A Cry for Leadership to Conquer HIV/AIDS in Ethiopia
By Abdul Mohammed
March 26, 2002
†† Last Tuesday, one thousand young people packed out the United Nations conference centre in
†† Addis Ababa for a question-and-answer session with Stephen Lewis, UN Secretary-Generalís
†† special representative for AIDS in Africa. It was a remarkable experience. The young peopleís
†† questions were fresh and direct, revealing a tremendous hunger for information about this
†† disease, an eagerness to learn, and a directness in confronting the core issues of sexual
†† behaviour. Some of their questions betrayed ignorance, for example about the effectiveness of
†† condomsóquestioners did not know that there are international standards that condom
†† manufacturers must meet if they are to sell their product.
†† According to these young people, elders are not communicating seriously with them including
†† the government. In this country, HIV/AIDS is still clouded in a conspiracy of silence. Those
†† who are HIV positive rarely admit the fact, and when someone dies of AIDS, it is commonly
†† said that he or she has died of meningitis or tuberculosis. Yet with more than three million
†† Ethiopians living with HIV and AIDS, our country is one of the worst affected in the world.
†† Africaís youth are increasingly recognized as a vitally important population group and social
†† category. Given Africaís rapidly expanding population, the population is skewed towards
†† younger age categories, so that youth hugely outnumber their elders. Social change and
†† economic development are strongly driven by this fact, while the marginalization of young
†† people in political structures contributes too much to political tension and distortion.
†† HIV/AIDS is the number one threat to Ethiopiaís young people. The median age of
†† infection for women in Africa is late teens, implying that a substantial minority of girls are HIV
†† positive before they turn 18. For men, the median age of infection is early or mid 20s. Young
†† women are both biologically and socially vulnerable to HIV. It is only by focussing on young
†† people that it will be possible to halt the HIV/AIDS pandemic, but we should not overlook other
†† communicable diseases, including especially STIs, drug, alcohol and tobacco abuse and their
†† health implications, accidents associated with dangerous occupations, violent crime, etc.
†† There are many components to this:
†† A focus on HIV/AIDS and young women is imperative. Measures to reduce the rates of
†† HIV incidence among women and girls aged under 24 will be the single most effective means of
†† blunting the AIDS pandemic. There is much that can be done directly with young women
†† themselves, both directly (providing access to sex education, life skills, condoms, microbicides
†† etc) and indirectly (increasing girlís educational and socio-economic opportunities, thereby
†† increasing their power and decreasing their reliance on selling or trading sex). There are many
†† things that must be done to address the wider social environment in which women and girls
†† are vulnerable to HIV/AIDS.
†† Dealing with HIV/AIDS in schools is an important component of overcoming the
†† pandemic. Sexual activities do take place in schools, sometimes between teachers and pupils
†† and among pupils themselves. They are a key site for HIV/AIDS educational activities, partly
†† because most young people can be found in school at one time or another. And schools are
†† models for society: modes of social interaction and hierarchy that exist in school are
†† replicated in society. If students learn exploitative relationships, command models of authority,
†† and gender inequalities at school, then it is unlikely that they will promote the necessary
†† social change in society later in their lives.
†† And this is a disease like no other. It kills adults in the prime of their lives, slowly over a period
†† of months and years, leaving a legacy of impoverished and orphaned families. Its incidence is
†† highest in the cities and towns, so that it is affecting the most economically active and the
†† most educated of our citizens. If HIV rates continue to rise, as they have done in Southern
†† Africa, we might find ourselves facing a situation in which one quarter of our adult population
†† is infected, adult life expectancy has been cut by fifteen years, our schools and hospitals
†† cannot recruit and train enough teachers and nurses to replace those who have died from
†† AIDS, and our food production is seriously cut back by the illness and death of millions of
†† farmers. As a society, we simply cannot afford to go down this track.
†† More than one year ago our former President promised to mobilise the country as if for war. He
†† rightly recognised the need to treat the HIV/AIDS pandemic as a national emergency, to take
†† it out of the health sector and make it a concern of every single government institution, not
†† to mention every community leader, business, priest and imam. It hasnít happened. Letís not
†† dwell on what has gone wrong but focus on what can be done better.
†† The first and biggest challenge is leadership. Overcoming the pandemic requires charismatic
†† and visionary leadership. HIV/AIDS is a political issue that requires political leadership to
†† mobilise people. It needs managers too, but they should not be at the top. More than
†† anything else, our government needs to communicate with the people in an open, frank,
†† creative and unhesitating way. We should receive AIDS messages every day from every one of
†† our ministers. Every single government institution, every school, every kebele office, every
†† church and mosque, should be teaching about the ABC of AIDS prevention and all other
†† aspects of the pandemic. And this must start from the top.
†† The main challenge for leadership is to break the silence. AIDS needs to become part of our
†† daily discourse. We need to accept those people living with HIV and AIDS, recognising that
†† they are valued members of the community with all their rights. We need to openly confront
†† the sexual practices that make our society so vulnerable to the pandemic, such as casual and
†† unprotected sexual encounters, husbandsí readiness to have girlfriends, and sexual relations
†† between teachers and pupils.
†† The next challenge is to gear up our institutions to handle the resources and implement the
†† programmes that are essential. Ethiopia we hear has already received about $60 million from
†† the World Bank for HIV/AIDS control programmes which it has not yet spent. There is another
†† $40 million due later this year from the Global Fund which will be disbursed through the Ministry
†† of Health. These amounts arenít big. In fact, for a population of 60 million people, with more
†† than 3 million already HIV positive, they are tiny. The recent report of the World Health
†† Organisationís Commission on Macro-economics and Health estimates that developing
†† countries need to spend a minimum of $30 per person per year on health care to prevent
†† needless disease and death. In our case, thatís more than a tenfold increase. Ethiopia will
†† probably need to handle twenty times as much money for our HIV/AIDS programme alone
†† before we can say that our efforts are commensurate with the problem.
†† Unfortunately, currently the disbursement rate is abnormally low. Itís nothing short of
†† unexplainable that the World Bankís $60 million has not been spent. Our people are crying out
†† for the simplest programmes of assistance. For example there is a big unmet demand for HIV
†† tests, for example so that couples can know one anthersí status before becoming engaged to
†† be married. In other African countries, the problem is the reverse: AIDS programmes are
†† expending massive efforts trying to persuade people to be tested. Being tested and knowing
†† oneís status is the first and most important step in making sure one doesnít take unnecessary
†† risks, or for those who are HIV positive, spread the virus to others. So letís establish a simple
†† and reliable countrywide testing system.
†† There are other simple measures too that havenít been taken. We know as recent UN report
†† indicated, ď babies do not have to be born with the AIDS virus. If mothers bottle feed their
†† children and health workers administer a simple regimen of inexpensive drugs to pregnant and
†† delivering mothers and to their new-borns, the rate of AIDS transmission from mother to child
†† drops drastically. Yet a lot of babies are infected with HIV/AIDS virus, at birthí.† We also know
†† that, even with the recent agreements made by international pharmaceutical companies, the
†† cost of anti-retroviral drugs, which suppress the development of HIV into full-blown AIDS, and
†† is too high for even middle-class Ethiopians. But anti-retroviral drugs arenít the only medicines
†† necessary. Many people living with HIV and AIDS die from diseases such as meningitis, or
†† suffer from treatable skin conditions. These opportunistic infections can be treated by
†† standard cheap drugs, which are much more in demand among a population with high rates of
†† HIV. But in Ethiopia theyíre simply not available. The systems should be there: the Ministry of
†† Health ought to make them function.
†† Ethiopia doesnít need an early-warning system for the AIDS crisis that is slowly but surely
†† enveloping our country. Itís happening in front of our eyes. Our young people can see it: they
†† are crying out for leadership to confront the crisis.