Ethiopia’s government has come up with an ambitious plan to halve new HIV infections, quadruple its annual condom distribution and put 85 percent of people who need life-prolonging HIV medication on treatment within five years.
An estimated 1.2 million Ethiopians are HIV-positive. According to the government, the country’s national prevalence is 2.4 percent, with stark differences between urban HIV prevalence, which stands at about 7.7 percent and rural levels of under 1 percent.
According to UNAIDS, Ethiopia has already managed to bring down new HIV infections by over 25 percent since 2001. The country’s HIV/AIDS Prevention and Control Office (HAPCO) says prevalence among young people is dropping.
“Data obtained from studies since 2007/08 and a draft national survey show that there are fewer and fewer young ones entering puberty being infected with the virus both in urban and rural areas,” said Yibeltal Assefa, director of planning, monitoring and evaluation at HAPCO.
“When you see the capital Addis Ababa for example, [the] prevalence rate among the young ones [aged 15-24] was above 12.1 percent in 2005… Two years later, in 2007, it went down to 6.2 percent, exhibiting [an] almost 50 percent decline.”
In its latest global report on the epidemic, UNAIDS reported decreases in prevalence among antenatal care attendees in both rural and urban areas of Ethiopia, and improved behavioural indicators such as fewer people who have had sex by the age of 15 and fewer people reporting sex with more than one partner in the past year.
According to the five-year plan, presented to parliament by HAPCO on 16 December, the government also plans to increase the coverage of antiretroviral therapy from 60 to 85 percent. Close to 400,000 Ethiopians require treatment for HIV.
Ethiopia is in the process of expanding the number of health centres to over 3,000 to reach its treatment targets. The plan also aims to increase national condom distribution from 97 to 400 million annually.
Ignorance still a challenge
While the country’s progress is impressive, analysts say there is still much to be done. A recently released survey by research group Population Council and the UN Population Fund, UNFPA, found that stigma and ignorance were still common among young people.
“A considerable percentage of young people had never heard of condoms or had no exposure to them,” the study found. “One third of young people [aged 12-24] felt that moral people do not use condoms; 48 percent of young people felt that condoms should not be used within marriage; and roughly half felt that condoms are used by promiscuous people.”
The authors recommended increased attention to marital transmission of HIV/AIDS and use of condoms within marriage.
Including MSM in the HIV agenda
The country’s HIV plan aims to be comprehensive, but glaringly absent from its HIV strategies is any programming specifically for men who have sex with men (MSM), who generally fall into “most at-risk” populations.
According to Israel Tadesse, a lawyer at Addis Ababa city municipality, Ethiopia’s criminal code imposes prison terms of 3-12 months on people found having sex with members of the same sex. Fear of legal repercussions is often a hindrance for gay people seeking HIV prevention and treatment services.
“There is anecdotal belief that the number of MSM is increasing but we don’t have any credible or official study or data,” HAPCO’s Yibeltal said. “Ethiopia is no island to the global state of things so I am sure in the near future it will be a threat. Therefore, necessary intervention should be implemented but the problem so far is a hidden agenda.”