Despite Successes, the Fight Against HIV Needs Renewed Commitment

Ethiopia has made great strides in combating HIV and AIDS over the last decade. According to the World Health Organisation, new HIV infections declined by 90Pct and AIDS-related deaths by 53Pct between 2000 and 2011. Other important figures, like the rate of transmission and number of newly infected individuals, have also decreased substantially since 2000. These achievements, however, have resulted in decreased funding from international donors like the President’s Emergency Plan for AIDS Relief (PEPFAR) and The Global Fund, which come mainly from the United States. According to some officials, the decreased prevalence of the virus has also contributed to a more lax attitude with regard to HIV among younger people who don’t view the virus as a substantial threat to their livelihoods. These dynamics worry many officials that the country may witness a resurgence of the virus in certain demographics. EBR’s adjunct staff writer Meseret Mamo explores the issue further and offers this report.

Roughly 17 years ago, nearly 3 million people in Ethiopia were infected with the HIV virus, making it the third largest infected population worldwide after South Africa and India. During that time, an estimated 280,000 people died annually due to AIDS-related causes.
Such horror and anxiety, however, has subsided in recent years. People don’t die from AIDS-related causes in as large a number because of the high penetration of antiretroviral drug usage among infected people. The population has also become better acquainted with and begun practicing certain prevention methods, which has also contributed to the decreased prevalence of the virus.
Due to efforts by government and non-governmental organisations (NGOs), the country managed to reduce the prevalence rate by 90Pct and death due to AIDS-related causes by 53Pct. Despite these successes, insiders say that there’s more work to be done before HIV is no longer a major public health threat.
“There is still a chance for the country to be burdened by HIV/AIDS,” says Achamyeleh Alebachew (MD), Deputy Director for Planning, Monitoring, Follow-up and Evaluation at the HIV/AIDS Prevention and Control Office (HAPCO). “Behavioural reluctance among the new generation towards taking precautions not to get infected is the major catalyst in this respect.”
Following a wide range of efforts to halt the spread of the virus, the HIV prevalence rate among adults between the ages of 15-49 decreased from 5.3Pct in 2003 to 2.1Pct in 2012, according to the Ministry of Health (MoH). The World Health Organisation says that number was down to 1.14Pct by 2014.
However, the spread of the virus is still high among females. The MoH estimates that nearly 60Pct of people living with HIV in 2014 were women. Their data also shows that the spread of the virus varies across spatial locations, as approximately 67Pct of all people living with HIV are located in urban areas, according to 2013 estimates. Overall, HIV prevalence rates are seven times higher in urban areas than in rural ones.
Stakeholders stress that certain groups, especially younger people, are not sensitive to the risks associated with the disease and there is a growing tendency among that demographic to think of HIV/AIDS as less of a threat than it actually is. In Ethiopia, patterns and changes in sexual behaviour, especially in extramarital relations associated with poverty, age, and gender inequities, contribute to HIV transmission dynamics.
Such reluctance can be observed through Getahun Delelew, 19, who is a freshman at Addis Ababa University. For Getahun, it is normal to have sexual intercourse at his age. “Me and my friends hangout in night clubs [and] sometimes we get drunk,” he told EBR. “In fact, I didn’t use a condom when I had sex for the first time,” he reveals. What’s more, he says he is not planning to have a single sexual partner or a monogamous girlfriend until he graduates, gets a job and is ready to marry.
The HIV/AIDS Strategic Plan, which was released in 2014, testifies to the fact that risky sexual behaviour is common among university students. According to the study conducted to prepare the Plan, 53Pct of those sampled in the survey were sexually active in 2013. Of this total, 81Pct of males and 63Pct of females were having sexual intercourse with a non-regular partner, though there was a high level of condom usage among the study sample.
Citing such facts, the Plan also notes that nearly 22,000 people were infected with HIV in 2013 – the vast majority of these cases involve people over the age of 14 in urban areas. The study also demonstrates that comprehensive knowledge about HIV transmission and risks is “very low” among all segments of the population.
Insiders say this lack of knowledge exacerbates the problem. In addition to behavioural attitudes, early marriage and sex between two people with a significant age difference are catalysts in the transmission of the virus, according to Achamyeleh. That’s why he believes that now is not the time to be satisfied with the promising results the country has achieved in containing the spread of the virus and reducing AIDS-related deaths. “The possible resurgence of the virus [could come as a result of] budget cuts from the donors,” she says.
According to UN data, Ethiopia’s total spending to tackle HIV was USD405 million in 2011/12, of which nearly 90Pct came from private or external donors. However, data from the Centre for Global Development shows that the following fiscal year, the amount of money given by donors such as PEPFAR and the Global Fund decreased by nearly 80Pct.
Officials say the decrease in funding doesn’t bode well for efforts to quell the spread of the virus. “Ethiopia showed great progress in tackling HIV/AIDS. Since we can’t expect the same amount of donations as the previous year, we are forced to decrease our efforts of tackling the virus,” says Sintayehu Girma, Director of Public Relations at HAPCO. “The global economic crises and Ethiopia’s economic progress are major reasons for the funding cuts.”
Although there is no programme that has been interrupted so far by HAPCO, officials are saying there is indolence among groups that work to prevent the spread of the virus. Information that used to be dispersed through different media concerning HIV/AIDS is not being broadcast. This is partly caused by diminishing funds, which contributed to decreased efforts in dispersing knowledge to the public.
HAPCO’s understanding is that if the behavioural reluctance on the risk-exposed community, especially among the youth, continues unchecked, the country’s successes might regress and bring about a revival of the virus among certain demographics. This reality would be unbearable to the country’s economy, since the cost of care and support of patients is costly and international donors are not providing generous funds like they did in the past. “That is why a regulation on community mobilisation is about to be ratified by the government,” says Achamyeleh.
It is not only the government’s interventions that have been highly affected by the decline of funds. A large number of NGOs have also faced a scarcity of funds. National Positive Women Ethiopians (NPWE), an umbrella organisation for 28 associations, has been adversely affected by a lack of funding. Ayele Mideksa, a project manager at the organisation, says USAID was the NGO’s major funder but stopped giving monies this year.
The group became active in 2006 as a national network, but because of financial problems funds have been accessible to only 16 of its members. By September, ten additional organisations will cease operation because of similar problems.
Ayele says that though funding has stopped with no hope of getting other financing, they are planning to make the associations member-owned; that way, they can raise monies domestically so that they survive on their own. “Behavioural reluctance can only be reversed through long-term projects,” Ayele argues. “Short-term and interrupted programmes will only have a temporary effect.”
Programmes run by NGOs like Mekdim Ethiopia, one of the pioneers in the fight against the pandemic, have also been adversely impacted by the decrease in funding. The organisation, which works on HIV prevention, stopped its children and youth programmes a year ago due to a lack of funding.
Other international NGO’s, like USAID, are also decreasing their HIV prevention efforts. USAID’s in-school programme that targeted youth ended its two-year duration last September and handed over the programme to the Ministry of Education. These diminished efforts support the claim that school clubs on HIV/AIDS are also showing indolence, which is an alarming sign in the eyes of some health officials.
Despite this, many argue that those involved in the issue can still make significant contributions to better understanding the transmission dynamics and impacts of HIV infection and advocating for and developing appropriate prevention, control and patient care programmes. This is because the virus is not solely a medical problem but is rooted in deep-seated attitudes and behaviours as well as poverty and institutional weaknesses that need attention.
The five-year Strategic Plan put prevention at the top of its priority list of tackling the pandemic and working with youth to create awareness as one of its top targets. Domestic resource mobilisation is also stated as the alternate source of financing programmes to bridge the financing gap.
Sintayehu says that since the greater amount of the investment on HIV goes to antiretroviral therapy, which consists of purchasing medications for HIV-positive citizens, there might come a time in which the country will be forced to shift budgets from other development programmes into HIV/AIDS interventions to achieve its goal of stopping AIDS by 2030.
That’s why for him and others who are close to the issue, the importance of prevention cannot be overstated. If the country doesn’t focus its efforts on prevention and educating the public, especially at-risk populations, then the meaningful strides the country has made in quelling the spread of the virus may prove all but futile. EBR

4th Year • February 16 2016 – March 15 2016 • No. 36

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