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ETHIOPIA: In search of "made-to-measure" HIV prevention

Photo: Terri O'Sullivan/Flickr
A rapidly expanding road network could blur the rural-urban HIV prevalence divide
ADDIS ABABA, 3 May 2010 (PlusNews) - 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.

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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.


Theme(s): Economy, HIV/AIDS (PlusNews), Migration, Prevention - PlusNews, Urban Risk,

[This report does not necessarily reflect the views of the United Nations]

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