage, and or use a condom.
Approaches in the Anti HIV campaigns have been effective but advocating for the use of condom for safe sex has not picked up, as it remains a taboo to speak or talk about the ‘device’ in public and also still rejected by many retail pharmacy shops.
Health experts here would love to see condoms sold in most shops particularly the OTCs, pharmacies and in clinics and also easily accessible in pubs, leisure centres, and in all hotels, but it is unfortunate that it is still difficult to find condoms being sold .
Ms Tatu Juma (not her real name), engaging in commercial sex says that she has on several occasions had difficulties in purchasing condoms.
“Recently I had a man who preferred to use it. I hunted for the condom without finding any in all the shops in some streets of Zanzibar town.”
Anonymous man, a guest from abroad who visited Pemba Island recently also mentioned that finding a condom to buy was a challenge as health experts insist that condoms are important in the protection of HIV and Sexual Transmitted Infections (STIs).
There have been complains about lack of condoms in both Pemba and Unguja, prompting researchers from the Zanzibar Aids Commission (ZAC), to investigate to find out the level of the problem in accessing condoms they believe it is important in war against the spread of HIV.
According to researcher Mr Gharib Said Gharib- monitoring & evaluation officer, ZAC the study conducted last October had main objectives to determine the extent to which male and female condoms are accessible in Zanzibar; and to determine the barriers to obtain male or female condoms.
Other objectives were to identify the reasons which make people in Zanzibar to use or not use the condoms; to understand community attitudes and perceptions towards condoms; and to determine how condom accessibility might be improved.
He said that the condom study covered all the 11 districts of Zanzibar islands. In Unguja the study took place in the districts of: Mjini, Magharibi A, Magharibi B, Kusini, Kati, Kaskazini A and Kaskazini B, while in Pemba the study targeted districts of: Chakechake, Mkoani, Wete and Micheweni.
The findings from the 425 people interviewed including Health facility staffs, peer educators, People Living with HIV (PLHIV), and Key Persons-KPs (drug users, commercial sex workers), said that condoms are easy to access in their communities.
Groups such as fishermen, Out of School (OoS), youth, women and men in the general population were with the views that condoms are to-some-extent accessible while most workers in informal sector, people with disability (PWD), youth in Higher Learning Institutions (HLIs), hotels staff, and people in rural areas reported low access to condoms.
Mr Gharib said “Barriers to obtaining and using condoms include Socio-cultural and religious restrictions which forbid people from using condoms; Ignorance on where to obtain and how to use condoms; long distance and challenges to reach condom distribution outlets for rural based populations; and absence of privacy and confidentiality at some condom distribution outlets.”
It is said that even health workers have the feelings that selling or distributing condoms is prohibited by religion and is a sin, therefore they become reluctant to store, distribute, or sale the condoms to the people who need it.
Asked why he does not sale condoms, Mr Khatib Othman, the OTC (Over-The-Counter), shopkeeper replied, “I am not interested because displaying and selling condoms encourages fornication prohibited by my religion.”
There are many OTC and pharmacy operators who have the perception like that of Othman, but health officers are asking them to change their mindset because selling or distributing condoms is not meant to promote fornication .
According to the quantitative study some members of the community also had the perception that condoms reduce “enjoyment and satisfaction in sexual intercourse; have various side effects during and after sex; pollute the environment when carelessly disposed of after usage; and give a false sense of security because they tend to burst or leak during sexual intercourse.
Due to low use of condoms, ZAC has launched a five years program to promote condom use because it is important in the campaign to reduce or control the spread of HIV particularly among the youth, and KPs.
“We appeal to NGOs and media to help us promote use of condoms while observing ethics. Since people are not comfortable to talk about condom in public, find acceptable ways to promote it.
Give the condom alternative name and encourage the use of it,” said Mr Saadat Iddi-Head of the advocacy, ZAC. He said condoms cannot be ignored because it has been effective in minimizing the spread of HIV and STIs, and unplanned pregnancy, and it is affordable to the majority who want to use.
Mr Iddi said that while in general population the prevalence is below one percent, it is high in KPs for example Drug users (syringe), is 11.3 percent; same sex is 2.6 percent; and commercial sex workers (women), is 19.3 percent, necessitating the need for condom use.
He said that there is evidence through research prove that use of condom is effective and should be promoted at this era of young people engaging in sex before marriage, and as a results they get underage pregnancy and STIs.
Mr Idd said that the Zanzibar AIDs Control Program (ZACP), in collaboration with Medicos del Mundo (MDM), started condoms promotion program in 2000 by distributing in health centres and to specific areas like bars and guest houses during outreach programs.
The advocacy officer says that the acceptance of condoms in the population including among religious clerics has been growing, but there is need to grow higher specifically the use among both the young people and couples or partners. “Use of condoms is beyond remaining safe from contracting HIV and STIs.
It is important in family planning,” he said adding that ZAC wants to see that condoms are available in all health centres, and pharmacies, and also that people in bars and fishing camps (Dago), do not have the difficulty in accessing the condom either by buying or free.
ZAC commissioner Ms Hasima Hamad throws the challenge to journalists asking them to use their communication skills to promote condoms with the focus of ‘talking’ widely, using acceptable language, about the advantages of condoms.
Studies also have shown that children between the age of ten and 19 years engage in sex while 65 percent of high school students practice sexual intercourse, and one in five sexually active teens will have had four or more sexual partners; this is why heath experts propose that students need to know the importance of safe sex practices.
However, the education policy strictly prohibits promoting condom in primary and secondary schools; because students at that stage are required to concentrate on studies only and that the consequences of encouraging condom use among young people may be regrettable.
Parents like Mr Haji Kombo are also against promoting condoms among students because they believe it is a wrong age to learn about sex. But studies have proved that many children starting at the age of ten onwards practice sex.
Some political leaders also feel that promoting condoms in public or national media may decay the fabric of social culture and lead to loose moral norms, therefore remain reluctant to talk about it.
International Condom Day (ICD), is observed on February 13 to raise awareness about safe sex, and this year’s Day (2019), advocates the use of condoms to prevent Sexually Transmitted Diseases (STDs), including HIV and unwanted pregnancies.
This year’s international condom day theme is about Safe Sex Practice which main aim is to reduce the spread of HIV through safe sex practices although many do not like the use of condoms, international condom day tries to place condoms as a healthy lifestyle choice.