HIV/AIDS

Available evidence suggests that the HIV/AIDS epidemic in Ethiopia started in the early 1980's. The first two positive samples were retrospectively detected from samples collected in 1984 for other research. The first two AIDS cases were officially reported from Addis Ababa in 1986. Based on recent sentinel surveillance data, the national adult prevalence rate is estimated at 6.6%. Rural prevalence is much lower than urban prevalence (3.7% and 13.7%, respectively). The number of reported AIDS cases stands at 130,000 as of September 2003. In the lower age groups (15-29) more females than males are affected. There are an estimated 1.2 million AIDS orphans in the country.

WHO has been providing technical assistance to the Ministry of Health (MoH) since the early days of the HIV/AIDS epidemics in Ethiopia. The first national taskforce on HIV/AIDS was established in 1985 with support from what was then the Global Program on AIDS (WHO-GPA). In 1986, again with strong support from WHO GPA, the MoH established the National AIDS Control Program (NACP) at department level. WHO provided direct technical assistance to this department by seconding international professional and administrative staff. WHO also provided funding for the initial phases of the establishment of the program, used, among others, for setting up HIV laboratories, conducting several surveys, training of health workers, and setting up an AIDS case reporting system.

Two medium term HIV/AIDS prevention and control plans were developed by the MoH in 1987 and 1992 with technical assistance from GPA. Based on this, resources could be mobilized to support the NACP. Accordingly, the second medium term plan was financed by the Royal Dutch Government. This support agreed during the lifetime of GPA was instrumental in enabling the WHO Country Office to continue assisting the MoH. Using these funds, several short-term professionals were recruited locally. They provided technical support in the areas of program management, surveillance, data management, clinical care and HIV testing. One professional was seconded to the MoH in 2003. Essential program supplies (test kits, drugs and protective materials) were also procured.

The MoH and its partners are currently working towards improving availability of prevention, care and treatment services to PLWHA. This effort received much needed support when Ethiopia's application to the Global Fund to Fight AIDS, Tuberculosis and Malaria was accepted. Accordingly, the country will receive substantial amounts of funding for its HIV/AIDS interventions.

The Ministry of Health and Regional Health Bureaus are the major implementers of health sector HIV/AIDS interventions in Ethiopia. Activities already underway include:

1. Promotion of safer sexual behavior
2. Treatment of STI
3. Voluntary counseling and testing
4. Blood safety
5. Universal precautions
6. Prevention of mother-to-child transmission of HIV
7. Management of opportunistic infections
8. Antiretroviral therapy
9. Epidemiological surveillance
10. Monitoring and evaluation

Community home-based care is provided to some PLWHA mainly by NGOs and community based organizations. The ministries involvement in this intervention is expected to be more intensive. WHO will continue to assist the MoH and other health sector partners in the planning, implementation, monitoring and evaluation of evidence based interventions for HIV/AIDS prevention, care and treatment.

Current structures

The national response is coordinated by the HIV/AIDS Prevention and Control Office (HAPCO). The National AIDS Council, which is a multisectoral forum comprising ministries, NGOs, religious leaders and prominent individuals is chaired by the President and coordinates the response at the highest level. The management board of HAPCO chaired by the Minister of Health provides policy guidance. Similar structures are replicated at regional level.

The MoH is responsible for implementing, coordinating and regulating the health sector response to HIV/AIDS in Ethiopia. The National AIDS Control Program (HIV/AIDS and Other STIs Prevention and Control Team) was created under the Epidemiology and AIDS Control Department (renamed "Disease Prevention and Control Department" in 2000) after the decentralization exercise of 1993. It comprises 5 professionals coordinated by a team leader. The decentralization initially resulted in a marked drop in implementation capacity both at the central and regional levels. It was also responsible for disruption of surveillance activities that were heavily dependent on support to regions from the center.