Kåre Moen

• Kitomary, Nuruel Robert; Metta, Emmy; Leshabari, Melkizedeck T.; Moen, Kåre & Mmbaga, Elia (2026). Prevalence and factors associated with mental distress among men at higher risk of HIV infection enrolled in an HIV pre-exposure prophylaxis program in Tanga, Tanzania. Frontiers in Psychiatry. 17. doi: 10.3389/fpsyt.2026.1605734. Full text in Research Archive
• Ally, Mwashungi M.; Kakoko, Deodatus Conatus; Omsland, Tone Kristin; Swai, Calvin; Metta, Emmy & Moen, Kåre [Show all 12 contributors for this article] (2025). Level of Healthcare Facility and Psychosocial Factors Influence Perceived Self-Efficacy for Appropriate Use of Hydroxyurea: Experience from Caregivers of Children with Sickle Cell Disease in Tanzania. Healthcare. 13(13), p. 1500–1500. doi: 10.3390/healthcare13131500. Full text in Research Archive Show summary

  Background: Sickle cell disease (SCD) is associated with high physical and psychosocial burden among patients and their families. Hydroxyurea (HU) improves health-related quality of life by preventing SCD complications. Despite its availability, HU is underutilised in Tanzania. Perceived self-efficacy for appropriate medication use influences medication usage among individuals with chronic illnesses. We studied factors associated with caregivers’ perceived self-efficacy for appropriate use of HU and its association with HU usage among children with SCD in Dar-es-Salaam. Methods: We conducted a cross-sectional study from May to August 2023. We enrolled 374 caregivers of children with SCD from two regional and two national hospitals. We adapted the self-efficacy for appropriate medication use scale, a multidimensional perceived social support scale, and a patient health questionnaire for assessment of self-efficacy, social support, and depressive symptoms, respectively. Results: Three-quarters of caregivers had high perceived self-efficacy scores for medication use. Attending national hospitals, high social support, and absence of depressive symptoms were positively associated with perceived self-efficacy (adjusted beta coefficient aβ 2.3, 95% CI 0.5–4.2; aβ 9, 95% CI 7.1–10.9; and aβ 5.3, 95% CI 2.8–7.8, respectively). Caregivers with high self-efficacy were 5.3 times more likely to give HU to their children compared with those with low self-efficacy (incidence rate ratio 5.3, 95% CI 3.3–8.3). Conclusions: Hospital levels and psychosocial factors influence caregivers’ perceived self-efficacy for appropriate HU use. We recommend targeted interventions to enhance psychosocial support among caregivers to increase caregivers’ perceived self-efficacy and HU utilization among children with SCD in Tanzania.

• Jonathan, Agnes; Swai, Calvin; Kakoko, Deodatus; Mmbaga, Elia; Balandya, Emmanuel & Metta, Emmy [Show all 12 contributors for this article] (2025). Caregivers´ beliefs about hydroxyurea influence its usage among children with sickle cell disease: a cross-sectional study in Dar-es-Salaam, Tanzania. Pan African Medical Journal. 52(31). doi: 10.11604/pamj.2025.52.31.45975. Full text in Research Archive Show summary

  INTRODUCTION: Hydroxyurea (HU) is a proven, safe, and effective treatment for sickle cell disease (SCD) but is underutilized in Tanzania. Caregivers´ beliefs influence medication usage in childr

• Mikomangwa, Wigilya P.; Metta, Emmy; Moen, Kåre; Mmbaga, Elia; Leshabari, Melkizedeck T. & Kibusi, Stephen M. [Show all 10 contributors for this article] (2025). “I Stopped to Prove them Wrong:” Reasons for Discontinuing Daily Oral HIV Pre-exposure Prophylaxis Among Women at High Risk of HIV in Tanzania—A Convergent Mixed Methods Study. Aids and Behavior. ISSN 1090-7165. doi: 10.1007/s10461-025-04879-5. Full text in Research Archive Show summary

  Abstract High discontinuation of pre-exposure prophylaxis (PrEP) among high-risk women undermines its effectiveness. However, there is limited evidence on the reasons for PrEP discontinuation among female sex workers in sub-Saharan Africa. Exploring population-specific reasons for PrEP discontinuation will guide the design of client-centered strategies. Thus, we explored the reasons for PrEP discontinuation among female sex workers in Tanzania using mixed methods from 2022 to 2023 in Tanga, Tanzania. Participants were recruited through respondent-driven sampling and followed up for 12 months, and quantitatively interviewed at months 1, 6, and 12. In-depth interviews were carried out alongside the 12-month survey with purposely sampled female sex workers who had discontinued PrEP. Separate descriptive (and log-binomial regression) and thematic analyses were performed, and the insights were compared and integrated. We enrolled 313 participants with a median age of 27 years (IQR: 23–32). At 6 months, 61.5% (95% CI 54.3–68.4) had stopped taking PrEP for ≥ 3months, increasing to 67.4% (95% CI 60.2–74.0) at 12 months. Self-perceiving to be at “medium” to “high” risk of HIV had a 20% lower risk of stopping PrEP for ≥ 3months compared to self-perceiving to be at low or no risk (aRR 0.8, 95% CI 0.783–0.896). Participants discontinued PrEP because of medical and pharmacological challenges; perceived negative social norms and societal pressures; perceived undesirable pill characteristics and dosing schedules; low self-assessed HIV risk; perceived low benefit of PrEP; and low self-efficacy in adhering to PrEP. Our findings highlight the need for a multi-component intervention to promote PrEP retention.

• Kionde, Faithness; Metta, Emmy; Mmbaga, Elia; Leshabari, Melkizedeck; Swai, Calvin & Mbotwa, Christopher [Show all 7 contributors for this article] (2025). Retention in HIV Pre-Exposure Prophylaxis Among Men Who Have Sex with Men in Tanga, Tanzania. HIV/AIDS. Volume 17, p. 194–194. doi: 10.2147/hiv.s527111. Full text in Research Archive
• Kitomary, Nuruel; Metta, Emmy; Leshabari, Melkizedeck; Moen, Kåre & Mmbaga, Elia (2025). Prevalence and Factors Associated with Probable Alcohol Use Disorder Among Men at Higher Risk of HIV Enrolled in the HIV Pre-Exposure Prophylaxis Program in Tanga, Tanzania. A Call for Integrated Care. Substance Abuse and Rehabilitation. Volume 16, p. 307–307. doi: 10.2147/sar.s553175. Full text in Research Archive
• Lichtwarck, Hanne Ochieng; Massawe, Emmanuel Peter; Mmbaga, Elia & Moen, Kåre (2024). What can PrEP do for female sex workers? Unpacking the “effectosphere” of biomedical HIV prevention in Dar es Salaam. Social Science and Medicine. ISSN 0277-9536. 358. doi: 10.1016/j.socscimed.2024.117245. Full text in Research Archive
• Mikomangwa, Wigilya; Moen, Kåre; Mmbaga, Elia; Metta, Emmy; Kibusi, Stephen M. & Leshabari, Melkizedeck T. [Show all 8 contributors for this article] (2024). HIV pre-exposure prophylaxis use during periods of unprotected sex among female sex workers in Tanga city, Tanzania: a control arm analysis of the pragmatic quasi-experimental trial. Frontiers in Public Health. 12. doi: 10.3389/fpubh.2024.1405765. Full text in Research Archive Show summary

  Background: Pre-exposure prophylaxis (PrEP) prevention-effective adherence is of critical importance but challenging particularly among key populations where periods of high HIV risk are frequent. We assessed the use of PrEP with reference to periods of unprotected sex among female sex workers in the city of Tanga. Methods: This was part of the pragmatic quasi-experimental trial for HIV PrEP rollout in Tanzania involving a control cohort of 313 female sex workers aged ≥18 years recruited by respondent-driven sampling and followed for 12 months. PrEP use and periods of condomless or unprotected sex were assessed at the 6th and 12th month of follow-up. Prevention-effective adherence was defined as PrEP use of ≥2 pills/week and ≥6 pills/week for anal and vaginal condomless sex. Multivariable modified Poisson regression was conducted to determine factors influencing PrEP use (≥2 pills/week). Results: Overall, 59.2 and 45.9% of participants had unprotected anal and vaginal sex with a client, respectively. The prevention-effective adherence for anal sex ranged from 8.0% (months 6) to 10.0% (months 12) while that of vaginal sex was from 10.1% (month 6) to 3.8% (month 12). Participants who lived with friends were 25.5 times more likely to use ≥2 PrEP doses per week than those who lived alone (aPR = 25.5; 95%CI: 2.55-255.42, p = 0.006). Compared to self-reporting poor health status, self-reporting good health status significantly increased the use of ≥2 PrEP doses per week (aPR = 17.4; 95%CI: 3.01-101.02, p = 0.001). Refusing condomless sex with a steady partner increased the likelihood of using ≥2 PrEP doses per week than accepting condomless sex with a steady partner (aPR = 11.2; 95%CI: 1.55-80.48, p = 0.017). The prevalence of using ≥2 PrEP doses per week was less among participants accepting condomless sex at high pay than those who refused (aPR = 0.1; 95%CI: 0.03-0.26, p = 0.000). Conclusion: Use of PrEP during periods of unprotected sex was rare among female sex workers. Living with friends, self-reporting good health status, and refusing condomless sex with steady partners were associated with increased use of ≥2 PrEP doses per week. However, accepting condomless sex for increased payment was associated with reduced use of ≥2 PrEP doses per week. This calls for an in-depth study to understand the perspectives and circumstances shaping poor adherence during periods of unprotected sex among female sex workers.

• Mbotwa, Christopher H; Kazaura, Method Rwelengera; Moen, Kåre; Sudfeld, Christopher R; Metta, Emmy & Leshabari, Melkizedeck T. [Show all 8 contributors for this article] (2024). Trial of an mHealth intervention to improve HIV prophylaxis for female sex workers, United Republic of Tanzania. Bulletin of the World Health Organization. ISSN 0042-9686. 102(12), p. 852–860. doi: 10.2471/BLT.24.291516. Full text in Research Archive Show summary

  Objective: To evaluate the effect of a mobile health (mHealth) intervention on early retention of female sex workers in human immunodeficiency virus (HIV) pre-exposure prophylaxis services in the United Republic of Tanzania. Methods: The study involved 783 female sex workers: 470 from Dar es Salaam who were given the Jichunge mHealth application (app) in addition to standard HIV pre-exposure prophylaxis (intervention arm), and 313 from Tanga who received pre-exposure prophylaxis alone (control arm). Participants were recruited using respondent-driven sampling and followed up for 12 months. Early retention was defined as attending a pre-exposure prophylaxis follow-up clinic within 28 days of an appointment scheduled for 1 month after starting treatment. To assess if the Jichunge app led to higher retention, we conducted intention-to-treat and per-protocol analyses using a regression model adjusted by inverse probability weighting. Findings: Early retention in HIV pre-exposure prophylaxis care was observed in 27.6% (130/470) of participants in the intervention arm and 20.1% (63/313) in the control arm. In the adjusted, intention-to-treat analysis, early retention was observed in 29.4% in the intervention arm and 17.7% in the control arm (risk difference: 11.8 percentage points; 95% confidence interval: 5.3-18.3). Conclusion: Early retention in HIV pre-exposure prophylaxis care was significantly greater among female sex workers in the United Republic of Tanzania who used the Jichunge app than in those who did not. Nevertheless, more than two thirds of sex workers using the application did not attend follow-up services after 1 month, suggesting that additional interventions are needed.

• Lichtwarck, Hanne Ochieng; Mbotwa, Christopher Hariri; Kazaura, Method Rwelengera; Moen, Kåre & Mmbaga, Elia (2023). Early disengagement from HIV pre-exposure prophylaxis services and associated factors among female sex workers in Dar es Salaam, Tanzania: A socioecological approach. BMJ Global Health. 8(12). doi: 10.1136/bmjgh-2023-013662. Full text in Research Archive
• Ishungisa, Alexander Mwijage; Mmbaga, Elia; Leshabari, Melkizedeck Thomas; Tersbøl, Britt Pinkowski & Moen, Kåre (2023). Five different ways of reasoning: Tanzanian healthcare workers’ ideas about how to improve HIV prevention among same-sex attracted men. BMC Health Services Research. 23(1). doi: 10.1186/s12913-023-09771-3. Full text in Research Archive Show summary

  Background Same-sex attracted men in Tanzania and globally carry a disproportionate burden of HIV. Drawing on qualitative research, this article explores healthcare providers’ ideas and recommendations regarding how to improve HIV prevention among same-sex attracted men. Methods We carried out a qualitative study among healthcare workers in the cities of Dar es Salaam and Tanga in Tanzania between August 2018 and October 2019. Data were collected using qualitative methods of data collection, specifically in-depth interviews, focus group discussions, and participant observation. Study participants were recruited through a purposive sampling strategy that aimed to ensure variation in age, education, and work experience. Forty-eight interviews with 24 healthcare workers, six focus group discussions, and participant observation were conducted. A total of 64 persons participated in the study. Results This paper describes five different “ways of reasoning” that were identified among healthcare workers regarding how to strengthen HIV prevention among same-sex attracted men. One held that punitive measures should be taken to prevent HIV transmission, another that health services needed to become more friendly towards men who have sex with men, a third that healthcare workers should reach out to provide more education to this population, a fourth called for strengthened collaboration between healthcare providers and same-sex attracted men in healthcare delivery, and the fifth proposed that activistic efforts be taken to remove structural barriers for same-sex attracted men to access healthcare. Conclusion When reflecting on what is needed to strengthen HIV prevention among men who have sex with men, healthcare workers described six different ideas. One was that restrictive and punitive measures ought to be taken to prevent HIV transmission through same-sex sex. The remaining five promoted understanding of and support for same-sex attracted men. They prescribed more healthcare education, measures to improve attitudes among healthcare workers, healthcare delivery with user involvement, and political action to achieve law reform. Finally, some study participants raised concerns about the implementation of the national comprehensive package for key populations.

• Mbotwa, Christopher H; Kazaura, Method Rwelengera; Moen, Kåre; Lichtwarck, Hanne Ochieng; Leshabari, Melkizedeck T & Metta, Emmy [Show all 7 contributors for this article] (2023). Effect of an mHealth intervention on retention in HIV pre-exposure prophylaxis services among female sex workers: Preliminary evidence of the use of the Jichunge app in Dar es Salaam, Tanzania. Digital Health. 9. doi: 10.1177/20552076231170507. Full text in Research Archive Show summary

  Background Mobile health (mHealth) applications have been reported to be effective in promoting access and adherence to health services. However, knowledge about their effect on retention in HIV preventive services among at-risk populations in sub-Saharan Africa is limited. Objective We aimed to evaluate the effect of the Jichunge mHealth application on retention in HIV pre-exposure prophylaxis (PrEP) services among female sex workers in Dar es Salaam, Tanzania. Methods We used respondent-driven sampling to recruit female sex workers eligible for PrEP and who owned a smartphone. All study participants were provided with a smartphone application (Jichunge app) aiming to promote PrEP use through medication reminders, easy access to PrEP information, online consultations with a doctor and/or peer educator, and online discussions between PrEP users. The effect of optimal use of the Jichunge app on retention in PrEP services at 1-month was modelled using log-binomial regression. Results A total of 470 female sex workers with a median age of 26 (interquartile range: 22–30) years were recruited. Overall, 27.7% of female sex workers were retained in PrEP services at 1 month. Retention was twice as high among optimal users of the app than among sub-optimal users (adjusted risk ratios = 2.00, 95% confidence interval (CI): 1.41–2.83, p < 0.001). Conclusion The optimal use of the Jichunge mHealth application was significantly associated with higher retention in PrEP services among female sex workers in Dar es Salaam.

• Haaland, Inga; Metta, Emmy & Moen, Kåre (2023). The use of PrEP among men who have sex with men and transgender women as Biomedical Prevention Work: A conceptual framework. Social Science and Medicine. ISSN 0277-9536. 333. doi: 10.1016/j.socscimed.2023.116147. Full text in Research Archive
• Mbotwa, Christopher H; Kazaura, Method Rwelengera; Moen, Kåre; Leshabari, Melkizedeck Thomas; Metta, Emmy & Mmbaga, Elia (2023). Retention in an mHealth App Aiming to Promote the Use of HIV Pre-Exposure Prophylaxis Among Female Sex Workers in Dar es Salaam, Tanzania: Prospective Cohort Study. JMIR mhealth and uhealth. 11. doi: 10.2196/46853. Full text in Research Archive Show summary

  Background: Increasing access to smartphones in sub-Saharan Africa offers an opportunity to leverage mobile health (mHealth) technology to improve access to health care in underserved populations. In the domain of HIV prevention, mHealth interventions can potentially contribute to solving the challenges of suboptimal adherence to pre-exposure prophylaxis (PrEP) and low retention in PrEP services among populations most vulnerable to HIV acquisition. However, there is a gap in the knowledge about the use of such interventions in sub-Saharan Africa. Objective: This study aims to evaluate the extent and predictors of retention in an mHealth app (Jichunge) that aims to promote adherence to PrEP and retention in PrEP care among female sex workers in Dar es Salaam, Tanzania. Methods: A prospective cohort of female sex workers residing in Dar es Salaam were recruited, using respondent-driven sampling. All participants were provided with the Jichunge app as they started PrEP. A questionnaire was used to collect data on sociodemographics and other structural factors, while app use data for the 60-day period following the first 150 days of being in the intervention arm were extracted from the app's back end. A multivariable log-binomial model was used to determine predictors of 6-month retention in the Jichunge app. Results: A total of 470 female sex workers were recruited. Nearly three-quarters of participants (206/284, 72.5%) who came to the 6-month follow-up interview no longer had the Jichunge app on their phones. The majority of these participants (193/206, 93.7%) no longer had access to the app because of issues related to their phones. Data extracted from the back end of the app showed that the use of the app declined over time, and only 13.4% (63/470) of the participants were retained (continued to use the app) after 6 months of intervention. At 6 months, women aged ≥35 years were >2 times more likely to use the app than women aged 18 to 24 years (adjusted risk ratio [aRR] 2.2, 95% CI 1.2-4.1; P=.01). Furthermore, retention in the app was higher among participants who demonstrated high PrEP awareness at baseline (aRR 1.8, 95% CI 1.1-3; P=.01) and among those who had experienced financial difficulties due to health care spending (aRR 1.9, 95% CI 1.2-3.2; P=.01). Conclusions: Most female sex workers (206/284, 72.5%) who were enrolled in PrEP care in Tanzania no longer used the Jichunge app after 6 months. Retention in the app at 6 months was predicted by older age, high PrEP awareness, and financial difficulties due to health care spending. Strategies for the long-term retention of participants in mHealth apps, such as systems for reinstallations of apps, should be considered during the design phase. Keywords: Africa; HIV; PrEP; engagement; mHealth; mobile health; pre-exposure prophylaxis; retention; sex workers.

• Mbotwa, Christopher; Kazaura, Method Rwelengera; Moen, Kåre; Leshabari, Melkizedeck T.; Metta, Emmy & Leyna, Germana Henry [Show all 7 contributors for this article] (2022). Predictors of mHealth use in promoting adherence to pre-exposure prophylaxis among female sex workers: an evaluation of the Jichunge intervention in Dar es Salaam, Tanzania. BMC Health Services Research. 22(1). doi: 10.1186/s12913-022-08245-2. Full text in Research Archive Show summary

  Background: There is evidence that pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission, and PrEP is recommended by the World Health organization (WHO) for use by individuals at high risk of HIV infection. However, low adherence has been reported to hamper its effectiveness. Some evidence indicates that mHealth interventions may be a promising way of promoting PrEP adherence. Nevertheless, evaluations of mHealth interventions in Africa, the region most affected by HIV, are scarce. This study aimed at identifying the extent of and predictors for use of a smartphone based mHealth application among female sex workers in Dar es Salaam, Tanzania. Methods: As part of a quasi-experimental study in Tanzania, 470 female sex workers who were eligible for PrEP and who owned a smartphone were recruited using respondent driven sampling. All participants were provided with an mHealth application called Jichunge, a smartphone-based app designed to promote adherence to PrEP by offering users information, advise and support during start-up and use of PrEP. We collected data through structured interviews at baseline and extracted user data from the app for a period of 30 days. Modified Poisson regression model with robust standard errors was used to identify predictors for the optimal use of the Jichunge app. Results: Overall, the optimal use of the Jichunge app was 46.4%. Optimal use was significantly higher among women who were older (aPR = 1.3, 95% CI: 1.10-1.65, p = 0.004 for age 25-34 years, and aPR = 1.6, 95% CI: 1.19-2.07, p = 0.001 for age at least 35 years), who had secondary education or higher (aPR = 1.8, 95% CI: 1.08-2.94, p = 0.023), who had suboptimal social support (aPR = 1.2, 95% CI: 1.02-1.48, p = 0.030), who had high awareness of PrEP (aPR = 1.3, 95% CI: 1.08-1.55, p = 0.005), and who had experience using common mainstream social media applications (aPR = 1.4, 95% CI: 1.08-1.71, p = 0.009). Conclusion: Optimal use of the Jichunge app was substantially higher among women with higher age, higher education, higher PrEP awareness, less social support, and experience using common social media applications. Individual and interpersonal factors should be considered in planning mHealth interventions. Further studies to determine predictors of longer-term mHealth engagement are needed. Trial registration: International Clinical Trials Registry Platform PACTR202003823226570 ; 04.03.2020.

• Likindikoki, Samuel; Meyrowitsch, Dan Wolf; Mizinduko, Mucho; Ishungisa, Alexander Mwijage; Tersbøl, Britt & Leyna, Germana Henry [Show all 11 contributors for this article] (2022). Socio-cognitive factors influencing access to HIV prevention services among people who inject drugs in Dar es Salaam, Tanzania: An integrated bio-behavioural survey. PLOS ONE. 17(1). doi: 10.1371/journal.pone.0261500. Full text in Research Archive Show summary

  Introduction: People who inject drugs (PWID) in Sub-Saharan Africa have limited access to comprehensive HIV services. While it is important to inform programming, knowledge about factors influencing access to comprehensive HIV services is scarce. We assessed the proportions of PWID with access to HIV prevention services and associated socio-cognitive factors in Tanzania. Methods: A cross-sectional survey was conducted among PWID between October and December 2017 in Dar es Salaam, Tanzania. Data on access to HIV prevention services, demographics and selected socio-cognitive factors were collected through structured face-to-face interviews. Weighted descriptive and forward selection multivariable logistics regression analyses were done to assess independent associations between HIV prevention services and predictors of interest. The results were two tailed and a p-value of less than 0.05 was considered statistically significant. Results: The study included 611 PWID (males: 94.4%) with a median age of 34 years (Interquartile Range (IQR), 29-38). A large majority of participants reported to have access to condoms (87.8%), sterile needles/syringes (72.8%) and ever tested for HIV (66.0%). About half (52.0%) reported to have used condoms in the past one month and about a third (28.5%) accessed a peer educator. The odds of testing for HIV decreased among participants who perceived their HIV risk to be high (aOR = 0.29; 95%CI: 0.17-0.49) and those experienced sexual violence (aOR = 0.60; 95%CI 0.37-0.98). However, the odds of testing for HIV increased among participants with secondary level of education (aOR = 2.16; 95%CI: 1.06-5.55), and those who reported having correct comprehensive HIV knowledge (CCHK) (aOR = 1.63; 95%CI 1.12-2.41). The odds of access to condoms increased among females (aOR = 2.23; 95%CI: 1.04-5.02) but decreased among participants with secondary level of education (aOR = 0.41; 95%CI: 0.19-0.84), an income of >TZS 200,000 (aOR = 0.39; 95%CI: 0.23-0.66) and those who perceived their HIV risk to be high (aOR = 0.13; 95%CI: 0.03-0.36). The odds of access to peer educators was higher among participants with primary (aOR = 1.61; 95%CI: 1.01-2.26), and secondary (aOR = 2.71; 95%CI: 1.39-5.33) levels of education. The odds of access to sterile needle and syringe decreased among participants who perceived their HIV risk to be high (aOR = 0.11;95%CI 0.05-0.22), and low-medium (aOR = 0.25;95%CI 0.11-0.52) but increased among those with primary level of education (aOR = 1.72;95%CI 1.06-2.78). Conclusion: Access to condom, HIV testing, sterile needles and syringes were relatively high among PWID. However, condom use and access to peer educators was relatively low. HIV knowledge and risk perception, gender, education, and sexual violence influenced access to HIV prevention services. There is an urgent need to address the identified socio-cognitive factors and scale up all aspects of HIV prevention services to fast-track attainment of the 2025 UNAIDS goals and ending the HIV epidemic.

• Lichtwarck, Hanne Ochieng; Kazaura, Method; Moen, Kåre & Mmbaga, Elia (2022). Harmful Alcohol Use and Associated Socio-Structural Factors among Female Sex Workers Initiating HIV Pre-Exposure Prophylaxis in Dar es Salaam, Tanzania. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. doi: 10.3390/ijerph20010698. Full text in Research Archive Show summary

  Harmful alcohol use is an important risk factor for premature mortality and morbidity and associated with increased HIV risk and lower uptake of and adherence to HIV interventions. This study aimed to assess the extent of harmful alcohol use and associated socio-structural vulnerability factors among female sex workers in Dar es Salaam, Tanzania, a key population in the HIV epidemic. Data from a study of female sex workers initiating pre-exposure prophylaxis (PrEP) recruited through respondent driven sampling were used. We assessed harmful alcohol use with the Alcohol Use Disorders Identification Test (AUDIT) defined as having an AUDIT score ≥ 16. Associations between harmful alcohol use and socio-structural factors were assessed using logistic regression with marginal standardization. Of the 470 women recruited, more than one third (37.3%) had a drinking pattern suggestive of harmful alcohol use. Such use was independently associated with sex work-related mobility (aPR: 1.36, 95% CI: 1.11-1.61), arrest/incarceration (aPR: 1.55, 95% CI: 1.27-1.84) and gender-based violence (aPR: 1.31, 95% CI: 1.06-1.56). The high prevalence of harmful alcohol use and the interconnectedness with socio-structural factors indicate a need for a holistic programmatic approach to health for female sex workers. Programming should not solely direct attention to individual behavior but also include strategies aiming to address socio-structural vulnerabilities.

• Ishungisa, Alexander Mwijage; Meyrowitsch, Dan Wolf; Mmbaga, Elia; Leshabari, Melkizedeck Thomas & Moen, Kåre (2022). Not a Problem at All or Excluded by Oneself, Doctors and the Law? Healthcare Workers’ Perspectives on Access to HIV-Related Healthcare among Same-Sex Attracted Men in Tanzania. Journal of the International Association of Providers of AIDS Care. ISSN 2325-9574. 21. doi: 10.1177/23259582221121448. Full text in Research Archive
• Likindikoki, Samuel Lazarus; Mmbaga, Elia; Mizinduko, Mucho; Alexander, Mwijage; Adams, Lisa V. & Horsburgh, Robert [Show all 12 contributors for this article] (2022). Testing for Drug-Related Infectious Diseases and Determinants among People Who Use Drugs in a Low-Resource Setting: A Respondent-Driven Cross-Sectional Survey. Tropical Medicine and Infectious Disease. 7(9). doi: 10.3390/tropicalmed7090213. Full text in Research Archive
• Valeur, Hanne Støre; Lie, Anne Helene Kveim & Moen, Kåre (2021). Patient Rationales Against the Use of Patient-Accessible Electronic Health Records: A Qualitative Study. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 23(5), p. e24090–e24090. doi: 10.2196/24090. Full text in Research Archive
• Mizinduko, Mucho; Moen, Kåre; Tersbøl, Britt; Likindikoki, Samuel; Ishungisa, Alexander Mwijage & Leyna, Germana Henry [Show all 12 contributors for this article] (2021). HIV testing and associated factors among female sex workers in Tanzania: approaching the first 90% target? AIDS Care. ISSN 0954-0121. 18, p. 1–6. doi: 10.1080/09540121.2021.2014779. Full text in Research Archive Show summary

  Use of HIV testing services among FSW in sub-Saharan Africa (SSA) is below the desired UNAIDS target of 90%. We estimated the prevalence and factors associated with HIV testing among FSW in Dar es Salaam, Tanzania. A respondent-driven sampling method was used to recruit FSW aged 18. Modified Poisson regression models were used to determine factors associated with recent HIV testing. Of 958 surveyed FSW (median age 26 years), 85.4% (95% CI: 82.3, 88.1) reported to have ever been tested for HIV and 65.3% (95% CI: 61.2, 69.3) tested in the past 12 months. Condom use on the last day worked (prevalence ratio (PR) = 1.17; 95% CI: 0.99, 1.38), no or low self-perceived risk of HIV acquisition (PR = 1.16; 95% CI: 1.02, 1.32), having never felt stigmatized as a sex worker (PR = 1.18; 95% CI: 1.04, 1.33), and having been in contact with a peer educator (PR = 1.33; 95% CI: 1.18, 1.49) during the past year preceding the survey were associated with recent HIV testing. Interventions aiming to mitigate stigma due to sex work, improve health education to address risk perception as a barrier to HIV testing, and scaling up peer educator's engagement should be given priority.

• Muparamoto, Nelson & Moen, Kåre (2021). Taraidiwa [“We Have Been Raided”]: Effects of and Meanings Ascribed to an Assault on an LGBTI Function in Harare, Zimbabwe. Journal of Homosexuality. ISSN 0091-8369. doi: 10.1080/00918369.2021.1923280. Full text in Research Archive
• Mauka, Wilhellmuss; Mbotwa, Christopher; Moen, Kåre; Lichtwarck, Hanne Ochieng; Haaland, Inga & Kazaura, Method Rwelengera [Show all 9 contributors for this article] (2021). Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. doi: 10.2196/23204. Full text in Research Archive Show summary

  Background: There is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed. Objective: We present the results of the development of a mobile app (Jichunge) intended to promote adherence to PrEP among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania. Methods: A participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW. Results: The relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app’s design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs. Conclusions: The participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion. Trial Registration: The trial registration number is PACTR202003823226570

• Mizinduko, Mucho; Moen, Kåre; Likindikoki, Samuel; Mwijage, Alexander; Leyna, Germana Henry & Makyao, Neema [Show all 12 contributors for this article] (2020). HIV prevalence and associated risk factors among female sex workers in Dar es Salaam, Tanzania: tracking the epidemic. International Journal of STD and AIDS. ISSN 0956-4624. 31(10), p. 950–957. doi: 10.1177/0956462420917848. Full text in Research Archive Show summary

  Since 2014, HIV care and treatment services among key populations including female sex workers (FSWs) have intensified in Tanzania. We sought to track the epidemic among FSWs in Dar es Salaam, Tanzania. We conducted a cross-sectional integrated bio-behavioral survey using respondent-driven sampling and a structured questionnaire. Blood was drawn for HIV testing. Modified Poisson regression was used to determine factors associated with HIV infection. We recruited 958 FSWs (median age 26 years) of whom 952 consented to HIV testing. The HIV prevalence was 15.3% (95%CI: 12.5-18.6). Factors associated with higher HIV prevalence included old age (25-34 years: aPR 2.38; 95%CI: 1.23, 4.60 and over 35 years: aPR = 6.08; 95%CI: 3.19, 11.58) and having experienced sexual violence in the past year (aPR = 1.94; 95%CI: 1.34, 2.82). Attaining higher education level was associated with lower HIV prevalence (aPR = 0.51; 95%CI: 0.36, 0.73 for primary school level and aPR = 0.20; 95%CI: 0.08, 0.46 for secondary school level and/or above). The HIV prevalence among FSWs in Dar es Salaam has decreased by half since 2013. Prevention strategies should target older FSWs, aim to educate young girls, and institute approaches to mitigate violence among FSWs.

• Muparamoto, Nelson & Moen, Kåre (2020). Gay, ngochani, ordaa, gumutete and mwana waEriza: ‘globalised’ and ‘localised’ identity labels among same-sex attracted men in Harare, Zimbabwe. Culture, Health and Sexuality. ISSN 1369-1058. doi: 10.1080/13691058.2020.1814967. Full text in Research Archive
• Ishungisa, Alexander Mwijage; Mizinduko, Mucho; Likindikoki, Samuel; Mmbaga, Elia John; Leshabari, Melkizedeck T. & Moen, Kåre (2020). Health services we can trust: how same-sex attracted men in Dar Es Salaam, Tanzania would like their HIV healthcare to be organised. Culture, Health and Sexuality. ISSN 1369-1058. doi: 10.1080/13691058.2020.1780316. Full text in Research Archive Show summary

  Drawing on qualitative research in Dar es Salaam, Tanzania, this article explores how men who engage in sex with other men perceive their interactions with healthcare providers, and how they would prefer healthcare services to be organised and delivered. The paper describes the strengths and weaknesses men associate with private and public healthcare; the advantages and disadvantages they associate with dedicated clinics for sexual minority persons; what they conceive of as good healthcare services; and how they would characterise a good healthcare worker. The paper also presents recommendations made by study participants. These include the view that health services for same-sex attracted men should be developed and delivered in collaboration with such men themselves; that health workers should receive training on the medical needs as well as the overall circumstances of same-sex attracted men; and that there should be mechanisms that make healthcare available to poorer community members. We analyse men’s views and recommendations in the light of theoretical work on trust and discuss the ways in which same sex attracted men look for signs that healthcare workers and healthcare services are trustworthy.

• Mwijage, Alexander; Moen, Kåre; Leyna, Germana Henry; Makyao, Neema; Ramadhan, Angela & Lange, Theis [Show all 11 contributors for this article] (2020). HIV prevalence among men who have sex with men following the implementation of the HIV preventive guideline in Tanzania: respondent-driven sampling survey. BMJ Open. 10(10), p. 1–8. doi: 10.1136/bmjopen-2019-036460. Full text in Research Archive Show summary

  Objectives: To estimate HIV prevalence and associated risk factors among men who have sex with men (MSM) in Dar es Salaam, Tanzania following the implementation of the national comprehensive package of HIV interventions for key population (CHIP). Design: A cross-sectional survey using respondent-driven sampling. Setting: Dar es Salaam, Tanzania's largest city. Participants: Men who occasionally or regularly have sex with another man, aged 18 years and above and living in Dar es Salaam city at least 6 months preceding the study. Primary outcome measure: HIV prevalence was the primary outcome. Independent risk factors for HIV infection were examined using weighted logistics regression modelling. Results: A total of 777 MSM with a mean age of 26 years took part in the study. The weighted HIV prevalence was 8.3% (95% CI: 6.3%-10.9%) as compared with 22.3% (95% CI: 18.7%-26.4%) observed in a similar survey in 2014. Half of the participants had had sex with more than two partners in the month preceding the survey. Among those who had engaged in transactional sex, 80% had used a condom during last anal sex with a paying partner. Participants aged 25 and above had four times higher odds of being infected than those aged 15-19 years. HIV infection was associated with multiple sexual partnerships (adjusted OR/AOR, 3.0; 95% CI: 1.8-12.0), not having used condom during last sex with non-paying partner (AOR, 4.1; 95% CI: 1.4-7.8) and ever having engaged in group sex (AOR, 3.4; 95% CI: 1.7-3.6). Conclusion: HIV prevalence among MSM in Dar es Salaam has decreased by more than a half over the past 5 years, coinciding with implementation of the CHIP. It is nonetheless two times as high as that of men in the general population. To achieve the 2030 goal, behavioural change interventions and roll out of new intervention measures such as pre-exposure prophylaxis are urgently needed.

• Likindikoki, Samuel; Mmbaga, Elia John; Leyna, Germana Henry; Moen, Kåre; Makyao, Neema & Mizinduko, Mucho [Show all 10 contributors for this article] (2020). Prevalence and risk factors associated with HIV-1 infection among people who inject drugs in Dar es Salaam, Tanzania: a sign of successful intervention? Harm Reduction Journal. 17(1). doi: 10.1186/s12954-020-00364-5. Full text in Research Archive Show summary

  BACKGROUND: Prevalence of HIV infection among people who inject drugs (PWID) has been reported to be higher than that of the general population. The present study aimed to estimate the prevalence of HIV infection and associated risk factors among PWID in Dar es Salaam, Tanzania, following the introduction of a comprehensive HIV intervention package (CHIP) for PWID in the country in 2014. METHODS: We conducted an integrated bio-behavioral survey (IBBS) among PWID using respondent-driven sampling (RDS) in Dar es Salaam, Tanzania, between October and December 2017. Data on socio-demographic characteristics and risky behaviors were collected through face-to-face interviews. Blood samples were collected and tested for HIV infection. We accounted for weighting in the analyses, and logistic regression was performed to assess risk factors for HIV infection. RESULTS: A total of 611 PWID (94.4% males and 5.6% females) with a median age of 34 years (IQR 29-38) were recruited. The overall prevalence of HIV infection was 8.7% (95% CI 6.5-10.9). The prevalence of HIV infections for males and females were 6.8% (95% CI 4.7-8.9%) and 41.2% (95% CI 23.7-58.6%) respectively. Adjusted weighted logistic regression analysis (WLRA) showed that being a female (aOR 19.1; 95% CI 5.9-61.8), injecting drugs for more than 10 years (aOR = 7.32; 95% CI 2.1-25.5) compared to 1 year or less and being 45 years or older (aOR = 34.22; 95% CI 2.4-489.5) compared to being 25 years or younger were associated with increased odds of HIV infection. Use of a sterile needle at last injection decreased odds of HIV infection (aOR = 0.3; 95% CI 0.1-0.8). CONCLUSIONS: The present study observed a decline in prevalence of HIV infections among PWID in Dar es Salaam (8.7%) compared to a previous estimate of 15.5% from an IBBS conducted in 2013. Despite the decrease, HIV prevalence remains high among PWID compared to the general population, and women are disproportionally affected. The decline may be possibly attributed to the on-going implementation of CHIP for PWID, highlighting the need for strengthening the existing harm reduction interventions by incorporating access to sterile needle/syringe and addressing the layered risks for women.

• Andreassen, Trude; Hansen, Bo Terning; Engesæter, Birgit Øvstebø; Hashim, Dana; Støer, Nathalie Charlotte & Trope, Ameli [Show all 9 contributors for this article] (2019). Psychological effect of cervical cancer screening when changing primary screening method from cytology to high-risk human papilloma virus testing. International Journal of Cancer. ISSN 0020-7136. 145(1), p. 29–39. doi: 10.1002/ijc.32067. Full text in Research Archive Show summary

  From 2015, Norway has implemented high‐risk human papilloma virus (hrHPV) testing in primary screening for cervical cancer. Women aged 34–69 years, living in four counties, have been pseudo‐randomly assigned (1:1 randomization) to either hrHPV testing every 5 years (followed by cytology if hrHPV is positive), or cytology testing every 3 years (followed by hrHPV testing if low‐grade cytology is detected). We compared anxiety and depression scores among participants by screening arm and results. In total, 1,008 women answered a structured questionnaire that included the validated Patient Health Questionnaire‐4 (PHQ‐4). The Relative Risk Ratio (RRR) of mild vs. normal anxiety and depression scores, and moderate/severe vs. normal anxiety and depression scores, were estimated by multinomial logistic regression with 95% confidence intervals (95% CIs). Compared to women who were screened with cytology, women randomized to hrHPV testing were not more likely to have mild anxiety and depression scores (RRR 0.96, CI 0.70–1.31) nor more likely to have moderate/severe anxiety and depression scores (RRR 1.14, CI 0.65–2.02). Women with five different combinations of abnormal screening test results were not more likely to have mild or moderate/severe vs. normal anxiety and depression scores than women with normal screening results. The likelihood of having abnormal long‐term (4–24 months after the screening) anxiety or depression scores among women 34 years and older was not affected by screening method or screening results. The results of our study suggest that a change to hrHPV testing in primary screening would not increase psychological distress among participants.

• Leyna, Germana Henry; Makyao, Neema; Mwijage, Alexander; Ramadhan, Angela; Likindikoki, Samuel & Mizinduko, Mucho [Show all 9 contributors for this article] (2019). HIV/HCV co-infection and associated risk factors among injecting drug users in Dar es Salaam, Tanzania: potential for HCV elimination. Harm Reduction Journal. 16(1). doi: 10.1186/s12954-019-0346-y. Full text in Research Archive Show summary

  BACKGROUND: Chronic HCV infection causes substantial morbidity and mortality and, in co-infection with HIV, may result in immunological and virological failure following antiretroviral treatment. Estimates of HCV infection, co-infection with HIV and associated risk practices among PWID are scarce in Africa. This study therefore aimed at estimating the prevalence of HCV and associated risk factors among PWID in the largest metropolitan city in Tanzania to inform WHO elimination recommendations. METHODS: An integrated bio-behavioral survey using respondent-driven sampling was used to recruit PWID residing in Dar es Salaam, Tanzania. Following face-to-face interviews, blood samples were collected for HIV and HCV testing. Weighted modified Poisson regression modeling with robust standard errors was used in the analysis. RESULTS: A total of 611 PWID with a median age of 34 years (IQR, 29-38) were recruited through 4 to 8 waves. The majority of participants (94.3%) were males, and the median age at first injection was 24 years (IQR, 19-30). Only 6.55% (40/611) of participants reported to have been enrolled in opioid treatment programs. The weighted HCV antibody prevalence was 16.2% (95%CI, 13.0-20.1). The corresponding prevalence of HIV infection was 8.7% (95%CI, 6.4-11.8). Of the 51 PWID who were infected with HIV, 22 (43.1%) were HCV seropositive. Lack of access to clean needles (adjusted prevalence ratio (APR), 1.76; 95%CI, 1.44; 12.74), sharing a needle the past month (APR, 1.72; 95%CI, 1.02; 3.00), not cleaning the needle the last time shared (APR, 2.29; 95%CI, 1.00; 6.37), and having unprotected not using a transactional sex (APR, 1.87; 95%CI, 1.00; 3.61) were associated with increased risk of HCV infection. On the other hand, not being on opioid substitution therapy was associated with 60% lower likelihood of infection. CONCLUSIONS: The HCV antibody prevalence among PWID is lower than global estimates indicating potential for elimination. Improving access to safe injecting paraphernalia, promoting safer injecting practices is the focus of prevention programing. Screening for HIV/HCV co-infection should be intensified in HIV care, opioid substitution programs, and other point of care for PWID. Use of direct-acting antiretroviral treatment would accelerate the achievement of hepatitis infection elimination goal by 2030.

• Steuernagel, Carolina Rau; Engebretsen, Eivind; Kristiansen, Hans Wiggo & Moen, Kåre (2019). Ethnography of texts: a literature review of health and female homosexuality in Brazil. Medical Humanities. ISSN 1468-215X. p. 1–10. doi: 10.1136/medhum-2018-011544. Full text in Research Archive Show summary

  This paper reviews the literature on health and female homosexuality in Brazil and, along the way, outlines an alternative approach to reviewing academic literature. Rather than summarising the contents of previously published papers, we relate to these publications primarily as partakers in the creation of knowledge. Inspired by Actor-Network Theory (ANT), we apply ethnographic methods to understand the papers as study participants endowed with action. We also draw on the notions of inscription and intertextuality to trace the complex relationship between the findings in the articles and the realities outside of them. We claim that ‘evidence’ is the product of translational processes in which original events, such as experiments, blood tests and interviews, are changed into textual entities. In addition, text production is seen as an absorption of everything else surrounding its creation. When events are turned into articles, the text incorporates the political environment to which original events once belonged. We thus observe a political text inscribed into the written evidence of sexually transmitted infections, and the practice of publishing about scientific vulnerabilities emerges as political action. In contrast with traditional ways of reviewing literature in medical scholarship, this article offers a reminder that although there is a connection between textual evidence and the reality outside publications, these dimensions are not neutrally interchangeable.

• Bhargava, Sameer; Hofvind, Solveig & Moen, Kåre (2019). Gender, letters, relatives, and God: mediating actors in mammographic screening among Pakistani women in Norway. Acta Radiologica Open. doi: 10.1177/2058460119875015. Full text in Research Archive Show summary

  Background: Pakistani immigrant women in Norway have lower attendance rates in the national breast cancer screening program (BreastScreen Norway) compared to non-immigrants and immigrants from most other countries. Purpose: To identify and explore human and non-human actors that play a role for Pakistani immigrant women’s attendance in the program. Material and Methods: Qualitative interviews with 16 Norwegian-Pakistani women in 2017 and 2018. Inspired by Latour, we explored how human and non-human actors act and interact when Pakistani immigrant women consider attendance in BreastScreen Norway. Results: Among the actors found to play a significant role in the relationship between Pakistani immigrant women and the screening program were trust in the healthcare system and breast cancer screening, the gender of the screening radiographer, the written information received from the screening program, family life, daughters, general practitioners, non-governmental organizations, religious beliefs, private service providers, monetary expenses, accessibility, worries, and digital tools. Conclusion: Many human and non-human actors work to shape and influence Pakistani immigrant women’s screening attendance, or lack thereof, for instance by creating thoughts, promoting opportunities, raising doubts and generating worries, thus variously encouraging, enabling, facilitating, discouraging or preventing attendance in organized breast cancer screening.

• Mutanga, Oliver & Moen, Kåre (2019). The push of stigma: a qualitative study on the experiences and consequences of sexuality stigma among same-sex attracted men in Harare, Zimbabwe. Culture, Health and Sexuality. ISSN 1369-1058. doi: 10.1080/13691058.2019.1674920. Full text in Research Archive Show summary

  This paper describes experiences of sexuality stigma among same-sex attracted men in Zimbabwe and analyses the consequences of such experiences for healthcare seeking. It draws on qualitative research carried out in Harare in 2017, which included in-depth interviews with sixteen gay and bisexual men, and key informant interviews with three representatives of organisations that work with gay men. There were numerous stories about sexuality stigma in the study participants´ social environments, including at home, in local communities and in healthcare facilities. We first offer a description of these and then go on to trace the implications of stigma on the relations between men who have sex with men on the one hand and the healthcare sector on the other. We conceive of stigma as a pushing force that exerts pressure on and in these relations, and identify five types of consequences of this. Stigma works to (1) produce geographical shifts in healthcare, (2) promote private over public care, (3) compartmentalise healthcare (with dedicated providers for queer persons), (4) deprofessionalise care, and (5) block access to appropriate healthcare altogether for some same-sex attracted men. Most of these consequences have negative implications for preventive or treatment-focused HIV programming.

• Mmbaga, Elia John; Leyna, Germana Henry; Leshabari, Melkizedeck T.; Tersbøl, Britt Pinkowsky; Lange, Theis & Makyao, Neema [Show all 8 contributors for this article] (2019). Effectiveness of health care workers and peer engagement in promoting access to health services among population at higher risk for HIV in Tanzania (KPHEALTH): study protocol for a quasi experimental trial. BMC Health Services Research. 19(1), p. 1–7. doi: 10.1186/s12913-019-4675-z. Full text in Research Archive Show summary

  BACKGROUND: While there are indications of declining HIV infection rates in the general population globally, Tanzania included, men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID), now called Key Populations (KP) for HIV epidemic have 2-20 times higher infections rates and contributes up to 30% of new HIV infection. Tanzania have developed a Comprehensive Guideline for HIV prevention among key population (CHIP) to address the epidemic among KPs. However, these populations are stigmatized and discriminated calling for innovative approaches to improve access to CHIP. This project seeks to test the effectiveness of healthcare workers and peer-to-peer engagement in promoting access to CHIP among HIV at risk populations in Tanzania. METHODS: A quasi-experimental design involving Dar es Salaam City as an intervention region and Tanga as a control region will be done. Using respondent driven sampling, 1800 at risk population (900 from Intervention site and 900 from control site) will be recruited at baseline to identify pull and push factors for health services access. Stakeholder's consultation will be done to improve training contents for CHIP among health care workers and peers. Effectiveness of healthcare workers training and peer engagement will be tested using a quasi-experimental design. DISCUSSION: The results are expected to co-create service provision and improve access to services among KPs as a human right, reverse HIV infection rates among KPs and the general population, and improve social and economic wellbeing of Tanzanian. TRIAL REGISTRATION: Retrospectively registered on 28th August, 2019 with International Standard Randomized Clinical Trial Number ( ISRCTN11126469 ). KEYWORDS: HIV; Health services access; Injecting drugs; Men who have sex with men; Sex work; Tanzania

• Bugoye, Fidelis Charles; Leyna, Germana Henry; Moen, Kåre & Mmbaga, Elia John (2019). Knowledge, Perceived Risk and Utilization of Prostate Cancer Screening Services among Men in Dar Es Salaam, Tanzania. Prostate Cancer. ISSN 2090-3111. doi: 10.1155/2019/2463048. Full text in Research Archive Show summary

  Background. Late diagnosis of prostate cancer is common in low and middle income countries and contributes to high morbidity and mortality of the disease. Utilization of prostate cancer screening services plays a major role in prevention of adverse outcomes. However, there is limited information on the knowledge about, the perceived risk of, and the utilization of prostate cancer screening in Tanzania. Objective. To determine knowledge and perceived risk of prostate cancer, and the utilization of prostate cancer screening services, and associated factors, among men in Dar es Salaam, Tanzania. Design. A population-based cross-sectional study involving men aged 40 years and above living in Dar es Salaam was conducted between May and August, 2018. Methodology. Participants were recruited through multistage random sampling and took part in structured face-to-face interviews. Categorical variables were summarized using proportions while continuous variables were summarized as medians and inter-quarterly range (IQR). Chi square test was used to compare differences between proportions, and logistic regression modelling was used to determine factors associated with utilization of prostate cancer screening. Both crude and adjusted odds ratios (OR), with corresponding 95% confidence intervals, are reported. All analyses were two-tailed and the significance level set at 5%. Results. A total of 388 men with a median age of 53 years (IQR 44–55) participated. Half (52.1%) had poor knowledge about prostate cancer and prostate cancer screening. A third (32.3%,) perceived the risk of prostate cancer to be low. Only 30 respondents (7.7%) had ever been screened for prostate cancer. Utilization of prostate cancer screening services was independently associated with age above 60 years [AOR = 21.46, 95% CI: 6.23, 73.93], monthly income above 305 US Dollars [AOR = 15.68, 95% CI: 4.60, 53.48], the perceived risk of prostate cancer [AOR = 16.34, 95% CI: 7.82, 14.92] and knowledge about prostate cancer [AOR = 67.71, 95% CI: 8.20, 559.57]. Conclusions. Knowledge about prostate cancer and prostate cancer screening services was low among men in Dar es Salaam with a third perceiving themselves to be at no risk for the disease. Utilization of screening services was low and associated with low income, younger age, low perceived risk of prostate cancer and low knowledge about the disease. Intervention measures aiming to increase knowledge about prostate cancer and screening services, and affordable provision of services, are urgently called for.

• Mmbaga, Elia John; Leyna, Germana Henry; Leshabari, Melkizedeck T. & Moen, Kåre (2019). Early Anal Sex Experience Among Men Who Have Sex with Men in Dar Es Salaam Tanzania: Implications for HIV Prevention and Care. Archives of Sexual Behavior. ISSN 0004-0002. doi: 10.1007/s10508-019-01529-5. Full text in Research Archive Show summary

  Early age at first sex experience has been attributed to medical and psychological consequences, including practice of risk behaviors and HIV infection later in life. Studies have examined early heterosexual experience, but little is known about early anal sexual experience among men who have sex with men (MSM) in Africa. We conducted a time to event analysis to examine the extent and role of early anal sexual experience and HIV risk and infection in the largest MSM survey in Africa. A total of 753 MSM with a mean age of 26.5 years and that at first anal sexual experience of 18.3 years participated. Of those who participated, 29.0% (219/753) had their first anal sexual experience at age below 15. MSM reporting early anal sexual experience were young, had men as first sexual partner (adjusted hazard ratio—AHR, 4.75; 95%CI: 3.51–6.43), assumed receptive position during last anal sex (AHR, 3.25; 95%CI: 2.42–4.35), had anal sex as first penetrative sexual experience (AHR, 5.05, 95%CI; 3.68–6.97), had unprotected first anal sex (AHR, 1.55, 95%CI: 1.03–2.33), not preferring women for sex (AHR, 2.78; 95%CI: 2.11–3.67), had non-consensual first sex (AHR, 1.53, 95%CI: 1.10–9.41), and HIV positive (AHR, 1.75; 95%CI: 1.21–2.50). A third of MSM engaged in anal sex at an early age and were more likely to report sexual abuse, practice HIV risk behaviors, and been HIV seropositive. Roll-out of the existing Comprehensive Guideline for HIV Treatment and Care for key population in Tanzania should be implemented alongside measures addressing sexual abuse among young people.

• Andreassen, Trude; Melnic, Adriana; Figueiredo, Rejane Augusta de Oliveira; Moen, Kåre; Şuteu, Ofelia & Nicula, Florian [Show all 8 contributors for this article] (2018). Attendance to cervical cancer screening among Roma and non-Roma women living in North-Western region of Romania. International Journal of Public Health. ISSN 1661-8556. 63(5), p. 609–619. doi: 10.1007/s00038-018-1107-5. Full text in Research Archive Show summary

  <p><i>Objectives</i>: Romania has Europe’s highest incidence and mortality rates of cervical cancer. Participation in the national cervical cancer-screening programme is low, especially among minority Roma women.</p> <p><i>Methods</i>: We conducted a cross-sectional study, using a structured questionnaire aiming to quantify reasons for screening attendance among women in North-Western region of Romania.</p> <p><i>Results</i>: 980 women were enrolled in this study. Data were analysed using logistic regression, estimating odds ratios (OR) and 95% confidence intervals (CI). This study revealed that Roma women (46%) attended screening less frequently that non-Roma women (63%),; however, ethnicity in itself was not associated with screening attendance. Instead we found that attendance to the cervical cancer screening programme was determined by having ever heard about a screening opportunity (OR 5.90, 95% CI 3.76−9.27) and having three or more sex partners (OR 5.99, 95% CI 1.71–21.04).</p> <p><i>Conclusions</i>: We concluded that information about the screening programme’s existence and its rationale does not reach the women targeted for screening sufficiently and argue that a process of user involvement aiming to build contact, interaction and cooperation between the programme and its potential participants is warranted.</p>

• Bhargava, Sameer; Moen, Kåre; Qureshi, Samera Azeem & Hofvind, Solveig (2018). Mammographic screening attendance among immigrant and minority women: a systematic review and meta-analysis. Acta Radiologica. ISSN 0284-1851. 59(11), p. 1285–1291. doi: 10.1177/0284185118758132. Full text in Research Archive
• Bhargava, Sameer; Tsuruda, Kaitlyn; Moen, Kåre; Bukholm, Ida Rashida Khan & Hofvind, Solveig (2018). Lower attendance rates in immigrant versus non-immigrant women in the Norwegian Breast Cancer Screening Programme. Journal of Medical Screening. ISSN 0969-1413. 25(3), p. 155–161. doi: 10.1177/0969141317733771. Full text in Research Archive Show summary

  Objective The Norwegian Breast Cancer Screening Programme invites women aged 50-69 to biennial mammographic screening. Although 84% of invited women have attended at least once, attendance rates vary across the country. We investigated attendance rates among various immigrant groups compared with non-immigrants in the programme. Methods There were 4,053,691 invitations sent to 885,979 women between 1996 and 2015. Using individual level population-based data from the Cancer Registry and Statistics Norway, we examined percent attendance and calculated incidence rate ratios, comparing immigrants with non-immigrants, using Poisson regression, following women's first invitation to the programme and for ever having attended. Results Immigrant women had lower attendance rates than the rest of the population, both following the first invitation (53.1% versus 76.1%) and for ever having attended (66.9% versus 86.4%). Differences in attendance rates between non-immigrant and immigrant women were less pronounced, but still present, when adjusted for sociodemographic factors. We also identified differences in attendance between immigrant groups. Attendance increased with duration of residency in Norway. A subgroup analysis of migrants' daughters showed that 70.0% attended following the first invitation, while 82.3% had ever attended. Conclusions Immigrant women had lower breast cancer screening attendance rates. The rationale for immigrant women's non-attendance needs to be explored through further studies targeting women from various birth countries and regions.

• Svendby, Rannveig; Romsland, Grace Inga & Moen, Kåre (2018). Non-disabled ableism: An autoethnography of cultural encounters between a non-disabled researcher and disabled people in the field. Scandinavian Journal of Disability Research. ISSN 1501-7419. 20(1), p. 219–227. doi: 10.16993/sjdr.6. Full text in Research Archive Show summary

  This article describes situations where preconceptions about disabled people were made apparent in a non-disabled researcher’s thoughts, words and actions in the course of fieldwork for a qualitative study into the lives of disabled young adults. The article uses these experiences as entry points to discovery and analysis of cultural ableism. It draws on critical theory and insights from the social model of disability, and takes an autoethnographic approach to highlight the researcher’s preconceptions and her process towards a more nuanced understanding of disability.

• Mmbaga, Elia John; Leyna, Germana Henry; Moen, Kåre & Leshabari, M.T. (2018). HIV Prevalence and Associated Risk Factors Among Men Who Have Sex With Men in Dar es Salaam, Tanzania. Journal of Acquired Immune Deficiency Syndromes. ISSN 1525-4135. doi: 10.1097/QAI.0000000000001593. Full text in Research Archive Show summary

  INTRODUCTION: Limited studies and differential risk behaviors among men who have sex with men (MSM) in Africa calls for population-specific studies. We present results from the largest integrated biobehavioral survey among MSM in Africa to inform programming. METHODS: This was a cross-sectional study using respondent-driven sampling to recruit MSM aged 18 and above. Data on sociodemographic characteristics and HIV-related risks were collected and all participants were tested for HIV, herpes simplex virus type-2 (HSV-2), hepatitis-B virus (HBV), and syphilis RESULTS:: A total of 753 MSM with a mean age of 26.5 years participated in the study and 646 (85.7%) provided blood for biological testing. The prevalence of HIV was 22.3%, HSV-2 40.9%, syphilis 1.1%, and HBV 3.25%. Significant risk factors for HIV were age above 25, having no children [adjusted odds ratio (aOR), 2.4, 95% confidence interval (CI): 1.4 to 4.2], low HIV-risk perception (aOR, 2.6, 95% CI: 1.2 to 5.3), receptive position (aOR, 8.7, 95% CI: 1.2 to 5.3), and not using water-based lubricants (aOR, 2.6, 95% CI: 1.0 to 4.5) during the last anal sex. Also associated with HIV infection was, having sexual relationships with women (aOR, 8.0, 95% CI: 4.1 to 15.6), engaging in group sex (aOR, 3.8, 95% CI: 1.6 to 8.4), HSV-2 seropositivity (aOR, 4.1, 95% CI: 2.6 to 6.5), and history of genital ulcers (aOR, 4.1, 95% CI: 1.1 to 7.2). CONCLUSIONS: HIV infection and HSV-2 were highly prevalent among MSM. Low perceived HIV risk, practice of risk behaviors, and infection with HSV-2 were significant predictors of HIV infection. Behavioral interventions, HSV-2 suppressive therapies, and pre-exposure prophylaxis are highly needed.

• Andreassen, Trude; Weiderpass, Elisabete; Nicula, Florian; Suteu, Ofelia; Itu, Andreea & Bumbu, Minodora [Show all 9 contributors for this article] (2017). Controversies about cervical cancer screening: A qualitative study of Roma women's (non)participation in cervical cancer screening in Romania. Social Science and Medicine. ISSN 0277-9536. 183, p. 48–55. doi: 10.1016/j.socscimed.2017.04.040. Full text in Research Archive Show summary

  Romania has Europe's highest incidence and mortality of cervical cancer. While a free national cervical cancer-screening programme has been in operation since 2012, participation in the programme is low, particularly in minority populations. The aim of this study was to explore Roma women's (non)participation in the programme from women's own perspectives and those of healthcare providers and policy makers. We carried out fieldwork for a period of 125 days in 2015/16 involving 144 study participants in Cluj and Bucharest counties. Fieldwork entailed participant observation, qualitative interviewing and focus group discussions. A striking finding was that screening providers and Roma women had highly different takes on the national screening programme. We identified four fundamental questions about which there was considerable disagreement between them: whether a free national screening programme existed in the first place, whether Roma women were meant to be included in the programme if it did, whether Roma women wanted to take part in screening, and to what degree screening participation would really benefit women's health. On the background of insights from actor-network theory, the article discusses to what degree the programme could be said to speak to the interest of its intended Roma public, and considers the controversies in light of the literature on patient centred care and user involvement in health care. The paper contributes to the understanding of the health and health-related circumstances of the largest minority in Europe. It also problematizes the use of the concept of “barriers” in research into participation in cancer screening, and exemplifies how user involvement can potentially help transform and improve screening programmes.

• Mmbaga, Elia John; Moen, Kåre; Leyna, Germana Henry; Mpembeni, Rose & Leshabari, Melkizedeck T. (2017). HIV prevalence and associated risk factors among men who have sex with men in Dar es Salaam, Tanzania. Journal of Acquired Immune Deficiency Syndromes. ISSN 1525-4135. 77(3), p. 243–249. doi: 10.1097/QAI.0000000000001593. Full text in Research Archive Show summary

  Introduction: Limited studies and differential risk behaviours among men who have sex with men (MSM) in Africa calls for population specific studies. We present results from the largest integrated bio-behavioural survey among MSM in Africa to inform programming. Methods: This was a cross-sectional study utilizing respondent driven sampling to recruit MSM aged 18 and above. Data on socio-demographic characteristics and HIV-related risks were collected and all participants were tested for HIV, Herpes Simplex Virus Type-2 (HSV2), Hepatitis-B Virus (HBV) and Syphilis. Results: A total of 753 MSM with a mean age of 26.5 years participated in the study and 646 (85.7%) gave blood for biological testing. The prevalence of HIV was 22.3%, HSV-2 40.9%, syphilis 1.1 %, and HBV 3.25%. Significant risk factors for HIV were age above 25, having no children (aOR), 2.4, 95% CI: 1.4-4.2), low HIV-risk perception (aOR, 2.6, 95% CI: 1.2- 5.3), receptive position (aOR, 8.7; 95% CI 1.2-5.3), and not using water-based lubricants (aOR, 2.6, 95% CI: 1.0-4.5) during last anal sex. Also associated with HIV infection was, having sexual relationships with women (aOR, 8.0, 95% CI: 4.1-15.6), engaging in group sex (aOR, 3.8, 95% CI: 1.6-8.4), HSV-2 seropositivity (aOR, 4.1, 95% CI: 2.6- 6.5) and history of genital ulcers (aOR, 4.1, 95% CI: 1.1-7.2). Conclusions: HIV infection and HSV-2 were highly prevalent among MSM. Low perceived HIV risk, practice of risk behaviours and infection with HSV-2 were significant predictors of HIV infection. Behavioural interventions, HSV-2 suppressive therapies and Pre-exposure Prophylaxis are highly needed. The final version of this research has been published in Journal of Acquired Immune Deficiency Syndromes. © 2018 Lippincott, Williams & Wilkins

• Mmbaga, Elia John; Moen, Kåre; Makyao, Neema & Leshabari, Melkizedeck T. (2017). Prevalence and predictors of human immunodeficiency virus and selected sexually transmitted infections among people who inject drugs in Dar es Salaam, Tanzania: A new focus to get to zero. Sexually Transmitted Diseases. ISSN 0148-5717. 44(2), p. 79–84. doi: 10.1097/OLQ.0000000000000555. Full text in Research Archive Show summary

  Background: Previous studies in Tanzania indicated that human immunodeficiency virus (HIV) prevalence among people who inject drugs (PWIDs) could be as high as 40%. We aim to provide data on the prevalence of HIV and sexually transmitted infection among PWIDs to inform national plans to get to zero. Materials and Methods: Respondent-driven sampling was used to collect drug use, and sexual practices data among PWIDs aged 15 years and older. Blood samples were examined for HIV, herpes simplex virus type 2, syphilis, and hepatitis B. Results: A total of 620 PWIDs with a median age of 32 (interquartile range, 17–52) participated in the study. Their use of drugs had typically started during adolescence. The prevalence of HIV was found to be 15.5%, whereas that of herpes simplex type 2 was 43.3%. Associated with an increased likelihood of HIV infection was being a female (adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.0–3.6), sharing of syringes (aOR, 2.4; 95% CI, 1.1–6.1), used syringes hidden in public places (aOR, 5.1; 95% CI, 1.3–10.2), and having had a genital ulcer during the last 12 months before this survey. On the other hand, being educated, use of noninjectable drugs, access (aOR, 0.5; 95% CI, 0.2–0.8), and use of clean syringes (aOR, 0.3; 95% CI, 0.1–0.6) were associated with decreased likelihood of HIV infection. Conclusions: The prevalence of HIV infection among PWIDs in Dar es Salaam is 3 times higher than that in the general population. Behavioral and biological risk factors contribute to HIV transmission and needs to be addressed to be able to get to zero. The final version of this research has been published in Sexually Transmitted Diseases. © 2017 Lippincott, Williams & Wilkins

• Svendby, Rannveig; Romsland, Grace Inga & Moen, Kåre (2017). The language of percentages: Ranking Bodies, Shaping Realities, and Limiting Opportunities. Disability and Rehabilitation. ISSN 0963-8288. 41(4), p. 382–388. doi: 10.1080/09638288.2017.1390789. Full text in Research Archive Show summary

  Purpose: This exploratory study is situated in a critical tradition. It aims to describe and analyse the reliance on percentage assessments of functional capacity among a group of young adults in rehabilitation after serious motor vehicle accidents. Methods: Qualitative interviews and participant observation. Thematic and theoretically informed analysis was carried out. Results: The concept of percentages played a significant role in the study participants’ meaning-making processes as they went through rehabilitation. Percentage scores below 100 made a strong impression on them and were associated with strong emotions. They also strove to prove their scores wrong, often by attempting to function in full time (100%) employment positions. Significantly, many talked as if they “were” their percentage scores. Conclusions: The utility of percentage logics is to describe parts of that which is full and whole, and we argue that this logic provides for specific and problematic ways of seeing and understanding impairment and disability. When scored on hierarchical scales, functional tests by necessity rank bodies and bodily functions as better or worse while precluding alternative understandings of affected function.

• Mmbaga, Elia John; Moen, Kåre; Makyao, Neema; Mpembeni, Rose & Leshabari, Melkizedeck T. (2017). HIV and STIs among men who have sex with men in Dodoma municipality, Tanzania: a cross-sectional study. Sexually Transmitted Infections. ISSN 1368-4973. 93(5), p. 314–319. doi: 10.1136/sextrans-2016-052770. Full text in Research Archive Show summary

  Objectives: To determine the seroprevalence of HIV, STI and related risks among men who have sex with men (MSM) in Dodoma municipality, Tanzania. Methods: A cross-sectional study using respondent-driven sampling was employed to recruit study participants aged 18 years and above. Data on sociodemographics, HIV/STI knowledge and sexual practices were collected. Blood samples were tested for HIV and selected STIs. Results: A total of 409 participants aged from 18 to 60 years took part in this study. The median age at first anal intercourse was 15 years. At last anal intercourse, 37.5% practiced receptive, 47.5% insertive and 15.0% both insertive and receptive anal intercourse. The seroprevalence of HIV, herpes simplex virus 2 (HSV-2), syphilis, hepatitis B virus and hepatitis C virus were 17.4%, 38.5%, 0.2%, 5.4% and 3.4%, respectively. A third of MSM perceived their risk for HIV to be low and this was associated with unprotected sex (adjusted OR (AOR), 4.8, 95% CI 1.8 to 10.2). HIV seropositivity was also associated with HSV-2 (AOR, 5.0, 95% CI 3.01 to 11.21); having lived outside Dodoma (AOR 1.7, 95% CI 1.1 to 6.7); age above 25 years; (AOR 2.1, 95% CI 1.7 to 3.7); sexual relationship with a woman (AOR 5.6, 95% CI 3.9 to 12.8); assuming a receptive (AOR 7.1, 95% CI 4.8 to 17.4) or receptive and insertive (AOR 4.5, 95% CI 1.9 to 11.4) position during last anal intercourse; engaging in group sex (AOR 3.1, 95% CI 1.2 to 6.1) and the use of alcohol (AOR 3.9, 95% CI 1.1 to 9.2). Conclusions: HIV prevalence among MSM is five times higher compared with men in the general population in Dodoma. Perceived risk for HIV infection was generally low and low risk perception was associated with unprotected sex. STI, bisexuality and other behavioural risk factors played an important part in HIV transmission. The findings underscore the need for intensified HIV prevention programming addressing and involving key populations in Tanzania.

• Moen, Kåre & Middelthon, Anne-Lise Orvin (2015). Qualitative Research Methods. In Laake, Petter; Benestad, Haakon Breien & Olsen, Bjørn Reino (Ed.), Research in Medical and Biological Sciences: From Planning and Preparation ot Grant Application and Publication.. Academic Press. ISSN 9780127999432. p. 321–378. Full text in Research Archive
• Moen, Kåre; Aggleton, Peter; Leshabari, Melkizedeck T. & Middelthon, Anne-Lise Orvin (2014). Gays, Guys, and Mchicha Mwiba: Same-Sex Relations and Subjectivities in Dar es Salaam. Journal of Homosexuality. ISSN 0091-8369. 61(4), p. 511–539. doi: 10.1080/00918369.2014.865457. Full text in Research Archive
• Moen, Kåre; Aggleton, Peter; Leshabari, Melkizedeck T. & Middelthon, Anne-Lise Orvin (2014). Same-Sex Practicing Men in Tanzania from 1860 to 2010. Archives of Sexual Behavior. ISSN 0004-0002. 43(6), p. 1065–1082. doi: 10.1007/s10508-014-0286-2. Full text in Research Archive
• Moen, Kåre; Aggleton, Peter; Leshabari, Melkizedeck T. & Middelthon, Anne-Lise Orvin (2013). Situating condoms in sexual lives: experiences of same-sex-attracted men in Tanzania. International Journal of Sexual Health. ISSN 1931-7611. 25(3), p. 185–197. doi: 10.1080/19317611.2013.804474. Full text in Research Archive
• Mmbaga, Elia John; Leyna, Germana Henry; Moen, Kåre; Dodo, MJ & Leshabari, Melkizedeck T. (2012). Sexual Practices and Perceived Susceptibility to HIV Infection among Men who have Sex with Men in Dar es Salaam, Mainland Tanzania. Journal of AIDS and Clinical Research. Full text in Research Archive
• Moen, Kåre; Aggleton, Peter; Leshabari, Melkizedeck T. & Middelthon, Anne-Lise Orvin (2012). Not at all so hard-to-reach: same-sex attracted men in Dar es Salaam. Culture, Health and Sexuality. ISSN 1369-1058. 14(2), p. 195–208. doi: 10.1080/13691058.2011.632825. Full text in Research Archive
• Middelthon, Anne-Lise Orvin; Moen, Kåre & Høstmark, Arne Torbjørn (2010). The silent life of good fatty tissue, The Taste for Knowledge Medical anthropology facing medical realities. Aarhus Universitetsforlag. ISSN 9788779345157. p. 83–96. Full text in Research Archive

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• Johansen, Ingrid H.; Blinkenberg, Jesper; Arentz-Hansen, Cecilie & Moen, Kåre (2018). Legevakthåndboken, 6. utg. Gyldendal Akademisk. ISBN 9788205506992. 1000 p. Full text in Research Archive
• Johansen, Ingrid H.; Blinkenberg, Jesper; Arentz-Hansen, Cecilie & Moen, Kåre (2015). Legevakthåndboken, 5. utg. Gyldendal Akademisk. ISBN 9788205355798. Full text in Research Archive
• Johansen, Ingrid Hjulstad; Blinkenberg, Jesper; Arentz-Hansen, Cecilie & Moen, Kåre (2012). Legevakthåndboken. Gyldendal Akademisk. ISBN 9788205304826. Full text in Research Archive
• Arentz-Hansen, Cecilie; Moen, Kåre; Andersson, Sven & Birgitta, Hovelius (2012). Jourhandboken. Studentlitteratur AB. ISBN 9789144054131. 982 p. Full text in Research Archive
• Arentz-Hansen, Cecilie & Moen, Kåre (2005). Legevakthåndboken. Gyldendal Akademisk. ISBN 9788205304826. 1088 p. Full text in Research Archive
• Moen, Kåre (2003). Helse på reisen. Gyldendal Akademisk. ISBN 9788205301832. 205 p. Full text in Research Archive
• Arentz-Hansen, Cecilie & Moen, Kåre (1998). Lommelegen. Universitetsforlaget. ISBN 9788200425588. 552 p. Full text in Research Archive
• Arentz-Hansen, Cecilie; Gilbert, mads & Moen, Kåre (1997). Gjør noe, da. Lærebok i livreddende førstehjelp. Sosial- og helsedepartementet. ISBN 9788254902967. 144 p. Full text in Research Archive
• Arentz-Hansen, Cecilie & Moen, Kåre (1997). Legevakthåndboken. Universitetsforlaget. ISBN 9788200415749. 674 p. Full text in Research Archive
• Arentz-Hansen, Cecilie & Moen, Kåre (1993). Legevakthåndboken. Universitetsforlaget. ISBN 9788200410775. 440 p. Full text in Research Archive

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• Jensenius, Alexander Refsum; Sandve, Geir Kjetil Ferkingstad; Boasson, Elin Lerum; Mjaaland, Marius Timmann; Skjelkvåle, Brit Lisa & Moen, Kåre [Show all 7 contributors for this article] (2026). What can the Centre for Global Sustainability do for UiO – and the other way around? Full text in Research Archive
• Haaland, Inga; Kristiansen, Hans Wiggo; Metta, Emmy & Moen, Kåre (2024). The Stigma of biomedical HIV Prevention among transgender women and men who have sex with men in Dar es Salaam. Full text in Research Archive Show summary

  Paper Short Abstract: The PrEP pill, intended to prevent HIV, also puts users at risk of different types of stigmatization related to gender, promiscuity and HIV. Social anthropology enables us to examine global health critically, explore the users' lived experiences, and understand what stigma means to PrEP users. Paper Abstract: Based on 11 months of ethnographic fieldwork following a Pre-exposure prophylaxis (PrEP) study for men who have sex with men and transgender women in Dar es Salaam, this study observed how the PrEP pill, intended to prevent HIV, also put users at risk of experiencing several types of social stigmatization. Anthropological perspectives and methods enable us to examine global health interventions critically, explore the users' lived experiences and employ theory to make sense of what, in this example, stigma means to PrEP users. Stigma was, above all, related to social exclusion when living with HIV, and being identified as a PrEP user might be (mis)read by the users' social environment to indicate HIV positivity. In this respect, PrEP use was mistaken for the use of ARVs. While neither PrEP use nor living with HIV was mainly linked to homosexuality, men who have sex with men were targets for PrEP interventions; PrEP users ran the risk of being stigmatized as "homosexual" or "gay". Lastly, for persons assigned male gender at birth who did sex work, PrEP became an important HIV preventative measure and enabled safer sex and more partners. However, the social risk of exposing PrEP use to clients was, for some, a constant concern, as their status as PrEP users could mark them off as promiscuous and as living with HIV. These findings show that HIV stigma persists and that interventions aimed at biomedically preventing HIV transmission may have the somewhat paradoxical effect of triggering different forms of stigmatization.

• Mikomangwa, Wigilya P.; Moen, Kåre; Mmbaga, Elia; Metta, Emmy; Kibusi, Stephen M. & Leshabari, Melkizedeck Thomas [Show all 8 contributors for this article] (2024). PrEP prevention-effective adherence among women at high risk of HIV: control-arm analysis of pragmatic trial. Full text in Research Archive Show summary

  Background: Prevention-effective adherence is of critical importance but challenging particularly among key populations where periods of high HIV risk are frequent. Pre-exposure prophylaxis (PrEP) prevention effective adherence involves aligning the use of PrEP pills with unprotected sex practice. PrEP Prevention-effective adherence among female sex workers is understudied globally. Objective: To determine PrEP prevention-effective adherence among female sex workers in Tanga, Tanzania. Methodology: This was part of the pragmatic quasi-experimental trial for HIV pre-exposure prophylaxis rollout in Tanzania (PREPTA) involving a control cohort of 313 female sex workers ≥18 years of age recruited using respondent-driven sampling and followed for 12 months. PrEP use and sexual behaviour were assessed at the 6th and 12th month of follow-up. Modified Poisson regression analysis was conducted to determine factors influencing PrEP at p <0.05. Results: Prevention-effective adherence among participants who had unprotected vaginal sex was 10.1% (month 6) and 3.8% (month 12). Also, the prevention-effective adherence among participants who had unprotected anal sex was 8.0% (month 6) and 10.0% (month 12). The use of ≥2 PrEP doses/week was associated with living with friends (aPR=25.5; 95%CI: 2.55-255.42, p=0.006), self-perceived health status (aPR=17.4; 95%CI: 3.01-101.02, p=0.001), refusing unprotected sex with steady partner (aPR=11.2; 95%CI: 1.55-80.48, p=0.017) and accepting unprotected sex at high pay (aPR=0.1; 95%CI: 0.03-0.26, p=0.000). Conclusion: PrEP use during unprotected sex was rare among female sex workers. Living with friends and refusing unprotected sex with steady partners were determinants of PrEP use. However, accepting unprotected sex for increased payment was significantly associated with lower PrEP use. This calls for an in-depth study to understand the circumstances shaping poor adherence during periods of unprotected sex among female sex workers.

• Litchwarck, Hanne; Moen, Kåre & Mmbaga, Elia (2023). Mental health and social vulnerability among HIV negative female sex workers in Tanzania – a cross-sectional analysis of data from a female sex worker cohort. Full text in Research Archive Show summary

  Introduction: Poor mental health is closely linked to sex work and HIV risk, but has received limited attention in research among female sex workers in Sub-Saharan Africa. Inspired by syndemic framework, which recognizes that the epidemics of HIV, substance use and poor mental health are interrelated, we investigate mental health outcomes among female sex workers at high risk of HIV in Tanzania. Methods: Data from a cohort of female sex workers initiating HIV pre-exposure prophylaxis use (PrEP) in Dar es Salaam was analysed. Participants were recruited through respondent driven sampling (RDS), and interviewed about depression (PHQ-2), anxiety (GAD-2) and hazardous alcohol use (AUDIT). We conducted weighted descriptive analysis and assessed sociodemographic predictors of mental distress (positive screen for PHQ-2, GAD-2 or both) using modified Poisson regression with robust standard errors. Results: A total of 470 women with a median age of 25 years were recruited. Nearly a third (n=143; 30%) screened positive for mental distress (n=106; 25.3% for depression, n=89; 18.4%, for generalized anxiety). More than two thirds (n=360; 69.6%) were categorized with hazardous alcohol use (AUDIT≥8). Predictors of mental distress were less social support (aPR=1.37, CI: 1.05-1.79) and working outside a bar setting (aPR= 1.52 CI: 1.13-2.06). Sex work stigma showed borderline significance (aPR=1.34, 0.99-1.80). Discussion: Our findings indicate that female sex workers in Tanzania are vulnerable to poor mental health outcomes, which is related to social disadvantage. Health programs and initiatives should acknowledge the presence of syndemics by offering comprehensive interventions that meet the range of health needs of female sex workers.

• Litchwarck, Hanne; Moen, Kåre & Mmbaga, Elia (2023). Good self-reported health and associated factors among HIV negative female sex workers in Tanzania – a salutogenesis perspective. Full text in Research Archive Show summary

  Introduction: Female sex workers carry a heavy burden of HIV and are disproportionally affected by unfavourable social determinants like poverty and violence. Research among this group often have a “risk-focus”, but might end up overlooking factors that contribute to better health. Inspired by “salutogensis”: a scholarly orientation that focuses on factors supporting health, we assessed self-reported health and predictors of good self-reported health among a cohort of HIV negative female sex workers starting PrEP in Tanzania. Methods: Female sex workers were recruited by respondent driven sampling and interviewed using a standardized questionnaire. Self-perceived health was measured using a five-point scale from “excellent” to “poor” and frequencies was weighted in descriptive analysis. We assessed if sociodemographic (age, marital status, education, income), social (social support, stigma) and sex work factors (self-perceived HIV risk, number of clients, age first sold sex) were predictors of good self-reported health (merging “excellent”, “very good” or “good”) using bivariate and multivariable modified poisson regression. Results: Of 470 participants, 81 (16.2%) described their health as excellent/very good, 359 (79.0%) as good, and 30 (6.3%) as fair/poor. Being < 24 years compared to >35 (PR=1.16, 95%CI: 1.01-1.33) having higher education (PR=1.06, 95%CI: 1.00-1.11), never being married/single (PR=1.08, 95%CI: 1.01-1.16), and having high level of social support (PR=1.08, 95%CI=1.02-1.14) predicted the outcome in bivariate analysis. Social support (aPR=1.08, 95%CI: 1.02-1.14) and marital status (aPR=1.08, 95%CI: 1.01-1.16) were independently associated with good self-reported health in the final model. Discussion/Implications: Despite being a key population vulnerable to disadvantageous disease-outcomes, the majority of the female sex workers in this cohort reported good health. Introducing a perspective founded on “salutogenesis”: i.e. a stronger focus on factors that promote health among female sex workers, such as building social ties, not merely avoiding disease and individual risk, can be a welcomed addition to health programs and policy.

• Moen, Kåre (2023). Kvalitativ forskning i medisin. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(12). doi: 10.4045/tidsskr.23.0411. Full text in Research Archive
• Mbotwa, Christopher; Kazaura, Method Rwelengera; Moen, Kåre & Mmbaga, Elia (2022). Preliminary effect of mHealth intervention on PrEP engagement among female sex workers in Dar es Salaam, Tanzania. Full text in Research Archive Show summary

  Background: Female sex workers are among groups at increased risk of HIV infection. In Tanzania, HIV prevalence among FSW is more than twice as high as other women in the general population. Pre-exposure prophylaxis (PrEP) has been proven to be effective in preventing HIV transmission, but low retention to services poses a challenge to its effectiveness. Innovative interventions to tackle the problem and help achieve universal health coverage goals are called for. Objective: To determine the preliminary effect of mHealth application on PrEP services engagement among female sex workers in Dar es Salaam. Methods: Using respondent driven sampling, 470 female sex workers eligible for PrEP and who owned a smartphone were recruited. All participants were provided with a smartphone-based mHealth app (Jichunge app) designed to promote PrEP use and retention among HIV at risk population. We utilized information collected during the baseline, follow-up, and data on the use of Jichunge app for a period of 30 days. The effect of Jichunge intervention on PrEP services engagement was assessed using generalized Poisson regression model. Results: Of 470 recruited participants, 253 (53.8%) were engaged in PrEP services in 6 months following the initiation of PrEP. Engagement in PrEP services was significantly higher among those who opened the Jichunge app after installation (APR=1.4, 95% CI: 1.13-1.85), used gamification functions (APR=1.5, 95% CI: 1.18-1.89), visited PrEP editorial contents (APR=1.4, 95% CI:1.16-1.67), consulted a doctor or peer educator (APR=1.5, 95% CI:1.29-1.79), or engaged in the discussion with other PrEP users (APR=1.4, 95% CI:1.17-1.62). Conclusion: The use of Jichunge mHealth application significantly increased PrEP services engagement among female sex workers in Dar es Salaam. The results indicate that use of mHealth interventions hold potential to promote universal health coverage in a cascade of PrEP and other related interventions. Recommendations: mHealth interventions should be incorporated in implementation of the PrEP roll-out to promote utilization of PrEP services among the targeted populations. Studies that compare between intervention and control, as well as specific PrEP cascade such as retention in clinical care and adherence to PrEP are needed for further evidence.

• Litchwarck, Hanne; Moen, Kåre & Mmbaga, Elia (2022). Perceived pre-exposure prophylaxis stigma among female sex workers: A potential barrier for intervention effectiveness. Full text in Research Archive Show summary

  Introduction: The antiretroviral medication pre-exposure prophylaxis (PrEP) provides 99% protection against HIV infection if taken daily. While PrEP is being rolled-out in Tanzania to female sex workers, uptake and adherence has proven to be a challenge during the demonstration trial in the country and beyond. Perceived PrEP stigma, the idea that people may come to stigmatize you because of taking PrEP, has been identified as a potential barrier to intervention effectiveness. Objectives/Aims: To assess perceived PrEP stigma and associated predictors among female sex workers initiating PrEP in Dar es Salaam. Methodology: Using respondent driven sampling, female sex workers in Dar es Salaam were recruited to a study in collaboration with a health clinic offering PrEP. We used a 5-point 10 item Likert scale to assess perceived PrEP stigma at baseline, with Cronbach’s alpha of 0.84. The stigma scale was dichotomized at score > 3 reflecting “higher perceived stigma”. We conducted bivariate analysis to assess for predictors, with confidence level at 5%. Results: A total of 470 female sex workers with a median age of 26 years (IQR:22-30) were recruited. More than half (58.9%, 95% CI: 36.7-45.6) had some secondary education. The median stigma score was 2.4 (IQR 2-3). A quarter (24.3%, 95% CI: 20.6-28.4) experienced “higher perceived stigma”. Factors associated with higher levels of perceived stigma were low social support (OR: 1.8, 95% CI: 1.2-2.8), limited access to condoms (OR 1.8, 95% CI:1.1-3.1) and having fewer clients per month (p-value 0.01). Conclusion: Higher perceived PrEP stigma was present among a quarter of female sex workers initiating PrEP in Dar es Salaam, with low social support, limited access to condoms, and having few clients being associated factors. We have not found any study of female sex workers that have examined this construct using a comparable scale limiting the opportunity for cross-context comparisons. Recommendation: Findings suggests that addressing socio-structural factors alongside PrEP provision can be important for the PrEP continuum of care.

• Litchwarck, Hanne; Mmbaga, Elia & Moen, Kåre (2022). Unprotected sex among female sex workers in Dar es Salaam: support for the ongoing scale up of pre-exposure prophylaxis in Tanzania. Full text in Research Archive Show summary

  Background: The HIV epidemic disproportionally affects female sex workers in Tanzania with 15% of female sex workers living with HIV in Dar es Salaam. Condoms is one important prevention tool, while Pre-exposure prophylaxis (PrEP), antiretroviral daily medication used as HIV prevention, currently is being introduced. We reflect on the need to scale-up this biomedical intervention based on estimated rates of unprotected sex prior to PrEP initiation. Methods: We collected data from a cohort of 470 FSW initiating PrEP in Dar es Salaam from March-July 2021 using respondent driven sampling. Weighted prevalence for sexual practices were calculated using STATA/SE 16.0. Results: Half (50.7%) reported to have had unprotected sex at last vaginal sex with clients. Of the 28.2 % who reported ever having had anal sex with clients, half (50.4%) did not use condom during last anal sex. The majority had steady partner(s) (64.4 %), and 85.2 % reported not using condom at last vaginal sex with this partner(s). For the 10.7 % of women reporting to have anal sex with a steady partner, 81.4% did not use condom last anal sex. Only 45.4 % agreed with the statement “using a condom every time during anal sex reduces the risk of HIV transmission”. Reasons for not obtaining a condom when needed were cost, stockout, not knowing where to obtain it, being drunk and things happening too fast. Close to half reported to have accepted condomless sex for more pay (46.9 %), while 48.0 % reported to have refused sex with a partner who opposed condom use. Discussion: Unprotected sex was common among female sex workers initiating PrEP in Dar es Salaam. Non-use was related to individual, social and structural constraints, highlighting the obstacles to condom use well known from previous research. The need for access to additional ways of protecting oneself from HIV infection seems clear, and this is among the reasons why the ongoing scale-up of PrEP in Tanzania may be of considerable importance.

• Haaland, Inga; Metta, Emmy & Moen, Kåre (2022). The role of Pre-Exposure Prophylaxis as HIV prevention for men who sell sex to other men in Dar es Salaam. Full text in Research Archive Show summary

  Background: Men who sell sex to other men are twice as likely to be infected with HIV compared to other men who have sex with men. PrEP use is very effective for preventing HIV infection among at risk populations including men who sell sex to other men. PrEP is freely available to key and vulnerable populations in Tanzania. However, there is limited information on PrEP use among men who sell sex to other men in Tanzania. Aim: Explore the role of PrEP as HIV prevention among male born persons who sell sex to other men. Method: This ethnographic field work and qualitative interviews was conducted between January 2021 and April 2022 in Dar es Salaam. In this paper, we focus on the findings from interviews with 16 participants who said they did ‘Ngono Pesa’, sex for money. Results: Participants saw several benefits with PrEP, as it provided safer working conditions and could facilitate condomless sex. Sex without a condom had a higher market price and was perceived to reduce pain associated with the unlubricated condoms in receptive anal sex. PrEP thus facilitated an increased number of clients per day. Regarding challenges, some clients mistook PrEP for HIV treatment, non-adherence to PrEP and stock-outs. The lack of PrEP could lead to either unprotected sex or temporary service disruption. Conclusion: As HIV prevention, PrEP were instrumental for men who sell sex. PrEP also facilitated less painful working conditions and contributed to a higher income. PrEP also caused challenges, such as loss of income for those who were perceived to be HIV positive by their clients. Secondly, unavailability of PrEP during travels and stock-outs put participants at risk of contracting HIV.

• Haaland, Inga; Metta, Emmy & Moen, Kåre (2021). Pre-exposure prophylaxis as HIV prevention in Dar es salaam: Perceptions and experiences among men who have sex with men and transgender women. Full text in Research Archive
• Mbotwa, Christopher; Mauka, Wilhellmuss; Lichtwarck, Hanne; Haaland, Inga; Kazaura, Method Rwelengera & Metta, Emmy [Show all 9 contributors for this article] (2021). mHealth interventions to enhance adherence to PrEP among Female Sex Workers in Tanzania: Lessons from the field. Full text in Research Archive Show summary

  Background: Pre-Exposure Prophylaxis (PrEP) is a recent biomedical tool recommended for HIV prevention among populations at increased risk. PrEP effectiveness largely depends on users’ adherence to medication but it has been a challenge in most trials. In Tanzania, the plan for roll-out are ongoing. However, poor adherence is one of the anticipated challenges. mHealth has emerged as one of the ways of promoting adherence in different medications. Aim: The aim is to highlight various challenges we experienced when implementing research on mHealth among female sex workers (FSW) in Tanzania. Methodology: This is pragmatic quasi-experimental study being implemented in Dar es Salaam (intervention) and Tanga (control). Respondent driven sampling was used to recruit 471 FSW in Dar es Salaam. All participants recruited were an mHealth app, a smartphone-based application called Jichunge. A subset of the sample was also invited to take part in qualitative interview. The findings for this study are based on the qualitative interviews and participant observation. Results: We experienced several challenges relating to phones and the app itself when enrolling participants to the Jichunge app. The lessons we learned includes the importance of having site equipped with all facilities for charging phones, strengthening screening for the ownership of phone as some participants could borrow phones, considering mHealth interventions accessible to both user and non-users of smartphone as well as online and offline services. Conclusions: Some prospective participants who did not had own smartphone wanted to take part in Jichunge intervention. In our case, to get access to PrEP was considerably more important to some people than to be straight forward about their phone ownership. We assume that many of the points we raise will be of relevance to consider also in other mHealth studies. Recommendations: To maximize usability of mHealth interventions in Tanzania and other developing countries, services accessible via non-smartphone and offline should be put forward. Early and continuously follow-up on people who stop using the mHealth is useful in mapping some issues relating to the app.

• Mauka, Wilhellmuss; Litchwarck, Hanne; Mbotwa, Christopher; Haaland, Inga; Kazaura, Method Rwelengera & Metta, Emmy [Show all 9 contributors for this article] (2021). The use of Jichunge app on Pre-exposure Prophylaxis adherence Among Men Who Have Sex With Men in Dar es Salaam Tanzania. Full text in Research Archive Show summary

  Background: Jichunge app is a mHealth intervention in a quasi-experimental study introduced to support PrEP adherence among Men who have Sex with Men (MSM) in Dar es Salaam Tanzania. Hence, this preliminary analysis aims to determine the Jichunge app use among MSM. Methods: A respondent-driven sampling (RDS) was used to recruit MSM between 23rd March 2021 and 17th July 2021. Through their mobile phones, the intervention group was installed with the Jichunge app and had access to register their daily PrEP, editorial & health educational content, a chatting forum with their peers, and online consultation with a doctor or peer educator expected to be followed for 12 months. The descriptive analysis was carried out to describe user status, accessing the app’s features, and drug registration. Results: A total of 422 MSM were involved in this analysis, whereby observation time was from 23rd March - 23rd July 2021, contributing 2073 days of data. MSM ever used the app overall, first and the third month from recruitment were 56.2%, 56.7%, and 89.8%, respectively; 51% ever visited editorial & health educational contents, 57.6% ever used chat forum, and 26.8% ever used online consultation. Overall, eighty-three percent (83%) ever registered their PrEP at least once into the app. Conclusion: The use of the Jichunge app and its features are optimum and may improve over time.

• Lichtwarck, Hanne Ochieng; Kazaura, Method Rwelengera; Mmbaga, Elia & Moen, Kåre (2021). Sex worker stigma among female sex workers initiating PrEP in Dar es Salaam Preliminary analysis from baseline data collection in the PREPTA study. Full text in Research Archive Show summary

  Introduction: Female sex worker stigma is an understudied social determinant of health. In the context of HIV/AIDS studies have found that FSW stigma can pose a barrier both to access prevention and treatment services. Methods: We did a baseline survey of 471 FSW in Dar es Salaam initiating pre-exposure prophylaxis (PrEP). The participants were recruited using respondent driven sampling. Interviews covered several topics of relevance to PrEP, including a 13 point item 4 item validated FSW stigma scale where statements reflected perceptions and experiences of being a FSW. Additionally we did qualitative interviews with 25 FSW. Results: Median stigma scale score was 30 (IQR 27-35), a lower score compared to another study conducted in a different region of Tanzania. A majority of respondents expressed agreement with four of the five positively phrased statements such as “You like your job as a sex worker” (73.4% either agreed or completely agreed). Additionally a majority indicated disagreement with seven of eight negative phrased statements such as “Working as a sex worker makes you feel like a bad person” (66.6% either disagreed or completely disagreed). Qualitative data indicated that several of the women had experienced or felt stigma related to their profession and one participant explained that this could for instance impede participation in research. However, several expressed that they saw sex work as any other work and had become self-assured as people able to sustain themselves and in many cases their family members. Discussion: These preliminary findings shows a nuanced picture of these sex workers own perspectives related to their work, stigma and themselves, and opposes a view of FSW as victims devoid of agency and self-assurance.

• Mauka, Wilhellmus; Moen, Kåre; Mbotwa, Christopher & Mmbaga, Elia John (2020). Jichunge mobile application: Key population group orientation and piloting. Full text in Research Archive
• Andreassen, Trude; Melnic, Adriana; Figueiredo, Rejane Augusta de Oliveira; Moen, Kåre; Şuteu, Ofelia & Nicula, Florian [Show all 8 contributors for this article] (2019). Correction to: Attendance to cervical cancer screening among Roma and non-Roma women living in North-Western region of Romania (International Journal of Public Health, (2018), 63, 5, (609-619), 10.1007/s00038-018-1107-5). International Journal of Public Health. ISSN 1661-8556. 64(6), p. 977–978. doi: 10.1007/s00038-019-01263-8. Full text in Research Archive
• Mmbaga, Elia John; Leshabari, Melkizedeck T.; Leyna, Germana Henry; Kazaura, Method Rwelengera & Moen, Kåre (2019). Presentation of the PREPTA project in a kick-off seminar. Full text in Research Archive
• Moen, Kåre (2018). Virkninger av legemiddelutprøving – i sin fulle bredde. Forskningsetikk. ISSN 1502-6353. Full text in Research Archive
• Moen, Kåre (2018). Entusiastisk om kvalitativ metasyntese. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: 10.4045/tidsskr.18.0078. Full text in Research Archive
• Rodriguez, Annika & Moen, Kåre (2011). A Critical Analysis of Norwegian Development Policy on Sexual Orientation and Gender Identity. Culture, Health and Sexuality. ISSN 1369-1058. 13, p. S129–S129. Full text in Research Archive
• Moen, Kåre & Middelthon, Anne-Lise Orvin (2010). Is it really the case that African same-sex attracted men are hard to reach? Full text in Research Archive
• Moen, Kåre (2010). Blaming exclusion on the Excluded: Public Health Discourse on African Same-Sex Attracted Men. Full text in Research Archive
• Moen, Kåre & Middelthon, Anne-Lise Orvin (2010). Gays, and Men who Like Gays: Selfunderstandings, sexual roles, gender expressions and the challenge of HIV among same-sex attracted men in Dar es Salaam, Tanzania. Full text in Research Archive
• Moen, Kåre (2010). Seksuell orientering og kjønnsidentitet i internasjonalt arbeid. Full text in Research Archive
• Moen, Kåre (2009). Easy-to-reach MSM in Africa. Full text in Research Archive
• Moen, Kåre & Middelthon, Anne-Lise Orvin (2009). Othering African same-sex attracted men. Full text in Research Archive
• Middelthon, Anne-Lise Orvin; Moen, Kåre & Høstmark, Arne Torbjørn (2008). The silent life of (good) fatty tissue. Full text in Research Archive
• Lichtwarck, Hanne Ochieng; Moen, Kåre & Mmbaga, Elia (2024). Pre-Exposure Prophylaxis Use among Female Sex Workers in Dar es Salaam, Tanzania: a Mixed-Methods Study. Universitetet i Oslo. ISSN 9788234804564. Full text in Research Archive Show summary

  Sex-workers in low-and middle income countries, including in Tanzania, are at increased risk of HIV. Pre-exposure prophylaxis (PrEP) taken as a daily oral drug is efficacious in preventing HIV. However, studies have shown suboptimal engagement with services providing PrEP. This thesis aimed to provide some of the first evidence on PrEP usage among female sex workers in Tanzania, including perceptions and experiences with PrEP and estimate disengagement with services and potential influencing factors, including harmful alcohol use. A total of 470 HIV negative female sex workers (≥18 years) living in Dar es Salaam were recruited through respondent-driven sampling. They were surveyed at baseline when initiating PrEP and their attendance was registered at first clinical follow-up (month 1). Qualitative interviews were also conducted with 40 female sex workers who were former or current PrEP users or who intended to start PrEP. Almost three quarters (74.6%) of the women did not attend the first follow-up appointment, and this was independently associated with mental distress. Older age and having more clients were protective factors for disengagement with PrEP services. Harmful alcohol use was prevalent (37.3%) and independently associated with experiences of arrest, gender-based violence and mobility. Harmful alcohol use was not associated with disengagement. PrEP had multiple and diverse effects, referred to as the “effectosphere” of PrEP. Despite high disengagement, PrEP could lead to empowerment and human flourishing by enabling a sense of freedom and confidence which could promote health, economic opportunities and social relations. However, PrEP could also expose sensitive information leading to stigma, arguments, create fear of harms and medicalize aspects of life. The findings indicate that PrEP is relevant for female sex workers, but PrEP needs to be integrated into holistic HIV prevention strategies that takes into account their complex social circumstances.

• Cavallo, Simon; Lichtwarck, Hanne Ochieng; Moen, Kåre & Mmbaga, Elia (2022). Prevalence of substance use and its association with sexual behaviours among men who have sex with men in Dar es Salaam, Tanzania. Universitetet i Oslo. Full text in Research Archive
• Moen, Kåre (2015). Emerging Grassroots Organising Among Same-Sex Attracted Men in Dar es Salaam. Universitetet i Oslo. Full text in Research Archive Show summary

  This master thesis deals with same-sex attracted men in Dar es Salaam, and the grassroots activism that such men have increasingly set into motion over the past five years. Drawing on 6.5 months of fieldwork in 2014, but also on fieldwork carried out in 2008/09, the thesis explores established and emerging forms of same-sex subjectivities and relations in the Tanzanian metropolis; describes grassroots activism against HIV and for rights; analyses the role public health has played for and in this mobilisation; and describes the emerging role and influence of western aid and LGBTI organisations. In the thesis, I first engage critically with the multiplication of western discourses that represent the African continent as homophobic through and through, and juxtapose this discursive production with some accounts of everyday, same-sex attracted lives in Dar es Salaam. I thereafter try to localise grassroots activism in the lived city, and to trace the ways in which grassroots organisations are linked to other entities, locally, regionally, and globally. I go on to identify significant discourses and controversies in which same-sex attracted lives and gei activism is entangled, and try to show the role that actors representing the realms of public health and global gayness play in the ongoing mobilisation. Towards the end of the thesis, I also engage with the economy of grassroots organising, and the market-like ways in which it often appears to be organised. The thesis describes a rich and vibrant same-sex sexual culture in Dar es Salaam; shows how grassroots mobilisation among same-sex attracted men is predominantly organised and performed by the poor; demonstrates how this activism was in part helped into being by the field of public health; detects emerging strains in the relation between public health and grassroots actors; and encounters the emerging presence of collaboration partners from western aid and LGBTI entities in Dar es Salaam. In a short final comment, I consider grassroots activism in Dar es Salaam as located betwixt and between ushoga, global gayness, and medicalised same-sex relations.

• Mmbaga, E.J.; Mpembeni, Rose; Moen, Kåre & Leshabari, Melkizedeck T. (2014). Prevalence of HIV, other STI, and health-related perceptions, reflections, experiences and practices among men having sex with men in Dar es Salaam. Muhimbili University of Health and Allied Sciences. Full text in Research Archive
• Moen, Kåre & Middelthon, Anne-Lise Orvin (2013). Same-Sex Attracted Men in Dar es Salaam 30 Years into the HIV Epidemic: A Qualitative Study. Universitetet i Oslo. ISSN 9788282645669. Full text in Research Archive
• Moen, Kåre (2007). Katastrofen som rammet landet vi flyktet fra: Tsunamien i et acehnesiske eksilperspektiv. Nasjonalt kunnskapssenter om vold og traumatisk stress. ISSN 9788281220171. Full text in Research Archive

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