Responding to the HIV Epidemic in Ethiopia
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.