UN Integrated Regional Information Networks - December 2, 2008

"It's a normal thing when you are away from home, doing hard work all day," Lusago, 25, told IRIN/PlusNews. "In the village, women don't have money or jobs so it's necessary to give them 1,000 shillings [US$0.80] after sex."

His story is by no means unique and may help explain why Iringa, which has a thinly spread population of 1.7 million in an area about twice the size of Belgium, has been particularly hard hit by the AIDS epidemic.

According to a study by the Tanzania Commission for AIDS (TACAIDS) released earlier in 2008, HIV prevalence in Iringa rose from 13.4 percent in 2003 to 14.7 percent in 2007, more than double the national prevalence of 6.2 percent.

In these fertile southern highlands, agriculture and timber production have contributed to an economic boom that is good news for job creation in a country where one-third of the people live on less than one US dollar a day, but bad news for the spread of HIV.

The busy Tanzam Highway, running for almost 1,000km from the commercial capital, Dar es Salaam, across the country to Tanzania's southern neighbours, Malawi and Zambia, cuts through Iringa, bringing a steady stream of relatively well-off truckers.

It is the truckers and seasonal farm workers like Lusago who keep the sex trade active and contribute to the escalating rate of HIV infections. "Sex is almost a commodity in this culture - widely available and not viewed as risky," said Ezekiel Mpuya, the region's medical officer.

He added that the temporary settlement of lumberjacks and farm workers in the area had created a major bridge for HIV transmission. "A micro-level industry has grown around them, with mainly women selling everything from groceries and alcohol to sex."

According to local HIV experts, a number of other risk factors collide in Iringa: polygamy is rife among members of the local Wahehe, Wabena and Wakinga ethnic communities, and it is common practice for widows to be "inherited" by relatives of their dead husbands.

Gosbert Buberwa, a senior technical officer with the US-funded Tunajali Care and Treatment Programme, said rural communities had been largely neglected by AIDS programmes. "We are concentrated on the easy-to-reach areas in towns and central places, but we haven't gone in deep."

The high mobility of many local people made their task even more difficult. "With so many pastoralists, migratory workers and fisherman - they keep moving around - you register someone for care today and you lose them the next."

Getting condoms, AIDS tests, life-prolonging antiretroviral drugs and the safe sex message to the cut off corners of this sparsely populated and mountainous region also presents a challenge said Buberwa. Health centres are few and far between; in some rural areas the closest clinic is a day-long trip by foot and bus.

Need for more HIV programming

Having woken up to the scale of the AIDS problem in Iringa, the government is in the final stages of drafting a five-year plan to tackle the crisis. "It's not enough for leaders to just say 'AIDS is dangerous' anymore," Mpuya said. "We need a better strategy."

Funding has been made available to ensure that a comprehensive programme is rolled out, but there is a need for better coordination and more resources for prevention efforts.

Private enterprises have also realised the danger the epidemic poses to their profits. Unilever Tea Tanzania, which produces 40 percent of the country's tea output, runs a hospital and clinics for its 6,000 seasonal labourers and their families to keep its workforce healthy.

With financial help from the Global Fund and the US President's Emergency Plan for AIDS Relief (PEPFAR), the company also educates workers on how to prevent HIV and provides counselling, testing and treatment.

A chat with local truckers suggests that prevention messages are beginning to be heard. Egbert Mahali, in the truck-stop town of Ilula, on the outskirts of Iringa, is repairing the engine of his truck, which is carrying sulphur to Zambia.

"If my truck isn't fixed by midnight I'll sleep in the cab so I won't be tempted to drink and convinced by women," he told IRIN/PlusNews. "A lot of people in my profession are wise these days; they see their friends die and decide to sleep alone."

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