Strategic Frame Work For The National Response To HIV/AIDS in Ethiopia (2001-2005)

 Strategic Frame Work For The National Response To HIV/AIDS in Ethiopia (2001-2005)



   According to the 1994 national population census it is projected that Ethiopia would have a

   population of 63.5 million by the year 2000, out of which 54 million (85%) lives in rural and 9.5

   million (15%) in urban areas. The age distribution shows that 44% of the population is below

   14 years while 42% are in the age group 15 and 49. The population beyond 50 years of age

   makes only 9%.


   Ethiopia is one of the least developed countries of the world. The GNP is around USD 102 and

   health service coverage is only 51 %. Adult literacy rate is around 23% and primary school

   enrolment less than 50%. The major source of income is from subsistence agriculture. The

   poor socio-economic status is further com- pounded by the emergence of HIV/AIDS in the last

   two decades.


   A) HIV/AIDS Situation in Ethiopia


   Globally, Ethiopia has the 16th highest HIV/AIDS prevalence of any country and the third

   largest number of people living with HIV/AIDS (PLWHA). One of every 11 people living with

   HIV/AIDS today is an Ethiopian. Life expectancy is already falling, and the epidemic is

   systematically undermining the country's effort to reduce poverty, especially, its investments

   in health, education, and rural development. Beyond its vast toll in Buffering and death, AIDS

   may also be costing Ethiopia significantly in its economic growth every year, further reducing

   the scope for poverty alleviation. HIV/AIDS now poses the foremost threat to' Ethiopia's



   If it continues unchecked, HIV/AIDS wi11 alter the trajectory of the country's development by

   retarding growth, weakening human capital, discouraging investment, exacerbating poverty

   and inequality, and leaving the next generation increasingly vulnerable to the impact of the

   epidemic. For this reason, HIV/AIDS cannot be viewed as merely one among many competing

   priorities in the nation's development. Investing adequately in HIV/AIDS prevention is now a

   precondition for virtually all other development investments to succeed. Ethiopia's future

   depends on addressing the epidemic forcefully and fast.


   HIV started to spread in Ethiopia in the early 1980s. From available data on the epidemic, the

   following can be sketched with some degree of confidence. The first evidence of HIV infection

   was found in 1984 and the first AIDS case was reported in 1986. HIV/AIDS prevalence was

   low in the 1980s, but increased quickly through the 1990s, and rose from an estimated 3.2

   percent of the adult population in 1993 to 7.3 percent (Ministry of Health, 2000) by the end

   of 1999.


   Rates among women attending antenatal clinics at sentinel surveillance sites in Addis Ababa

   have exceeded 10 percent since 1993 and were most recently estimated at 15.1 percent by

   the ministry of Health. Even higher rates have been reported from Gambella (19 percent) and

   Bahir Dar


   (20.8 percent). As no routine surveillance exist in rural areas, the level and trend of HIV/AIDS

   prevalence in these areas are difficult to estimate. Although some data suggest that HIV/AIDS

   prevalence may be levelled off in urban areas, the evidence is by no means conclusive and

   there is no reason to believe that rates will remain low in rural areas. The estimated HIV

   prevalence for the rural population by the year 2000 was 5 percent. As a whole an estimated

   5,000 people are newly infected each week in the country. If the incidence does not drop

   quickly, one third of the Ethiopians in the age group 15-24 could ultimately die of AIDS.


   Underlying factors or Determinants for the Rapid Spread of HIV/AIDS in Ethiopia


   The direct causes for the fast progression of the epidemic in this country are unprotected sex

   and high frequency of casual partners.


   There are also several underlying factors that promote the direct causes. In the Ethiopian

   context, the following are the major underlying factors:


   a. Poverty


   High rate of unemployment

   High rate of prostitution

   High rate of economic migrants


   The relationship between HIV/AIDS and poverty HIV/AIDS has to be integrated into all

   development policies especially the Poverty Reduction Strategy.


   b. Ignorance


   Low awareness level on HIV/AIDS


   Misconceptions about the virus, its transmission, and prevention


   c. Gender inequality


   Women being more vulnerable to HIV than men


   Inability of women to negotiate about sex


   d. Cultural barriers


   "Silence" about the epidemic

   Stigma and discrimination  against PLWHA.

   Denial about the extent of the problem in the country


   Abduction, rape and female genital mutilation

   The taboo attached to talking about sex within the family and the community.


   e. War and displacement


   Presence of a big mobile military population in the country

   Presence of a huge displaced population

   Permanent mobile populations


   Impact of HIV /AIDS


   The impact of HIV/AIDS in Ethiopia has been devastating. Already, an estimated 2.9 million

   Ethiopian adults and 250,000 children are living with HIV/AIDS more than in any other country

   except South Africa and India. Approximately 750,000 Ethiopian children are estimated to

   have been orphaned by AIDS. In urban areas, AIDS patients occupy half of the hospital beds.

   About 90 per cent of reported AIDS cases are between the ages of 20 and 49, the most

   important years from both an economic and a parenting standpoint. Among this group, AIDS is

   now the leading causes of death. Stigma, fear, and denial are still Common.


   B) Govermnent's Response to the HIV / AIDS Epidemic


   Ethiopia established a National Task Force on HIV in 1985. Two Medium Term prevention and

   control plans were designed and implemented between 1987 and 1996. Efforts were made ill

   the area of IEC, condom promotion, surveillance, patient care and expansion of HIV screening

   laboratories in different health institutions. However, the impact was low as compared to the

   extent of the problem. The involvement of the public at  the community level was quite

   minimal. Coordination and integration across sectors were not adequately established.


   With the HIV/AIDS situation worsening the government approved in August1998 a

   comprehensive HIV/AIDS policy to provide an enabling environment for a multi-sectoral

   approach for the prevention and control of the epidemic.


   The National AIDS Prevention and Control Council was then established in April 2000 and is

   headed by the president of the Federal Democratic Republic of Ethiopia. The council consists

   of members from. Sector Ministries, Regional States, NGO's religious bodies and representation

   from civil society and People living with HIV/AIDS. The Council oversees the implementation of

   the federal and regional HIV/AIDS plans, examines and approves annual plans and budgets,

   and monitors plan performance and impact. The Council has appointed a National HIV/AIDS

   Board of Advisors to meet on a monthly basis to oversee the plan. A National HIV/AIDS

   Prevention and Control Secretariat is also established under the Prime Minister's Office to

   coordinate and facilitate  the multi-sectoral response to HIV/AIDS.