Overview of HIV/AIDS

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SUB-SAHARAN AFRICA: 67.1%
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 A global view of HIV infection
33 million people [30–36 million] living with HIV, 2007

2.2
 HIV prevalence (%) in adults (15–49) in Africa,
2007

2.8
 New Infections

• More than 95% are in developing countries

• About 16.8 % are in children < 15 years of age
• Approximately 83% are persons aged 15 to 49
years, of whom:
– Nearly 50% are women
– About 50% are 15 – 24 years old

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SUB-SAHARAN AFRICA: 70.2%
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SUB-SAHARAN AFRICA:70%
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 HIV AND WOMEN

Nowhere is the epidemic’s ‘feminization’ more apparent than in sub-Saharan Africa,

where 57% of adults infected are women, and 75% of young people infected are
women and girls.
HIV AND WOMEN
GLOBAL: TREND OF HIV PREVALENCE AND
DEATH DUE TO AIDS

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SSA: TREND OF HIV PREVALENCE AND DEATH
DUE TO AIDS

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 Historical Overview and National Responce of
HIV/AIDS in Ethiopia

• 1984: The first evidence of HIV infection in Ethiopia

• 1985: A National HIV/AIDS Taskforce was established

• 1986: The first two AIDS cases reported to the Ministry

of Health

• 1987: The National AIDS Control Program (NACP) was

formed at the MOH

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 Historical Overview and National Responce of
HIV/AIDS in Ethiopia
• 1989: Ministry of Health drafted a four-point policy
statement on HIV prevention

• 1989: HIV surveillance activities were started

 At present there are 115 HIV sentinel surveillance sites

– Urban: 40
– Rural: 75
• 1991: The first draft of a national policy
was created
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 Historical Overview and National Responce of
HIV/AIDS in Ethiopia
• 1998: HIV/AIDS Policy

• July 2002: Policy of ARV drug supply and use

• 2003: Fee based ART

• 2003: Guideline (Revised in 2007)

• March,2005: Free based ART program was started

• Mid 2006: Decentralization was started

• June 2007: point estimate

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 III.Impacts of HIV in Ethiopia

•HIV is driving the TB epidemic.

Estimated New Adult TB Cases

300

250
T h o u san d s

200

150

100

50

0
1984 1989 1994 1999 2004 2009 2014

Not Due to HIV Due to HIV

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 Impacts of HIV/AIDS in Ethiopia

• Decrease in life expectancy

Fig. Estimated & Projected Life Expectancy

60

50

40
Y ears

30

20

10

0
1984 1989 1994 1999 2004 2009 2014

Life Expectancy Lost to AIDS

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 Impacts of HIV/AIDS in Ethiopia

• Social:
- increased number of orphans;
- Old men remaining with out support;
• Economic: HIV more affects the productive age group
Impact at rural house-hold level:
-- Loss of income (50 % or more);
– Loss of labour;
– Loss of skilled manpower and knowledge;
-- Reduction in savings and investment;
– Expenses for treatment, funeral, teskar;
– Need to sell livestock to meet expenses;

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 Impact on Industry

• Loss of workers
– Expenses for recruiting and training replacements
– Reduced productivity in cases of skilled workers or
managers
• Lost work days due to sickness
– 30 - 240 days per year
• Lost work days due to funeral leave
• Increased health care costs
– 50% illness due to AIDS
– Loss of skilled professionals
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 The HIV prevalence and current
status of the epidemic in Ethiopia
• National HIV prevalence: 2.4% for 2010
– Female: 2.9%
– Male: 1.9%
• Urban HIV prevalence : 7.7%
• Rural HIV prevalence : 0.9%
• The highest HIV prevalence in Ethiopia occurs in
the age group 15-24

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 Age & Sex Distribution of Reported
AIDS Cases (1986 - June 2003, Ethiopia)
 The HIV prevalence and current
status of the epidemic in Ethiopia
• PLHIV: 1,216,908
 Males: 41 %
 Females: 59 %
• Children (<15 years) :79,871 (6.6%)
• New Infections: 137,494 (Incidence: 0.29%)
• AIDS Deaths: 28,073
• Total AIDS Orphans (2010): 804,184
• Total ART Need in 2010: 397,818 (26,053 children)
• Ever enrolled in chronic HIV care: 443, 964 ( FEB 2010)
• Ever started on ART: 246,347 (FEBRUARY 2010)
• Currently on ART: 179,183 (FEBRUARY 2010)
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Source: Single point prevalence estimate-calibrated out put, FHAPCO/MoH, 2007
Regional HIV Prevalence, Single Point
Estimate, 2010

3.1 %

2.2%
2.9%
2.2%

1.6%
9.2% 4.9%
3.8%

2.4%
1.5%

0.9%
1.7
%

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TREND OF HIV PREVALENCE IN ETHIOPIA

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MAJOR ACHIEVEMENTS
VCT sites expanded from 658
in 2004/5 to 1,525 currently
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The number of clients receiving HIV counseling and testing
services has increased considerably, from 448,000 (between mid-
2004 and mid-2005) to more than 4.5 million (between mid-2007
and mid-2008)

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Trends of ART Service Providing Facilities
Expansion, December 2009

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Adults and children receiving chronic
HIV care and ART, December 2009

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Number of facilities providing PMTCT services

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PMTCT program implementation trend,
December 2009

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 DECENTRALIZATION AND GENDER ISSUES

• The proportion of patients receiving ART

outside Addis Ababa increased from 35%
in 2005 to 75% in 2008
• The proportion of women and children out
of the total number of patients who
received ART, increased from 25% in 2005
to 55% in 2008

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TOWARDS UNIVERSAL
ACCESS
 DEFINITION
• Universal access implies that all people
should be able to have access to
information and services that are:
Equitable
Accessible
Affordable
Comprehensive
Sustainable

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 NATIONAL TARGETS BY 2010

• Condom use by sexually active population (age

15-49) will increase from 10% in 2007 to 60% by
2010
• 9.27 million People to be counseled and tested
in 2010
• 80% of HIV Positive Pregnant women will
receive PMTCT service by 2010
• People receiving ART will increase from 32% in
2007 to 100% by 2010

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WHERE ARE WE NOW?

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MAJOR CHALLENGES

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HUMAN RESOURCE FOR HEALTH

Flows in health labour market Abroad

(using a country-perspective) public & private health facilities

Overall External
Training HRH shortages brain drain
International
institutions organisations

Private-not-for-
profit sector:
NGOs - missions
Management
Public sector & Admin
MoH

Rural facilities

Urban facilities
Private-for-profit
sector

Internal
brain drain
Maldistribution

Attrition
due to illness, death, retirement,
work in other sectors ...

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PEPFAR ESTIMATES,2004

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 LACK OF FOCUS AND DUE ATTENTIONS FOR
PREVENTIVE ACTVITIES

• There were 75,000 HIV-positive pregnant women in 2007,

of whom only 8,000 (10.7%) received antiretroviral
prophylaxis
• Sexually Transmitted Infection prevention and treatment is
somewhat neglected
• Comprehensive knowledge of HIV/AIDS prevention and
transmission among the adult population was very low
(22%) in 2005, with no improvement in 2007
• National HIV/AIDS estimates indicated that the estimated
and projected number of new HIV infections has been
increasing since 2004 and will continue to increase until
2010
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TB patients registered and screened for
HIV and co-infection (2007-2009)

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Proportion of HIV + clients screened for TB

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LOW PAEDIATRIC ART UPTAKE

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CARE AND SUPPORT FOR PLHIV

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 OTHERS
• The quality of care and lost to follow up of
pre-ART patients
• Loss-to-follow up of patients started on
ART
• Linkage between the various HIV services
still loose
• Weak referral system
• Weak local resource mobilization
• Low paediatric ART uptake
• Quality of care
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