Rainbow-Ethiopia (Addis Ababa, Ethiopia): As we commemorate world AIDS 2013 with a theme of “Getting to Zero” by 2015 – Zero AIDS Related Deaths, Zero New Infections and Zero Discrimination , HIV/AIDS remains one of the key development challenges in Ethiopia. Analysis by the World Health Organization (WHO) in 2011 showed that HIV/AIDS has led to a seven-year loss in life expectancy, close to a million orphans, and the loss of productivity and income at workplace with severe effects on households and communities across Ethiopia. According to the National AIDS Resource data in 2003, women and young people between the ages of 15-24 were at higher risk of acquiring the disease. Ten years later in 2013, while the total adult prevalence has significantly declined, the number of PLWHA has not changed much (approximately 800,000), and number of children orphaned due to HIV/AIDS has increased by more than 22%.
Ethiopian Government and the International Community Response to HIV/AIDS
Ethiopia’s HIV/AIDS response is mostly donor-assisted. For instance, in 2004/05, from the estimated US$ 208.7 million needed to support the scaling-up of ART to reach the treatment target of 100 000 by the end of 2005, Ethiopia contributed only 21%. The remaining 79% was covered by foreign funding (WHO, 2005). The Ethiopian government’s major development partners for the national HIV/AIDS response include the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), Presidential Emergency Programme for AIDS Relief (PEPFAR), the World Bank (up to 2011), UN Development Assistance Framework (UNDAF) and the HIV Governance Pooled Fund. The national HIV/AIDS response aims at attaining universal access to HIV prevention, care and treatment; and improving the health system in Ethiopia.
The Global Fund is the major source of funds for the Ethiopian government multisectoral HIV/AIDS response. The Global Fund resources are channeled through the Federal Ministry of Health (FMOH), Federal HIV Prevention and Control Office, Network of Networks of HIV Positives in Ethiopia (NEP+) and Ethiopian Interfaith Forum for Development Dialogue and Action (EIFDAA). From 2003-2013, Ethiopia has received US$803, 728,322 from Global Fund; and 270,000 people are on ART as a result of the support (Global Fund, 2013).
US government/PEPFAR provides extensive support for the national HIV/AIDS response. Ethiopia is one of the largest recipients of PEPFAR, and its projects are implemented through USAID, CDC, the Department of Defense, Peace Corps and the Department of State Refugee Bureau. From the fiscal years 2004 – 2011, Ethiopia has received close to US$1.8 billion in PEPFAR funding to fight HIV/AIDS (PEPFAR, 2010).
Including Males who have Sex with Males (MSM) in the National HIV agenda
Although the government especially the Federal HIV Prevention and Control Office (FHAPCO) acknowledge and aggressively working on heterosexual and mother-to-child transmissions (MTCT) as a major modes of transmissions of the epidemic in Ethiopia, some studies indicate that there is a very little awareness and high incidence of HIV and sexually transmitted infections (STI) among men who have sex with men (MSM) and the growing number of male sex workers in different parts of the country, the prevalence of multiple sexual partners (MSP) among Men who have sex with men (MSM), have also contributed to the highest vulnerability of men who have sex with men (MSM) and to the spread of the epidemic in the country.
Few researches and ancedotal studies suggest that high risk sexual practices among the MSM are very common and the levels of knowledge and awareness associated with HIV/STI-related risks are very low among MSM in Ethiopia. This suggests that MSM bear a disproportionate burden of HIV compared with the general population. Studies from other countries in the region with similar epidemics have shown that MSM comprise a substantial portion of new infections. For example, in Kenya, recent studies have found that MSM account for as much as 15.2 percent of new infections.
A lack of data combined with severe stigma and the criminalization of same-sex sexual practices creates major barriers to addressing HIV/STI issues among MSM and to reaching MSM population for all other health, social, or economic related needs.
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. Ethiopia’s criminal code imposes prison terms of up to 10 years 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.
So far, the Government of Ethiopia and its development partners like the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), Presidential Emergency Programme for AIDS Relief (PEPFAR), the World Bank (up to 2011), UN Development Assistance Framework (UNDAF) and the HIV Governance Pooled Fund has no any specific program intervention design for MSM and nor did they make a concerted effort to study the extent of the practice and its importance in spreading HIV in the country. Neither official government records nor specific programs exist for HIV/AIDS intervention among MSM in the country. Nevertheless, despite the criminalization, denial and discrimination of homosexuality in the country, MSM do exist in Ethiopia and equally suffer from the HIV/AIDS epidemics. In fact, as most MSM in the country are likely to engage in heterosexual relationships (“cross bridging of HIV transmission”), educating them about HIV/AIDS has wider implications with regard to preventing the spread of HIV into the general public.
As an agency of social justice, the government of Ethiopia should outlaw hate crimes, discriminatory healthcare practices, and solicit citizens’ participation in designing and implementing MSM targeted intervention plans to contain the HIV epidemic. The Ethiopian government and its major donors such as the Global Fund and PEPFAR should take concrete steps to more effectively reach MSM and other vulnerable key populations by changing its policies and laws that impede effective HIV programming. This should include the repeal of laws that criminalize consensual adult same-sex sexual practices and the implementation of policies that seek to aggressively combat stigma and discrimination aimed at sexual minorities and PLHIV.
- On World AIDS Day, here’s how the world looks (savetime.com)
- Knowing HIV status lowers sexual risk among US gay and bisexual men (theglobaldispatch.com)
- Our Shared Responsibility in Ending AIDS (huffingtonpost.com)
- HIV and Young People: The Fight Continues (thehopescholarship.wordpress.com)
- Women, HIV And AIDS (womenandraceinamerica.wordpress.com)