Tanzania Caitlin Kennedy
MSPH Program, Department of International Health, JHSPH
In the Iringa Region of Tanzania, HIV prevalence is estimated at over 16% of the adult population, which is more than three times the national average. This region also has one of the lowest male circumcision rates in the country. Male circumcision has been shown to reduce a man's risk of heterosexual HIV acquisition by up to 60%, and the government of Tanzania has recently initiated a program to circumcise men in the region. As male circumcision is promoted as an HIV prevention strategy, concern exists that nen may increase sexual risk behaviors because they believe they are less likely to acquire HIV. This could potentially decrease the impact of the intervention, since men are not fully protected and women do not receive any direct protection against HIV if their male partner is circumcised. This research will use qualitative methods to evaluate the behavioral impact of male circumcision in Iringa, Tanzania. Semi-structured interviews will be conducted with circucised men and their female partners in order to obtain an in-depth understanding of how male circumcision is perceived within the Tanzanian context, and if behavior has changed as a result of these perceptions. Results from this research will be used to provide recommendations for locally-appropriate inteeventions to increase correct knowledge about the benefits and risks of male circumcision, thereby reducing the threat of increased risk behavior.
I arrived in Dar es Salaam, Tanzania in August 2011, eager to begin my research project and eager to settle in to my new home for the next ten months. Before leaving Dar es Salaam to travel to my field site in Iringa, I visited the National Institute for Medical Research (NIMR) to check on the status of my application. I had submitted an application for ethical approval two months before and had been in contact with multiple people from NIMR in the weeks leading up to my arrival. I had been told that my application had been received, was reviewed in late July and that I could come to collect the reviewer comments when I arrived in August. However, upon arrival, I was told that they had never heard of me and that they had never received my application, despite what I had been told over the phone. Frustrated, I realized that all of my planning ahead in order to be able to start the project in August was futile. I would spend the next four months waiting for the approval that I needed to actually begin my research.
During my time in Tanzania, I learned many valuable lessons. The most important, and perhaps the most practical for conducting research in a developing country, is to be flexible and patient. Things do not often happen on time. Ethical approval can be delayed by four months. People often show up for meetings hours late, if at all. Buses break down on the side of the road, delaying travel for several hours. Trains are regularly delayed by days at a time. Fortunately, I was able to stay in Tanzania for ten months and was able to wait for things to happen at their own pace. Looking back, I am grateful for the delay in receiving ethical approval because I was able to spend time getting to know Iringa, learning Swahili and developing and conducting an intensive training on qualitative research methods. When final IRB approval was granted, I was proficient in Swahili, had made contact with dozens of recruitment sites and had a team of four very qualified and talented research assistants who were eager to begin the project. One of the most rewarding aspects of my project was my interaction with my research assistants. Coming to Tanzania I did not know what to expect or who I would hire to collect data for my project. However, I was pleasantly surprised to receive over 50 applications for the job. In fact, the most challenging aspect of selecting research assistants was choosing four among many very qualified candidates. I believe that these four dedicated women were most of the reason for the project’s success. Not only were they very eager to learn about qualitative research and HIV prevention, but they understood the local area, had contacts with many local government leaders and community-based organizations and were willing to work long, hard hours to complete the project. Because of their self-motivation, I was able to leave most of the participant recruitment and bureaucratic aspects of the project to my research assistants, which gave me the opportunity to focus on providing mentoring and feedback on all of the interviews and focus groups. Because of their motivation and dedication to the project, we collected more data than I had anticipated which provided us with a wealth of information. Conducting this research on women’s needs in male circumcision programs has given me a great appreciation for the importance of formative research and a thorough understanding of community perceptions in public health programs. Furthermore, this project has shown me the impact that applied research can have on people’s lives. I came into the project with no research experience and unsure of whether I would be able to complete all aspects of the project. Now, ten months later, I have worked through multiple bureaucratic processes, trained and mentored research assistants, coordinated over 50 in-depth interviews and focus group discussions, analyzed data and developed manuscripts and conference abstracts. This experience has been very empowering and given me the confidence to consider a career in HIV prevention research and I am very grateful for the opportunity.
 | Men and boys waiting to be circumcised at a clinic in Makambako, Tanzania |  | Community meeting to discuss research project in Ilula, Tanzania |  | Erica Layer conducting an interview with a woman in a rural village |  | Male circumcision campaign billboard in Iringa, Tanzania with slogan “Dondosha Mkonosweta” (Kiswahili for “Drop your sweater sleeve”) |  | Women walking home from the market in a rural village |
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