AIDS epidemic in the country

Source: HIV and AIDS estimates (2014)[1] from UNAIDS Data

General description: In 2013 there were an estimated 793,700 (716,300-893,200) people living with HIV including 200,300 (172,400 – 232,400) children according to the latest EPP/Spectrum modelling. As per the same modelling, the paediatric HIV population in Ethiopia are mostly older children who were vertically infected in earlier years when the coverage and effectiveness of PMTCT in the country was low/MTCT rates high (in 2013 163,800 HIV positive children were aged 5-14 years).

The HIV epidemic in Ethiopia is becoming more concentrated in urban areas and along major transport corridors. DHS 2011 data shows HIV prevalence in large towns including Addis Ababa the regional capital increased from 2005 to 2011, which may be associated with labour migration to large urban areas and large scale construction projects as well as a growing service industry.

Variations in HIV prevalence are also observed among regions. According to the 2011 DHS Gambella region and the urban administrations of Addis Ababa and Dire Dawa have the highest prevalence while SNNPR and Oromia region the lowest. However, due to their large population size, Oromia, Amhara and SNNPR regions have the largest PLHIV population, still bearing a significant proportion of the epidemic burden (see Figure 2).

AIDS epidemic among key populations: According to the national MAPRs (Most at Risk Populations) surveillance study conducted by the Ethiopian Public Health Institute (EPHI) and Centre for Disease Control (CDC) in all regional capitals between July 2013 and January 2014, HIV prevalence among female sex workers was estimated at 23.8% overall. However prevalence ranged from 15.0% in Hawassa (SNNP region) to 33.0% in Mekele (Tigrai region).

High risk sexual behaviours have also been reported among university and high school students. However, no representative seroprevalence data for university students are available and seroprevalence data for high school students show minimum HIV prevalence. According to one study of students from five universities 81% of male and 63% of female students had sex with a non-regular partner in the last 12 months. Among currently sexually active male students almost two thirds (64%) had sex with at least one female sex worker in the past year.

Data is lacking to assess the size of the population, risk behaviours and seroprevalence among injecting drug users (IDUs) and men who have sex with men although a bio behavioural study is underway among IDUs in Addis Ababa.

National AIDS response

Key populations: Peer education is one of the key interventions implemented to reach most at risk populations (MARPs) in Ethiopia. In 2012/13 368,733 MARPs were reached through peer education a significant increase on previous years. In the same period 35,562,166 condoms were distributed specifically to MARPs, a more than fourfold increase on the number distributed in the previous year (7.7 million). Additionally, in 2012/13 income generating activities (IGA) training was provided to 20,322 sex workers and vulnerable women and a further 17,483 received IGA start-up capital.

Education: HIV prevention activities implemented within schools (primary, secondary and higher education institutions) include: school CC, peer education, life skill education, strengthening and supporting anti-AIDS clubs (AACs) and AIDS resource centres. In 2012/13 CC was implemented in 9,127 schools out of the total number of public and private schools (31,688) corresponding to a coverage of 28.8%. In addition 1,053,609 students were estimated to be reached through peer education from the total high school and TVET student population, which represents coverage of about 30%. A further 9,127 schools provided life skills education representing coverage of 28.2%; there were 1,010 functional youth centres and 901,265 students were estimated to have participated in school clubs;

Male circumcision: Male circumcision at birth is widely practiced in most regions of Ethiopia. Currently 92% of adult males report being circumcised (EDHS 2011). In Gambella, lower rates of male circumcision are thought to contribute to the particular severity of the epidemic in the region28. Programmes to enable, promote and provide voluntary medial male circumcision to at least 80% of adult males are currently underway.

ART: The scale up of free ART services has been one of the greatest achievements of the HIV programme response over the last decade. The number of facilities providing ART services has expanded in health centres and hospitals, reaching 913 in 2012/13, mainly public facilities. Of the estimated 593,400 (540,100 – 668,300) adults living with HIV at the end of 2013 (EPP/Spectrum estimates 2014); 298,512 were on treatment (50%). Ethiopia has now reached a symbolic milestone for curbing the spread of the epidemic, where the number of newly started clients on ART (on average 58,000 adults each year) has surpassed the number of new infections in adults > 15 years (7,700 – 21,200).

Challenges and actions

1)      Reduction of sexual transmission of HIV by 50 percent by 2015;

2)      Prevention of mother to child transmission to eliminate new HIV infections among children by 2015 and substantially reduce AIDS-related maternal deaths;

3)      Provide treatment and care services to reach (globally) 15 million people living with HIV with lifesaving antiretroviral treatment by 2015;

4)      Increase domestic HIV resources to close AIDS resource gap by 2015 and reach annual global investment of $22-24 billion in low- and middle-income countries;

5)      Eliminate gender inequalities and gender-based abuse and violence and increase women and girls' ability to protect themselves from HIV infection;

6)      Eliminate stigma and discrimination against people living with and affected by HIV;

7)      ART: One of the successes of the large scale free ART programme has been its equal access by both men and women. A major challenge of the programme remains the very low coverage of children (all children below 15 years are eligible for treatment as per guidelines, December 2013). Of the 200,300 (172,400-232,400) children estimated to live with HIV in 2013 (EPP/Spectrum guidelines, 2014), only 18,931 (9.5%) received ART in 2013. This requires urgent attention to identify possible factors for low performance; increase efforts to identify children living with HIV in the community especially in the older age ranges, and develop strategic actions to improve coverage rates.

[1] http://www.unaids.org/en/regionscountries/countries/ethiopia/