Population growth and the rise in Human Immunodeficiency Virus (HIV) cases in Tanzania

Abstract

IntroductionHighlight Population growth in Tanzania, with a rapid increase of 37% over the past decade, has significantly impacted public health policies, particularly in the context of increasing HIV/AIDS cases. The HIV prevalence rate of 4.9% in Tanzania, one of the highest in the world, is exacerbated by annual population growth, leading to an increasing number of people living with HIV/AIDS. To address the HIV/AIDS epidemic in Tanzania, enhancing sexual health education, routine screening of adolescents, implementing preventive strategies, such as PrEP (pre-exposure prophylaxis), improving mother-to-child transmission prevention through PCR tests at birth, and all crucial steps in the face of rapid population growth should be emphasized. Population growth is an important factor that impacts the public health of a community because it significantly influences the planning and execution of public health policies in a country. Population growth in many developing countries such as Tanzania has affected the incidence and prevalence rates of diseases and infections such as HIV/AIDS and the public health field in general1. Over the past decade, Tanzania has experienced rapid population growth at a rate of 37%. The 2022 census results showed that the population of Tanzania reached nearly 63 million compared with the 2012 census2. Meanwhile, according to UN projections, the country is expected to grow between 2 and 3% by 20502,3. Along with this fascinating population growth in the country, there are ~1.7 million cases of HIV in Tanzania, which is 5.1% of its 2020 population, and subsequently ranked fourth worldwide4. Different factors can be attributed to the rapid spiking of HIV cases in most low- and middle-income countries, such as Tanzania, including a low level of education, poor adherence to voluntary testing and counseling, and having multiple sexual partners5. The health system in Tanzania is not stable enough to counteract independently different critical public health problems such as HIV/AIDS and yet encounters a vast population growth, and critics have risen regarding the capability of the accountable Ministry of Health (MoH) in collaboration with the National Bureau of Statistics (NBS) of the country in resolving this scenario. However, close observation of the implications of population growth and the rise of HIV cases should, in disguise, press a button for prompt action. Inference of population growth and rise of HIV cases Current data reveal an HIV prevalence rate of 4.9% in the general population, placing Tanzania among the countries with the highest prevalence rates of infection in the world as of 20206, which may in part be attributed to the increase in the population seen annually in the country. With a population growth rate of 3.0% per year7, subsequently, the number of people living with HIV/AIDS also increases with each population growth spurt in the country. In 2013, after the 2012 census, statistics revealed that, in a population of 47.79 million people, there were a total of 1.4 million people living with HIV/AIDS in Tanzania5. Moreover, in the year 2019, in a population of 59.87 million people, there were a total of 1.7 million people living with HIV/AIDS in Tanzania8. Furthermore, in the Tanzania HIV Impact Survey (THIS) Report of 2016–2017, the incidence of HIV infection among adults aged 15 years and older was 0.24% overall, indicating an additional 72 000 new cases annually9. The increase in HIV cases and the increase in population require maximum attention, considering that each population growth spurt sees an increase in the number of young adults in the country, who as far as HIV/AIDS is concerned, are the riskiest group for acquiring new infections. Data from the report revealed that approximately one-third (31.7%) of young adults aged 15 years and above engaged in risky behavior and reported having sex in the 12 months preceding the survey with a non-marital or non-cohabiting partner9. Moreover, the significant heterogeneity across age, gender, socioeconomic status, and geographic location contributes to increasing the numbers by implying differentials in the risk of HIV transmission8. Efforts and challenges As HIV/AIDS remains a challenge worldwide, including in Tanzania, much effort has been made to prevent and suppress new HIV/AIDS cases and burden rates. The use of antiretroviral therapy (ART), which is not a cure, helps one stay healthy. The use of preventive measures, such as the use of condoms, practicing safe sex, and many others, have worked to prevent HIV/AIDS. Awareness campaigns such as the ‘Ishi’ Youth campaign, male circumcision, and condom programming, together with the use of highly sensitive and specific HIV screening tests, have virtually worked as a preventive measure. The administration of a short course of nevirapine to infected mothers during labor and newborns postpartum has proven to reduce the risk of mother-to-child transmission10. Furthermore, donor contributions from organizations such as AMREF, PEPFAR, and ICAP account for improved services for HIV prevention, care, and treatment. However, despite all the energy invested in combating the infection, financing is still one of the major problems facing the country, thus hindering the prevention of HIV/AIDS. Still, stigma toward people living with HIV/AIDS proves to be one of the stumbling blocks in attaining maximum prevention of the infection. Most HIV/AIDS clients tend to be discrete and difficult to open up concerning this global epidemic because of the fear of isolation in the community. Moreover, ministries of health around the world, health organizations, and health stakeholders incur difficulties in the implementation of strategies and necessary efforts to reduce HIV/AIDS in Tanzania because most healthcare workers are afraid of contracting HIV from their patients, thus affecting the delivery of their services due to personal fear of their protection or shortage of supplies such as protective equipment such as gloves. Poor infrastructure that lacks sufficient consulting room leads to a lack of confidentiality and privacy of the patient, thus making it difficult for healthcare workers to perform their duties effectively11. Recommendations According to the THIS in 2017, people with or without education below the primary level were more likely to have never tested for HIV than those with secondary and tertiary education levels12. Counteracting this, the government should invest more in providing and raising sexual health education to curb continuing deterioration by increasing voluntary HIV testing and raising awareness campaigns in the media, school clubs, and families among youth, particularly targeting adolescents. Nevertheless, adolescents should be prioritized in HIV prevention strategies, in particular Tanzanian settings, because of the growing population to reduce the incidence by planning long-term sustainable and integrated testing and treatment targeting adolescents as they age12. The MoH should establish routine screening of adolescents aged 15 years and above as the major strategy in timely diagnosis and early treatment initiation to achieve viral load suppression. A combination of preventive strategies could be more effective but should be used consistently and correctly. Health centers should also enforce pre-exposure prophylaxis (PrEP) for high-risk groups such as sex workers, HIV-negative partners of a serodiscordant couple when HIV is not infected on ART or on ART <6 months or has not attained viral suppression less than 50 copies/ml, homosexuals, and drug addicts. The drugs recommended are emtricitabine (FTC) 200 mg/tenofovir disoproxil fumarate (TDF) 300 mg (Truvada) per oral daily13. In addition, a continual emphasis on public campaigns for intravenous drug users would be a beneficial option in preventing HIV acquisition among drug addicts. Prominent stakeholders and health care practitioners can help in the treatment of substance use disorders, such as medication-assisted treatment and the establishment of syringe service programs (SSPs) to obtain safe and disposable needles. Post-exposure prophylaxis is the most reliable preventive strategy for occupational HIV transmission from an infected person, rape, sexual assault, or slipped or torn condoms in sex with a discordant partner. However, it must be administered within 72 h after exposure, and TLD (TDF+3TC/FTC+DTG) is recommended for adults and adolescents14. The ministry should enforce PCR tests at birth for high-risk newborns to prevent mother-to-child transmission (MTCT) to capture more children on regular medication, as the study demonstrated that without any intervention, 20–45% of infants become infected through MTCT during pregnancy, labor, and breastfeeding15. Conclusion The whole world is in a phase of rapid population growth, which is a huge hallmark for public health and a powerful indicator of the increase in the prevalence of both infectious and non-infectious diseases, including HIV/AIDS. Developing countries, including Tanzania, will be affected if the aforementioned recommendations are not considered. Therefore, they should involve themselves either directly or indirectly to reduce the prevalence of HIV/AIDS as a result of the ongoing population increase. Ethics approval Not required. Consent Not required. Sources of funding This work did not receive any funding. Author contribution I.K.P.: conceptualization, writing – original draft, reviewing, and editing; S.B.S., M.E., D.B.B., and J.B.: writing – original draft and reviewing; G.N.: reviewing and editing the final draft. Conflicts of interest disclosure The authors declare no conflicts of interest. Research registration unique identifying number (UIN) Name of the registry: not applicable. Unique identifying number or registration ID: not applicable. Hyperlink to your specific registration (must be publicly accessible and will be checked): not applicable. Guarantor Innocent Kitandu Paul. Data availability statement No primary data were used for this paper. Provenance and peer review Not commissioned, externally peer-reviewed.