HIV Epidemic in Ethiopia
- Population: 85 million
- Adult HIV prevalence: 2.4%
- Prevalence among women 2.8 percent
- Prevalence among men:1.8 percent
- HIV prevalence among Men who have sex with men (MSM): Unknown
- Rural prevalence: 0.9 percent
- Major urban areas prevalence: 7.7 percent
- Epedimic Type: Heterogenous with marked variations across regions and population groups
- People living with HIV: 980,000
- People receiving ART’s: 222,700 (UNAIDS,2010)
A lack of data combined with severe stigma and the criminalization of same-sex sexual practices create major barriers to addressing HIV/STI issues among MSM and to reaching MSM population for all other health, social, or economic related needs.
Inequality, exclusion, no MSM-specific HIV programming and targeted funding
The government has done nothing to address the specific HIV prevention and treatment needs of MSM. No other stakeholders are involved in MSM-targeted HIV prevention and programming with the exception of our poorly resourced local community based organization.
Anecdotal reports among MSM indicate that unprotected anal sex is very common, and MSM in some contexts engage in transactional and commercial sex. Although condoms are available at relatively low cost through some social marketing organizations like DKT-Ethiopia and other NGOs, the level of condom use is still very low. However, availability of water-based lubricants is very limited; therefore, most MSM reportedly use saliva and oil based lubricants like Vaseline and lotions, which are riskier in terms of HIV transmission.
Criminalisation and fear
Same-sex sexual practices are categorized as “indecent acts” and remain criminalized in Ethiopia. Article 629 of the Ethiopian Criminal Code prohibits such behaviour, and respondents indicated that violators may be imprisoned for up to 10 years. Furthermore, respondents indicated that the maximum sentence can be applied when a sexual partner transmits a communicable infection such as HIV (and is previously aware of having the infection); when an adult is charged with committing homosexual acts with a person under the age of 15; or when distress, shame, or despair drives one partner to commit suicide. When the Criminal Code was revised in 2005, for the first time in 48 years, the statutes and language criminalizing homosexuality were not changed.The very fact that homosexuality is criminalized gives license to a wide range of hate crimes and violence against the MSM community, emboldening offenders to act with impunity. Yet there has been no visible support to ease or reform the laws from any government officials or agencies, or even from most national and local civil society organizations.Criminal Code prohibitions against homosexuality and widespread stigma, greatly limits the ability of MSM groups to obtain support and financing or to openly work with members of the population.
Prevailing stigma and discrimination also prevent MSM from seeking appropriate information, care, and support related to HIV/AIDS.Widespread Homophobia, stigma and discriminationIn addition to the legal sanctions and criminalization, the stigmatization of homosexuality by religious leaders, government officials, and the general public in Ethiopia complicates efforts to reach MSM and raise awareness about HIV and other health issues. The challenges are just as significant in Addis Ababa, where MSM are likely living in higher numbers, because levels of social, political, and economic stigma are as high there as in the rest of the country.
Access to Health and other Psycho-social Services
The impact of all these challenges is undeniably negative for MSM and, more broadly, for effective public health policy making. Stigma, violence, detention, and lack of safe social and health resources make it hard for MSM to reach and utilize even the few reliable HIV prevention services that do exist. MSM rarely find non-judgmental, MSM-sensitive, and clinically competent healthcare services. In most facilities, public and private, MSM face insensitivity, discrimination, refusal to provide care, and sometimes physical abuse from healthcare providers. Many are therefore reluctant to seek care or postpone visits to facilities, thereby potentially putting their health at serious risk. (There very few private clinics in Addis Ababa are relatively supportive and friendly to MSM, but services there are prohibitively expensive for many members of the community. That is especially true for male sex workers, who are particularly vulnerable to HIV and STIs and would benefit the most, but who cannot afford the clinics’ fees.)
Most MSM have little access to programs and services that address structural drivers such as joblessness, poverty, and depression. Such challenges are especially problematic among specific sub-populations such as young male sex workers in Addis Ababa, a group that is perhaps the most marginalized of the marginalized. They seem to be suffering from a double burden of dealing with their stigmatized sex trade and sexual practices, and neither their health nor economic needs are being recognized or met.
Global Fund Support and Engagement
No Global Fund money has ever been allocated for MSM-targeted epidemiological research or for prevention, treatment, care, and support programs specifically for MSM. Given the lack of services, resources, and attention in general, it is not surprising that MSM are not represented on the Global Fund CCM or that MSM service issues are not discussed during its meetings.
PEPFAR Support and Engagement
The Ethiopian and U.S. governments signed a partnership agreement through PEPFAR in October 2010 to collaboratively expand and sustain an effective response to the HIV/AIDS epidemic in Ethiopia over the next five years. The framework’s goals and objectives are consistent with Ethiopia’s Strategic Plan for Intensifying Multispectral HIV/AIDS Response in Ethiopia 2010–2014 (SPM II) and the Health Sector Development Plan IV 2010/11–2014/15 (HSDP IV), PEPFAR’s strategic plan, and the principles of the U.S. government’s Global Health Initiative. The partnership framework also seeks to ensure that U.S. government contributions towards the SPM II and broader health sector development programs complement and leverage other stakeholders. PEPFAR’s current strategic plan promotes HIV prevention for MSM as well as increased epidemiological research to better understand the extent and impact of HIV among the population.
It also specifically mentions the importance of paying “due consideration” to stigma and risks associated with disclosure.
Our Ongoing and Planned Projects
Mercy Integrated Men’s Health Clinic
Addis Ababa, Ethiopia
Screening: We provide free and confidential HIV screening in a discreet and relaxed environment. If you do test positive we’ll also undertake CD4 testing and counsel you on your healthcare needs, and provide as much support as you need. If you’re thinking about having a HIV screening, please visit our clinic.
Screening and treatment: We offer free and confidential screenings for sexually transmitted infections such as syphilis, gonorrhea, chlamydia and genital warts. We’ll also treat your STI, free of charge.
Prevention: Free male and female condom promotion and distribution.
Free condom compatible water based lubricants access
We will also begin to offer vaccination against viral STIs such as Hepatitis B very soon.
Other health concerns: In addition to HIV and other STIs, feel free to consult with us if you have any other sexual health concerns. We also address prostate, testicular and anal health.
Psychosocial Support Services
Let’s face it – the way we feel about ourselves and others, our moods and our relationships all impact on our sexual attitudes and behaviour. We offer a range of free psychosocial services that augment our medical services.
Counselling: We offer free, professional short-term counselling to men on any dynamic that relates to their sexual wellbeing. In addition to counselling individual men we specialize in counselling same-sex male couples in a confidential and relaxed environment. Men who have recently tested HIV positive or who are about to initiate HIV-related treatment are encouraged to utilize our counselling service.
Professionally facilitated Support and Discussion groups
Our project is changing social attitudes towards lesbian, gay, bisexual and transgender (LGBT) people and improving the services they can access. This will reduce the HIV risks they face, reduce HIV prevalence, and improve their overall health.
Ethiopia has made impressive economic progress and is now a planning to be come a middle-income country of 2 by 2025. However, homosexuality is illegal and LGBT people are often harassed ad threatened. Stigma and discrimination against LGBT people is widespread, with many in society believing homosexuality ‘unafrican’ and against traditional cultural and Christian values. Criminalization reinforces these attitudes. As a result, the LGBT community faces exclusion from society, from health services and from the jobs market. This increases their vulnerability and the HIV risks they face.
It has made tackling HIV a priority, with early success providing free access to life-saving antiretroviral treatment. However, homophobia has hampered prevention efforts with LGBT people, with few services catering for their needs. Over 20% of men who have sex with men say they are afraid of using health services because of stigma and discrimination.
Improving data, measuring impact and linking services
Creating a Community, Assessing Risks & Developing Skills (CARDS) Project among Men Having Sex with Men (MSM) in Addis Ababa, Ethiopia
• Review existing relevant training materials and adapt for Ethiopian context.
• Review existing relevant BCC materials and adapt for Ethiopian context.
• Assist other interested and concerned governmental and non-governmental stakeholders in assessing HIV prevention needs of marginalized men in Addis Ababa and identifying evidenced based HIV prevention interventions.
• Assist in refining an activity work plan for HIV prevention targeting marginalized men at high risk for acquiring HIV and other STIs.
• Assist other interested and concerned governmental and non-governmental in the identification of clinical service provision sites or/and facilities
• Support interested organizations in the establishment of a peer education system among MSM
• Support the project and research firms in facilitating the planned formative assessment of sexual health needs related to HIV/STIs.
Our project focuses on a number of key activities to achieve its objectives. It will:
- Carry out research to increase the data available on what drives unsafe sex among the LGBT community, and use this data to improve services;
- Support project partners to measure the impact of their work better, helping them to access new funding opportunities;
- Use links with LGBT-friendly health providers to get the needs of the LGBT community incorporated into the work of mainstream health service providers;
- Use the lessons learned from the our projects to access more funding for LGBT services.
- Our project will build on the strong advocacy work of our other grass root partners to put LGBT health issues on the political agenda and get them included in national plans.
Homophobia, poverty and persecution
Our project is reducing the HIV risks facing lesbian, gay, bisexual and transgender (LGBT) people by improving knowledge, changing attitudes and improving health services. This will reduce HIV prevalence among these groups and improve their overall health.
Ethiopia – poor and landlocked – is one of the least progressive countries in Africa for (LGBT) people. Sex between people of the same gender is illegal, and there is widespread homophobia, social stigma and discrimination. This limits job opportunities and access to services, leading to poverty and exclusion. LGBT people face persecution by the police and have no laws to protect them. As a result many prefer to become invisible, living on the margins to avoid persecution.
Ethiopia has no mainstream LGBT-friendly health care facilities, so people fear discrimination from health workers and the possibility of having their HIV status disclosed against their will. As a result many individuals rarely get their health concerns checked. There is no official data that shows the HIV prevalence rate among men who have sex with men but it is highly likely that the prevalence can’t be underestimated because of the invisibility of the LGBT community. The widespread assumption is that infection rates have grown in recent years.
Improving data, building networks, lobbying for change
Our project will focus on a number of key activities to achieve its objectives. It will:
Improve data collection to provide a better evidence base for health planning and advocacy;
Build networks between government agencies and groups working on HIV and human rights to get the needs of LGBT people recognized;
Lobby for the adoption of United Nations’ recommendations on LGBT issues, so LGBT partners can be part of national working groups;
Develop supportive networks of health professionals and raise their awareness of gender identity and sexuality issues;
Build our capacity to support other partners in the region.
Our project’s strength is its focus on both health and human rights in an integrated programme. It also taps into Rainbow-Ethiopia’s extensive knowledge on LGBT issues, human rights and community empowerment.
National LGBT Human Rights Advocacy Campaigns
- Creating HIV policy and advocacy strategies at the local and national levels to challenge legal and political restrictions on MSM.
- Using diverse approaches to HIV services to provide a full range of health and support programs
- Engaging law enforcement, government, and media to address stigma and discrimination
- Finding common ground with other marginalized groups like female sex workers, positive groups, etc..
- Providing HIV interventions and advocacy in the face of severe discrimination
- Doing more with fewer resources
- Sensitizing religious leaders, the media, and healthcare providers.
- Creating safe social spaces where LGBTI individuals and MSM can attend support group meetings and peer-to-peer forums
- Providing security training to its members to help identify and avoid threats
- Providing comprehensive wellness programs developing programs that reach MSM where they are—online, at home, in clubs