Ethiopia
has an estimated 2 million people living with HIV and the third highest
number of infections in Africa, according to UNAIDS. With a population
of 67 million people and per capita income of less than US$100
annually, it is also one of the world's poorest countries.
The
barriers to HIV prevention, testing and care in Ethiopia are immense.
Eighty-five percent of the population lives in rural areas and suffers
from a severe lack of access to public health services. There is also a
critical shortage of physicians (an estimated 1,200 in public service
practice for a population of 74 million) and other trained health care
workers. Further, per capita expenditures for health from all sources
is only US$5.60 compared to US$12.00 per person in the Africa region as
a whole.
This healthcare landscape has fueled the spread of HIV in Ethiopia.
The Ethiopian Ministry of Health (2006) estimates the current adult HIV
prevalence at 3.5%. This figure jumps to an estimated 5% among pregnant
women, but uptake of antiretroviral prophylaxis for PMTCT has been
minimal and the rate of HIV transmission to children born to HIV
positive women remains at 25 percent. Of 1.32 million Ethiopian people
who are HIV-positive, it is estimated that fewer than 10% know their
HIV status. As of December 2006, only 48,737 people were currently on
ART in Ethiopia, including 2,291 infants and children under 14, out of
277,800 HIV positive people in need of ART (including 43,100 children).
The Ethiopian Ministry of Health has set FY 2007 targets, which
include: 1,054,000 individuals to receive HIV counseling and testing;
100,000 people to be on antiretroviral treatment and 4,748 HIV positive
pregnant women to be treated with a complete course of antiretroviral
prophylaxis to prevent transmission from mother to child.
To reach these targets, the Ministry of Health has an ambitious
roadmap for scale-up of HIV prevention, treatment and care that charts
the delegation of responsibility for achievement of national targets
from central hospitals outwards to the local health centers and private
clinics. In response to the extreme shortage of qualified health care
workers, the Ministry also enacted a plan to further decentralize its
operations through collaborations with community-based NGOs.
As part of this effort, the Ministry of Health has encouraged
African Services to replicate its highly successful prevention outreach
and VCT model at additional sites and to add diagnosis and prophylaxis
of opportunistic infections and first-line antiretroviral therapy to
its VCT services.
