(July 2005) Small fishing and farming villages dot the rural landscape along the Indian Ocean on Tanzania ‘s northern coast. Local men have fished for subsistence in this area for generations, while women have traditionally managed households and acted as primary caregivers.

But over the past several decades, the fish trade has lured greater numbers of nonlocal fisherfolk, brokers, and entrepreneurs to the region. And this influx of a highly mobile male population has combined with chronic poverty, the low status of women, and a growing sense of hopelessness to generate a culture of high-risk behavior—particularly regarding sex—in these communities. As a result, HIV prevalence rates in northern coastal Tanzania are said by health workers there to be two to three times higher than the country’s national rate of 7 percent for sexually active adults ages 15 to 49.1

Women who now must contribute significantly to their household incomes but who lack options to do so have turned in increasing numbers to sex work—a practice that has facilitated the spread of the epidemic. HIV/AIDS is now an important part of a vicious spiral of poverty, natural resource degradation, and ill health in these communities. Interventions to address these issues must deal with their integrated nature—especially with how indigenous gender roles place both men and women at heightened risk for contracting HIV.2

Male Mobility, Masculinity, and HIV/AIDS

Migrant fishermen and businessmen from local villages and as far away as Dar es Salaam, Zanzibar, and Tanzania’s inland cities travel up and down the northern Tanzanian coast for four to six months annually to fish or to engage in trading, marketing, and transportation activities related to the fish and seafood business. In villages such as Saadani—whose population swells from 1,900 to 3,000 during the high fishing season of March to June—new bars, eating places, and lodges catering to the migrant workers have become intersections for alcohol, drugs, and sex.

These male migrants have formed new sexual networks that have increased the opportunities for HIV to spread into many of the small fishing and farming villages in the area as well as the migrants’ home communities. Many migrants are also ill-informed about condom use and HIV/AIDS generally: Studies done in Tanzania found that fishers were five times more likely to die of AIDS and other causes than are farmers in the same region.3

These men are also rendered more vulnerable to infection by the existing gender relations and prevailing power structures within their communities. In addition to the boredom and loneliness of these jobs, the men endure dangerous and unpleasant working conditions, poor accommodations, and isolation. They often respond to these conditions with exaggerated “masculinity” and sexual bravado. Alcohol consumption is extremely high in Tanzanian fishing communities, and taking multiple sex partners and hiring sex workers are common and socially acceptable practices.

‘We Risk Dying From AIDS for the Sake of Our Children’

Women have always had primary responsibility in northern coastal Tanzania for rearing children and ensuring sufficient resources to meet family needs. But new economic and social factors—including declining fish catches, reduced agricultural productivity, and husbands spending more money on alcohol and sex—have driven women in these communities to seek cash income to support their households.

Such opportunities have been dwindling, however. Farming has become less attractive: Increased shoreline and near-shore ocean water temperatures during the past two years have killed off large portions of seaweed farms, and disease and marauding wildlife have decimated cashew and fruit crops. Women in Tanzania also have severely limited access to education, employment, credit, and transportation. As a result, northern coastal women—married and unmarried, young and old—are increasingly turning to sex work, exposing them to a high risk of HIV infection.

“We accept that it is now the female burden to provide for our children,” says a woman from Mkwaja village. “We risk dying from AIDS for the sake of our children.”

The true scope of HIV prevalence in the coastal region is not known because of low diagnostic and testing rates. But local Tanzanian health workers use the significant increase in opportunistic disease cases there to estimate that between 12 percent and 20 percent of coastal Tanzanian women are infected with HIV. According to hospital records from Pangani District on the northern coast, HIV prevalence among those tested there in 2004 was 29 percent for females and 17 percent for males. (Fifty-eight percent of all Tanzanian adults living with HIV/AIDS are women.)

Yet few women choose to undergo testing because of persistent stigma in these communities regarding HIV. “We are afraid to know our HIV status,” explained one woman in the tiny village of Sange, “because knowledge will hasten death, and our husbands will divorce us before we die.”

In addition, women and teenage girls everywhere are especially vulnerable to HIV infection for biological, social, and cultural reasons. Girls in these communities typically marry at ages 12 or 13, often just after their first menstrual bleeding. Cultural and religious norms allow men to take several wives, so that young girls are often married to much older, sexually experienced men. Furthermore, women are more likely to be asymptomatic of sexually transmitted infections (STIs) and less likely to seek treatment for STIs, which increases the likelihood they will contract HIV.

Poverty From HIV/AIDS Also Contributes to Natural Resource Degradation and Food Insecurity

Because HIV/AIDS often affects people in their prime working ages—between ages 25 and 45—the poverty that the epidemic precipitates can have deleterious impacts on agricultural productivity and natural resources. These impacts can hit particularly hard in a region such as northern coastal Tanzania, where livelihoods are highly dependent on agriculture and fishing.

As men and women die or become too ill to work, family members are forced to find new ways to provide for their families. The loss of income from a male head-of-household puts additional burdens on his wife and children to find alternative sources of income, which can ultimately lead to more intense and less-sustainable resource use and extraction.

In northern coastal Tanzania, such alternative practices often include unsustainable harvesting of forests and forest products such as wild foods and medicinal plants, which are then sold at local markets. Increased woodcutting to produce charcoal for sale is also common, especially when families face severe food shortages and must secure cash quickly to buy food. And the use of small-mesh nets for both marine and freshwater fishing has increased as widowed women and their children try desperately to make a living from declining shallow-water fish stocks.

The impacts of HIV/AIDS also often exacerbate vulnerability to food insecurity and cyclical poverty. Without men to undertake the heavy labor of plowing and harvesting, women must sometimes substitute less labor-intensive (and less-nutritious) crops such as maize for beans. Children also become more involved in chores such as water and firewood collection, and their attendance at school becomes less of a priority.

Only Multifaceted Interventions Will Work

Understanding the different perceptions, roles, and responsibilities of men and women—and the culturally constructed power relations between them—is crucial for effectively addressing the root causes of coastal Tanzania’s most pressing issues.

For women, interventions should aim to provide women with increased autonomy over and diversification of income-generation activities; improved access to health care (including voluntary counseling and testing services); and educational services regarding nutrition, HIV/AIDS, and inheritance rights. Leadership development training and increased opportunities to participate in decisionmaking processes are equally crucial.

Men also require opportunities for livelihood diversification, access to information about HIV/AIDS, and an active role in the management of the coast’s natural resources. The strong links between poverty, mobility, and HIV/AIDS will require integrated, creative solutions that focus on promoting gender equality, increasing awareness about HIV/AIDS, and developing viable and sustainable livelihoods.

Melissa Thaxton is a policy analyst at PRB.


  1. USAID, “Tanzania HIV/AIDS Indicator Survey (THIS)” (Dar es Salaam: USAID/Tanzania, Dar es Salaam, 2005).
  2. This article is based on information gathered in January and February 2005 for a threats assessment for the Population, Equity, AIDS, and Coastal Ecosystems Project (PEACE). Funded by USAID, PEACE is a pilot project designed to explore the links among HIV/AIDS, population, and the environment in Tanzania. The threats assessment was conducted by PRB; the University of Rhode Island’s Coastal Resources Center (URI/CRC); IUCN-The World Conservation Union; and the Tanzania Coastal Resource Management Project (TCMP).
  3. Martha Ainsworth and Innocent Semali, “Who is Most Likely to Die of AIDS? Socioeconomic Correlates of Adult Deaths in Kagera Region, Tanzania,” paper presented at the 13th International Conference on HIV/AIDS, July 8-14, 2000, Durban, South Africa.