http://www.irinnews.org
May 3, 20101
1 - ETHIOPIA: In search of "made-to-measure" HIV prevention
ADDIS ABABA, 3 May (IRIN) - With more than half of all Ethiopian adults tested
for HIV in the past five years and a campaign for behaviour change in place,
specialists are now calling for a more targeted approach.
"Most-at-risk populations" (MARPs) have to be targeted through better
understanding of how the epidemic is affecting them and in turn, to develop a
more specific response.
"The government has launched a vigorous campaign to fight HIV, but now it is
important to ... target specific groups among whom the epidemic is raging," said
Desmond Johns, UNAIDS country director for Ethiopia. "High testing numbers mean
little unless you are testing people at risk, such as commercial sex workers."
High-risk groups in Ethiopia include sex workers, uniformed forces and migrant
workers, street children, students and discordant couples. Men who have sex with
men have, for the first time, been included in the national strategic plan for
the next five years, still in draft form.
"We are preparing to undertake a national MARPs survey to determine the type of
MARPs, their distribution, HIV prevalence, patterns of sexual behaviours,
predisposing factors and their potential in bridging the spread of the epidemic
to the general public in order to inform how we can conduct tailored behavioural
change interventions with a package of prevention services to these groups,"
said Meskele Lera, deputy director-general of the Federal HIV/AIDS Prevention
and Control Office (HAPCO).
"MARPs are already a priority; what needs to be done is scaling up services to
a level of universal access among these groups," he added.
A more focused response means that regional HAPCOs will need to draw up
specific plans for prevention in their regions, where the risks and prevalence
differ widely.
"For instance, the proportion of men not circumcised in Gambella [in western
Ethiopia] is 53.2 percent, according to the Ethiopian DHS [demographic and
health survey] 2005," Meskele said. "In most of the regions, male circumcision
is above 90 percent, so promoting male circumcision as a biomedical intervention
should be done in targeted areas like Gambella region, by taking into account
the national context."
A changing landscape
"This is not your typical sub-Saharan epidemic; we have a generalized epidemic
overall, but within that we see higher prevalence rates in the urban areas and
usually lower prevalence rates in most rural areas of the country," Akram Eltom,
HIV team leader for the UN World Health Organization (WHO), told IRIN/PlusNews.
According to HAPCO, the provisional national HIV prevalence in 2010 is 2.3
percent, but big cities such as Addis Ababa have an average HIV prevalence of
about 7 percent, while rural areas - home to 85 percent of the population - have
an average prevalence of 0.9 percent.
A rapidly expanding road network means, however, that the distinction between
urban and rural populations is becoming increasingly blurred as small towns
spring up along the new highways.
"Ethiopia doesn't really suffer from forced migration; what we have is low
intensity but high-volume migration for economic purposes," said WHO's Eltom.
"The country's road network is expanding extremely quickly; what used to be
called the Nazareth corridor ... from Djibouti through Nazareth to Addis, may
now have expanded to include other cities, given the improved road transport and
emerging work opportunities in several new urban areas.
"Whether it is the emerging patterns of human mobility... or whether it is the
emergence of new socio-economic realities in population settlements not
previously thought to be affected by HIV, the social, cultural and economic
interactions associated with all of these are opening up a host of complex
vulnerability situations that merit better understanding and a more targeted
response."
He noted that work was already under way to tackle the new, diverse face of the
epidemic.
According to Meskele, HAPCO was drafting a prevention roadmap to direct the
country's multifaceted HIV epidemic.
"By augmenting our interventions to reflect the epidemic and dealing with the
heterogeneous epidemic heterogeneously, we will see even more advances in
behaviour change," he said.
kr/mw
[ENDS]
UN Health 4 group ends visit to Ethiopia with proposal for joint Flagship Programme on Maternal and Newborn Health
http://www.unicef.org/infobycountry/ethiopia_52311.html
ADDIS ABABA, Ethiopia, 05 January 2010 – Ethiopian health officials, the UN Country Team in Ethiopia and visiting UN Health 4 (H4) partners have developed a comprehensive two-year work plan to support maternal and newborn health (MNH) and survival in the country.
The Health 4 represents an intensified joint effort by four international agencies, UNICEF, WHO, UNFPA and the World Bank, to support countries in improving maternal and newborn health and saving the lives of mothers and babies.
The 10-day H4 mission to Ethiopia concluded with a meeting in Addis Ababa on 9 December, involving UN agencies, officials from the Ethiopian Federal Ministry of Health (FMoH), and the Health Population and Nutrition Donor Group. The work plan that was agreed focuses on both immediate and long term interventions. It involves four strategies:
* Increase demand, access and utilization of quality MNH services
* Improve the quality of MNH services
* Strengthen monitoring and evaluation of MNH services
* Improve managerial and institutional capacity, advocacy and partnerships in order to encourage increased political and financial commitment
“We are going to submit the proposal for the joint UN Flagship Program on maternal and newborn health to the potential funders,” said Dr. Razia Pendse of the WHO Partnership Department of Making Pregnancy Safer.
Improving newborns’ prospects for survival
About 50 per cent of all maternal deaths annually occur in sub-Saharan Africa, as do deaths among children under five. Since 1990, the number of estimated annual global maternal deaths has remained around 500,000, while the absolute number of child deaths in 2008 declined to an estimated 8.8 million from 12.5 million in 1990, the base line year for the Millennium Development Goals (MDGs).
The MDG 5 target is to reduce by three quarters the maternal mortality ratio, while the MDG 4 target is to reduce by two thirds the under-five mortality rate.
However as the overall under-five mortality rate has fallen since 1990, neonatal deaths have not dropped as dramatically, and therefore constitute a much higher proportion of overall under-five deaths – thus there needs to be a greater emphasis on improving the health of newborns. There is a demonstrated link between a mother’s health and the health and welfare of her children, particularly newborns. Lowering a mother’s risk of mortality directly improves her baby’s prospects for survival.
According to the most recent estimates, Ethiopia has a lifetime maternal mortality risk of 1 in 27 and an under-5 mortality risk of more than 1 in 10.1 - ETHIOPIA: Bright lights, big city is high risk for students
November 2, 2009 http://www.irinnews.org
ADDIS ABABA, 2 November (IRIN) - Being a university freshman is an exciting time
for any young person, but many students get carried away, partying too hard and
taking sexual risks.
"It's a chance to experience life; there is no family, there are no
restraints," said Biniam Mohammed, project coordinator of the Modelling and
Reinforcement to Combat HIV/AIDS (MARCH) [http://www.aau.edu.et/march] project
in the Siddist Kilo Campus of Addis Ababa University (AAU). "Some use it in a
good way but some do risky things, such as chewing khat [a mild stimulant] .
having [unprotected sex] and using commercial sex workers.
"Some of these students will have limited awareness of the risks of HIV/AIDS,
and then there is peer pressure as well," he added.
Ethiopia's overall HIV prevalence is a relatively low 2 percent, but prevalence
in the capital, Addis Ababa, is 7.5 percent. According to the Federal HIV/AIDS
Prevention and Control Office (FHAPCO), anecdotal evidence of widespread unsafe
sexual practices suggests students may be among the more high-risk groups in
terms of HIV vulnerability.
MARCH statistics show that 50 percent of AAU students are sexually active, but
only half of them use condoms, said Biniam.
High-risk behaviour
"Often they do not use condoms. they are doing it emotionally, without any
thought," said Selam, a 19-year-old AAU student.
Selam added that students coming to the city from the countryside usually had
less information about HIV and were not as street-smart as Addis youth, leaving
them unprepared to resist unwanted sexual advances or insist on protected sex.
Former student Girma Tesfaye, now Addis Ababa project coordinator for
HIV-focused NGO Mekdim, says female students often fall prey to "sugar daddies".
"There are lots of beautiful girls at university and older people with
beautiful automobiles stop around the university and look for them," he said.
"It is common to take students this way. They have lots of money; they will
provide the girls with money and different [presents].
"The older 'daddy' may have three or four partners in such a way, which
facilitates the spread of HIV," he added.
Selam agrees that this is a significant problem, noting that in the early
evening, heavily made-up and scantily clad female students make their way to the
area outside the main gates known as the Debab to try to find a rich boyfriend,
usually one who already has a wife, and quite possibly a string of other
girlfriends.
"If you have sex because of a threat, or you have a 'sugar daddy', it is
one-sided and that makes them more at risk," said MARCH's Biniam. "Influenced or
coerced sex is high risk."
Evidence also suggests that male students use local sex workers; a survey
[http://siteresources.worldbank.org/INTHIVAIDS/Resources/375798-1103037153392/EthiopiaSynthesisFinal.pdf]
of Addis-based sex workers found that 5.8 percent of their clients were
students. Sex workers in the nearby Arat Kilo area confirmed that many of their
clients were AAU students.
MARCH, with funding from the US President's Emergency Plan for AIDS Relief,
produces Life 101, a quarterly photo graphic novel that follows the story of
three students and one couple at AAU as they experience daily university and
city life and deal with issues such as transactional sex, condom use,
relationships, testing for HIV, and gender equity. MARCH also facilitates
student-led entertainment events to stimulate discussion of the issues.
Recently, more than 20 Ethiopian university presidents initiated a request
[http://hapco.gov.et/index.php?option=com_content&task=view&id=103&Itemid=2] to
the Ministry of Education and FHAPCO for more HIV activities, including a
national HIV/AIDS policy and strategy for universities, an HIV/AIDS research and
information centre, gender and HIV/AIDS advocacy efforts and sustainable
training and discussion forums.
wd/kr/mw
September 2, 2009 http://www.irinnews.org
1 - ETHIOPIA: Thousands affected by acute watery diarrhoea
ADDIS ABABA, 1 September (IRIN) - Ethiopian health authorities have dedicated
three hospitals in Addis Ababa to patients suffering from acute watery diarrhoea
(AWD), according to a health official.
Thousands of people have been infected and 34 killed by the outbreak, says the
Health Ministry. Ahmed Imano, head of public relations in the ministry, said
there were fears it could escalate with the rains.
"If the people do not take extra care, the number of patients will increase and
the outbreak will escalate," Ahmed told IRIN on 1 September. "The public should
treat water before use."
The hospitals - Zweditu, Ras Desta and Yekatit - have set up tents to
accommodate patients. So far, about 5,700 cases have been reported across the
country, including 4,200 in the capital, over the past two weeks.
Some 27 died in 31 woredas (districts) outside Addis Ababa. "The fatality rate
in Addis Ababa is 0.2 percent," Ahmed added.
He blamed the outbreak on poor sanitation and hygiene, as well as contaminated
water. According to the World Health Organization (WHO), diarrhoea is spread
through contaminated food or drinking water or from person-to-person.
AWD is one of the three clinical types of diarrhoea, which can be caused by a
variety of bacterial, viral and parasitic organisms.
"There are a number of diseases that causes diarrhoea; we [have] not identified
which specific type of disease caused AWD," Ahmed said. "We are still studying
that. Now our main focus is saving lives."
In a bid to contain the situation, residents of Addis Ababa have been advised
to take precautionary measures such as frequent hand-washing, avoiding raw food
and ensuring that drinking water is boiled, filtered and cooled before
consumption, according to the UN Office for the Coordination of Humanitarian
Affairs (OCHA).
"The number of hospitalized patients has dropped to 140," Ahmed said. "In the
first week around 500 patients came to hospital."
Diarrhoeal disease is the second leading cause of death in children under five
years old, killing 1.5 million every year, according to WHO.
HIV/AIDS
===============
A Dream Come True
By: Gelila Bogale
http://www.etharc.org/inside_scoop/a_dream_come_true.html
Long before the Betengna Radio Diaries program brought her story to life on the Amhara Mass Media Agency station, Worke Birru always dreamt of reaching out to people and sharing her story about living with HIV. Sixteen years ago, Worke, now 41, was the first woman in Bahir Dar, Amhara Region to declare her positive sero-status to the public. Now, it’s the public that always seeks her out to hear her story.
“If I want to buy groceries in the morning, I can never return home as early as I plan to. People, especially young people, surround me in the market and stop me to talk about my story that aired on Betengna. I can not say no; it is always so much fun and I find it hard to say no to them. It’s overwhelming to see how much people have come to love me and always ask to hear more from me. I am speechless about how Betengna has changed my life.”
Worke, who has co-founded Tesfah -Goh PLWHA association in Bahir-Dar, is one of those rare people whose very presence lifts the spirits of those around her. Her playful eyes and innocent smile show that she’s a woman with a story to tell.
“I met the Betengna producers a year ago at the Tesfa-Goh PLWHA association,” she reveals. “I told them my story and they asked me to come to Addis to record the program.” For her, this was a turning point in her life. It was the moment when her wish to share her story and experiences with others came true.
Worke’s story was first broadcasted on the 8th of March, 2008 and continued for 31 weeks. During those weeks, her story was so rich that it took on the flow of a novel written by a talented writer. Her diaries talk freely about love, hate, infidelity, health and living with HIV.
Ato Getaneh Derseh, Head of Amhara HAPCO, said that Worke’s story has been a great asset in the fight against HIV/AIDS in Amhara region, particularly in terms of helping to change people’s risky behaviors. He states that her story is something from which everyone can identify with and learn from. Ato Getaneh declares “Our office is ready to help Worke in everyway possible towards achieving her goal to fight the epidemic.”
Mantegbosh, a 21 year old commercial sex worker who lives in Bahir Dar, says she never misses an episode of Betengna. She listens to Worke’s story every Saturday morning. “I was especially addicted to Worke’s story because I love the way she tells it and I learned a lot from her.”
Amel Belay, the Betengna Radio Diaries coordinator, says “What is so captivating about Worke’s story is that it turned out to be a heartbreaking narrative after weeks of humorous episodes which really touched the audience. Worke’s rustic slang and her wit, despite her being unable to read, made the program the hit that it is.”
Today, Worke lives in the hearts of many Betengna listeners. It is therefore not surprising that young and old people from all walks of life in Bahir Dar have something to say about how her story affected them. Her strength and endurance has taught people how to live positively whether they are HIV positive or negative. In a country where over a million people live with HIV, Worke has done her part in her community to decrease stigma against those living with HIV.
Interested in hearing Worke's story? Follow this link.
Story By:
Gelila Bogale
AIDS Resource Center (ARC)
Email: gelilab@etharc.org
Agents of Change Empower the Community
By: Frehiwot Yilma
http://www.etharc.org/inside_scoop/agents_of_change.html
It is not common to see people decline better positions and better pay. It is less common to see a person defy his boss to keep a promise made to others. It’s even rare here in Ethiopia to see a husband not reacting to being insulted by his wife in public.
Adem Adeo works in Arsi Negele Woreda in Oromia region. He lived all his life in this town. Adem is one of those people who have challenged and defied common sense. He has done the uncommon. Some think he is strange and some say he is remarkable. One thing is for sure: Adem is determined to change the course of history in his community. He is a born leader - an agent for change.
Adem declined an appointment to a position of head of Trade and Transport of the Woreda, a position that came with prestige and privileges. But it would take him off his mission – protecting his community from HIV.
“First time I was appointed as a focal person for HIV/AIDS for the health bureau, I had no idea what I was getting myself into. It didn’t take me too long, though, to see the suffering that HIV had brought upon our community. I was shocked at the number of people dying from AIDS, families breaking up; children without parents; the stigma and discrimination.”
Adem says that what really got to him was the silence. He says no one was discussing the issue. “I couldn’t sleep at night. I kept thinking about all this,” says Adem as he recalled his first appointment in 2005.
The best way to tackle this, he said to himself, was to bring the community together to discuss and find a solution. It didn’t take long to convince the traditional leaders to stand by him as they could also see the devastation HIV was making in the community. “I had a meeting with the leaders. They asked me how committed I was to lead the meeting and help them discuss the issue. I gave them my word that I will not miss a meeting. With their blessing and active support I began my work.” Almost 70 people turned up for the first meeting.
He started with 10 kebeles but now he is coordinating CCs in 47 kebeles. One group comprises of 70 people.
“Next year all the community conversation groups will begin demonstrating what they have learned. They even have started helping out those who are HIV positive and the elderly. And in the coming year, this will be a way of life in Arsi Negele, when I see this then I can take other responsibilities.”
In community conversations issues are openly discussed. HIV/AIDS, family planning, rape, poverty, etc. are among topics discussed. The community uses the age old tradition known as “Odaa” in the Oromo region of Ethiopia for the new and current issues like HIV and AIDS.
CC has also become an arena of public speech. Everyone is encouraged to contribute to the discussion. Usually a special clap is given to a person who delivers a speech: a thunder clap called ‘angaasuu’ in Afan Oromo. All the hands point towards the person and they clap three times: two for the satisfaction and one for the person. This encourages participants to involve in the discussion and impress their peers.
“One of the issues that have got a serious attention in community conversation (CC) is stigma and discrimination,” says Ato Abatye Hailemarian, Behavioral Change Communication expert at Oromia Health Bureau HIV Prevention and Control Department (OHB-HAPCD). He says, “The CC is fast becoming very effective because it is participatory and inclusive of the community. The solution to the particular problem comes from the community.”
Ato Abatye says that the change in behavior has resulted in the utilization of various services by the community which has also increased by surprisingly many folds.
“Before we started CC in Oromia out of the estimated total population of 30 million people only 42,000 people have accessed HIV Voluntary Counseling and Testing (VCT) services. This number changed to over 1.2 million people after we started CC.” Ato Abatye.
Most of the facilitators of the CC said that there is a change in people’s behavior among the community since they began participating in CC.
Amarech Kalo, a female facilitator, said “People were resistant to join any HIV related meetings. They would even set their dogs on us when we go to their doors. But now they come on their own free will.”
Amarech says that women facilitators like her have benefited more than any other in the Woreda. She says, “I got married too early and had a baby too soon. I had to quit school. But now thanks to the CC I have stated school again. It made me realize it is not too late to go back to school. I now facilitate and lead discussions with my community. Women know about their rights more now and about family planning and HIV/AIDS.”
Ato Abraham Tufa, former chairman of the Hadabeso kebele and current participant of CC says, “When I was first elected chairperson of the Kebele Office (neighborhood), I felt responsible especially to the young people who work at the Langano Lake Resort which is near our village. Our village was among the highly affected. When the CC started, I thought it would be the best way to reach the community. Ato Adem made this possible through his dedication to the work. He has always been by our side.”
Currently, the bureau has established CCs in 5,764 kebeles which is 86% of the initial plan. And there are 9,812 CCs in total.
Ato Abatye said, that the main challenge that CC faces is when a community is not open to discussion on HIV/AIDS issues. In this regard community leaders’ especially the traditional and religious leaders’ commitment is vital. The community listens to them.
He said “CC requires a strong commitment from the leaders and requires patience from them as it takes time to see the fruit of the work done. Also there should be more partners’ participation in the process as there needs to be an integration of action”
The other major challenge according to Ato Abatye, is availability of VCT or ART. Some places are remote from service centers.
The ripple effect Adem is making in his community is now recognized by the Oromia Regional Health Bureau. The Bureau recognizes the roles committed leaders are playing in the various Woredas - leaders like Adem Adeo that are paving the way to bring change for the better.
In Adem’s words ‘we only live once, so why not give a 100% gut for what we do so as to leave a better tomorrow”.
‘Angaasuu’ for Adem Adeo and for those toiling day and night to make our world a better place to live in.
Story By:
Frehiwot Yilma,
ARC Staff
Based on WAD Theme 2008
AIDS Resource Center (ARC)
Email: firehiwoty@etharc.org
Strategic Pediatric HIV/AIDS Communication Improves Children’s ART Enrolment and Adherence
Woliso, September 13-16, 2010
An HIV/AIDS Pediatric Communication Strategy development workshop was held to increase HIV positive children’s ART enrolment and adherence through bridging the communication gap that exists between HIV positive children and their parents, care takers, as well as health care providers. The first of its kind to address this issue, the workshop was attended by pediatricians, healthcare professionals, communication experts, as well as representatives from different organizations.
HAPCO’s (HIV AIDS Prevention and Control Office) single point estimate indicates that 79,871 children under the age of 15 are living with HIV and only 10,496(13%) of them are on ART. The low rate of ART enrolment and adherence for HIV positive children can be partly attributed to a lack of guidelines on how to communicate vital information to them and their caretakers regarding their status and the need for managing their condition
One of the presenters at the workship, W/ro Hanna Shoaamare, Media Program Assistant at JHU-CCP/ARC stated that pediatricians as well as parents and care takers of HIV positive children refrain from telling the children their status as they lack the proper communication skills and fear that the information could emotionally and psychologically traumatize the child. Parents of these children especially avoid the task, fearing that the child will disclose the information to others, which could lead to rejection and discrimination, added W/ro Hanna.
national_pediatric2In a situation where multiple care-takers are involved in an HIV positive child’s life, information about HIV status and ART medication requirements fail to be transferred correctly preventing caretakers from providing the needed care to the child, said W/ro Hanna.
Ato. Solomon Tamerat, ART Communication Assistant Officer at JHU-CCP/ARC said that previous efforts in HIV pediatric care have been geared towards preventing mother to child HIV transmission but now the government, donors and partner organizations are also seeing the great need for working with HIV positive children and their caretakers to ensure that they have access to live-saving ART treatment.
Educating HIV positive children about their status and the importance of ART medication in leading a healthy life with consideration to their emotional and psychological well being is the best way to increase their ART adherence said Ato. Solomon.
The workshop was organized by the Ministry of Health and facilitated by JHU-CCP/ARC. A pediatric HIV/AIDS communication framework was drafted addressing this important issue at the policy maker, health care provider, community and individual levels.
Contact Person
Ato. Solomon Tamerat
ART Communication Assistant Officer at JHU-CCP/ARC
