Responding to the HIV Epidemic in Ethiopia


Students in North Gondar, Ethiopia participate in a sex education class.
Photo: Adam Rogers / UNCDF

Ethiopia’s HIV crisis

Ethiopia’s first cases of HIV were reported in 1986 and the disease rapidly spread. By 2009, an estimated 1.1 million Ethiopians were living with HIV but the country had limited resources and capacity to address the epidemic.

In the late 1990s the Government launched a major HIV programme with support from UNDP’s Leadership Development Programme and Community Conversations approach. By 2008, the prevalence of HIV had been reduced and 53 percent of people needing treatment were receiving it.

Engaging with people and communities

As a co-sponsor of UNAIDS, UNDP works to help countries respond to the development and social dimensions of HIV. It recognizes that action in social protection, gender, human rights and the environment can contribute to better health outcomes. UNDP helps countries integrate HIV priorities into national planning processes, strengthen governance and coordination of HIV responses and promote human rights and gender equality.

Major achievements include:

  • increased demand for voluntary counselling and testing;
  • increased condom use;
  • integration and expansion of voluntary counselling and testing;
  • initiation of prevention of mother-to-child transmission and antiretroviral services; and
  • encouraging trends in the involvement of people living with HIV and AIDS to strengthen local engagement.

In the 1990s UNDP launched the Leadership Development Programme and Community Conversations methodologies to promote partnerships and encourage strategic multisectoral responses to HIV. The Leadership Development Programme unites leaders from across sectors, empowering individuals to develop organizational cultures that can generate transformational change. Community Conversations is a community-based programme that facilitates dialogue and decision-making, enabling communities to generate their own responses to the HIV epidemic. Both approaches aim to develop leadership at different levels of society; they are mutually reinforcing.

In Ethiopia, UNDP’s approach began with advocacy and support to the Ministry of Public Health in planning a nationwide response. UNDP later became operationally involved by supporting the introduction of Community Conversations. Applying expertise developed around the world, UNDP trained local facilitators to initiate community conversations across four provinces, with striking results. Communities were enabled to acknowledge the HIV epidemic and to explore harmful norms or practices that fuelled its spread. Women in particular were empowered to address issues such as gender-based violence and sexual and reproductive health.

In 2004, the Government adopted the Community Conversation approach as part of its national strategy. The methodology was mainstreamed throughout the country and used not only to stimulate open discussion and behavioural change, but also to help prioritise within the national AIDS programme.

In 2009/10, 89.3 percent of kebeles (Ethiopia’s basic administrative unit) conducted community conversations, and 24,723 community facilitators were trained. An equally impressive performance was reported for school-based community conversations. The number of engaged communities continues to increase.

Making a difference: the transformational impact

Ethiopia’s achievements in stemming the spread of HIV are impressive. Not only has incidence of the disease been controlled and reversed, but the country’s ability to treat those already infected has grown (see graphs below). Life expectancies have increased, reducing the economic consequences of early death.

Nevertheless, significant challenges remain. A high turnover of key government staff and tensions between local and national institutions complicate the sustainability of progress. Extending the national programme to sparsely populated areas stretches available resources to the limit and sustainable funding remains a challenge.

HIV Testing Centre Expansion

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Rise in HIV Testing Population

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Supporting Transformational Change
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Lessons Learned

There is little doubt that UNDP’s Leadership Development and Community Conversations programmes contributed significantly to the success of Ethiopia’s HIV programme. A number of factors influenced this outcome:

 

Strategic positioning of HIV in the wider public health and development arena: HIV was not treated as an isolated health sector issue but as a challenge requiring a concerted effort among health and non-health sectors.

 

Government leadership: From the outset, the Government responded to the HIV challenge. It put in place a national institutional framework to manage a national programme. Faced with the early success of the Community Conversation methodology, it quickly financed and mainstreamed the methodology nationwide.

 

Applying global programmes at a country level: At the time they were introduced in Ethiopia, UNDP’s Leadership Development Programme and Community Conversations were global programmes. This enabled Ethiopia to share its experience and benefit from similar work in other countries.

 

International partnerships: UNDP was one of a range of actors who complemented each other in supporting national programmes. To its credit, the Government was open to these international partnerships. This ensured the necessary financial resources to address the HIV challenge.

 

Paving the way with institutional development: The flow of international funds required empowered and responsive institutions. While there were tensions between national institutions at different levels of society, overall national capacity to design and implement programmes has been greatly enhanced over the past 15 years. There was a steady escalation of capacity development policies and programmes during the 1990s and early 2000s, of which the Leadership Development Programme and Community Conversations were an important part. This paved the way for major resource flows starting in 2005, from the Global Fund to Fight AIDS, Tuberculosis and Malaria, and from the US President’s Emergency Plan for AIDS Relief.