Prevalence and distribution: The Fifth National HIV/AIDS Report in 2003 indicated a total of 1.5 million persons living with HIV/AIDS in the country with an adult prevalence of 4.4%. The prevalence greatly varies in urban (12.6%) and rural areas (2.6%). There is also higher rate of infection among women (5.0%) than men (3.8%). Although urban areas have greater prevalence, infection is stabilizing while there is gradual but steady rise in prevalence in rural areas.
Impacts: AIDS has so far shortened life expectancy by 4.6 years and caused tuberculosis incidents to increase by 38% in 2003. It has increased hospitals’ bed occupancy (from 40 to 60% in 1999) and depleted the productive force as well as aggravated food insecurity in Ethiopia.
Vulnerability: Women, youth, young commercial sex workers, the rural population and orphans and children in general are the most vulnerable groups identified. Women, due to economic, educational, and biologic factors as well as various harmful traditional practices are considered more vulnerable than men. Age, emotional development and financial dependence as well as poverty and awareness about the disease are major factors of vulnerability among youth and in rural communities.
Policy, strategy and legal frameworks: The National AIDS Policy was drafted in 1991 and approved in 1998. A National Strategic Framework was formulated in 2002 with focus on reducing transmission. It was replaced by a strategic plan in December 2004 with focus on community mobilization of target groups including youth (15-29 years of age), rural communities and people living with HIV/AIDS.
A women policy was enacted in the country in 1993 with the objective of facilitating equality, equal access to services and eliminating prejudice against women. The national poverty reduction strategy papers also identify HIV/AIDS as focus area. The country has ratified the Universal Declaration of Human Rights (UDHR) and relevant treaties like the Convention of the Elimination of All Forms of Discrimination against Women (CEDAW) and The Convention on the Rights of Child. Various laws in the country, such as Laws of non discrimination and equality before law; participation in the economic, political and cultural life of society; the rights of women, children and other vulnerable or affected group; have helped strengthen protection of vulnerable (specifically women and children) and affected society groups.
Barriers for implementation: Although the country has a number of positive policies, strategies and legal frameworks, pertinent to HIV/AIDS prevention and control, there are also serious structural and economic barriers to implementation.
There is not enough integration between the legal framework and HIV/AIDS risks e.g. protection of girls/women and helping rape victims. The national strategy has not specifically included women among the vulnerable groups. Rural areas are only to a limited degree benefiting from interventions including services like information, Voluntary Counseling and Testing and Anti Retroviral Treatment. There are also barriers of cultural and social norms and practices. Gender inequality is the most important. Stigma and discrimination and harmful traditional practices like female genital mutilation, early marriage, abduction and widow inheritance are also common.
Stakeholders analysis: As legal duty bearers, through the HIV/AIDS Prevention and Control Offices (HAPCO) coordination role at different levels (national, regional and district), various sectors mainly Ministry of Health, Agriculture, Youth and Culture, Education and also women Affair’s Offices are also involved in the response to different extent. The major moral duty bearers in the country include faith and community based organizations, non governmental organizations etc.
Conclusion and recommendation: Based on the analysis, girls and women were found to be the most vulnerable groups and PLWHA being second in that respect. Gender inequality has been found to be the root cause for the spread of HIV in addition to harmful traditional practices. Involving boys and men and focusing on rural areas were the most important recommendations of the analysis.
Program strategy
Program focus: Prevention of HIV/AIDS is the program focus of DCA Ethiopia targeting women and girls as primary right holders and PLWHA included as secondary.
Geographic focus: The rural poor population of the two largest regions of the country, Oromia and Amhara, with specific focus on Arsi, Bale and Borena zones of Oromia and North and South Wollo and North Shewa from Amhara region.
Problems to be addressed: The four major problems to be addressed in the HIV/AIDS Program are:
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Gender inequality
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Harmful traditional practices
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Stigma and discrimination
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Access to information and service.
Programme objectives: With an overall objective of empowering vulnerable groups, in particular girls and young women, to claim and access rights from duty bears to knowledge, prevention, care and support and treatment for reduced vulnerability to HIV/AIDS, the program will have four specific objectives:
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Vulnerable right holders are empowered to protect themselves against the risks of HIV/AIDS
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The right to non-discrimination and access to services for PLWHA is respected, protected and supported
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Action taken by duty bearers to integrate gender equality in programs to reduce women’s risk of HIV infection
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Strengthen networking and partners’ capacity to plan, implement and monitor program activities
Programme cohesion: The DCA Ethiopia country program has three programme types: food security, political space and the HIV/AIDS. Integration of the three programs in order to bring synergy is given priority. There will be both functional and geographic integration.
Programme timeframe and timetable: The program objectives are anticipated to be met in minimum of five years duration, from 2006 to 2010. A mid-term evaluation is planned at 2008 with an aim to gather lessons learned and if required to redirect the remaining phase of the program.
Programme partners and alliances: Through a platform established among its partners DCA will facilitate networking and collaboration, help partners share best practices and lesson learnt and also facilitate joint planning and capacity building and exposure initiatives to strengthen monitoring and evaluation and further development of the program. DCA, as an organization working through partners has identified some of the partners expected for collaboration in the coming years.
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