Ethiopia - Country Progress Report - unaids

Report on Progress towards Implementation of the UN Declaration of Commitment on HIV/AIDS
stable 2003 onwards until 2010.
2.3. Vulnerable and Most-at-risk Populations
An “Epidemiological Synthesis” exercise commissioned by HAPCO and the World Bank in 2007 reviewed and analyzed
available data from the mid-1980s up to 2005. According to the findings of the review team, uniformed services,
truckers, refugees and displaced people, street children, daily laborers, students and other mobile populations are
the most vulnerable groups in the country. However, data are lacking to measure accurately the recent spread of HIV
in these groups and their role in the further spread of HIV to the general population. Other potential high risk groups
include the following:
• Refugees and displaced persons: There has been little research done specifically on displaced persons in
Ethiopia, but as part of the ANC surveillance in 2005, HIV prevalence was recorded at about 13% in Dima
Refugee Camp, a figure considerably higher than the national average.
• Prison populations: The only data on HIV prevalence among prisoners are from 1990 in Dire Dawa (n=450),
indicating a prevalence of 6.0%.
• Men who have sex with men (MSM): This population has been essentially unstudied in Ethiopia. After many
years of denial, evidence is emerging about MSM populations in other East African countries, so it is likely that
such a community exists in Ethiopia, and is probably at even greater risk because of stigma and lack of access
to services. In fact a recent exploratory study has proved that MSM exist and practice in Addis Ababa 8 .
• Injecting drug users: Similarly, this population is also unknown and un-researched in Ethiopia, but is one of
the groups at highest risk in other countries.
• College and pre-college students: in recent years a number of new training and higher learning institutions
have been opened. These sites and their student populations have not been studied, but there is some
anecdotal evidence suggesting widespread unsafe sexual practices.
2.3.1. Female Sex Workers
Due to their high HIV prevalence, their increased ability to transmit HIV when co-infected with other STIs, and to the
broad population groups they reach through their clients, sex workers have long been identified as the ‘core group’
most at risk of both acquiring HIV and transmitting it within a localized or wider sexual network 9 .
Regrettably, in the last decade there has been no HIV prevalence study on sex workers in Ethiopia, which significantly
limits our understanding of the epidemiology as well as the recent dynamics of spread of HIV in the population. Given
the evidence of the increased number of sex workers in the country, the increased utilization of sex workers, and
the decreasing median age of the sex worker population, more research is needed to inform a policy of increased
prevention and treatment activities in this population 10 .
Additionally, the size of the sex worker population in Ethiopia is not known. In 1990 it was estimated that about
7.1% (35,000) of the sexually active female population of Addis Ababa were sex workers. Considering the high influx
of people into urban areas over the past 15 years and the increased number of teenage sex workers, it might be
expected that the current number of sex workers in the city would be much higher 11 .A mapping of sex workers in
Addis Ababa conducted by FHI in 2002 came up with a much lower estimate than the one reported in 1990, and also
indicated that other various types of ‘hidden sex workers’ also exist in the country, mainly in big cities, although the
extent is unknown and difficult to investigate 12 .
The FHI study found that an increasing number of sex workers are seeing five or more partners per week: 14.7% in
1989 to 45.1% in 2002 to 34.6% in 2005. Available data also indicate that in recent years much younger women are
becoming sex workers. Since 1989, the median age of sex workers in Addis Ababa has declined from 31.2 years to
21-22 years 13 . Strikingly, about one-third (30.2%) of the sex workers in 2005 was in the age group 15-19 years. The
fact that an increasing number of young women in their teens and early 20s are joining the sex trade signals a huge
potential for the spread of HIV among young people in the country, assuming that young female sex workers are also
less skilled in defending themselves from “unprotected sexual” exploitations.
8 Seifu Hagos: Assessment of HIV/AIDS Related Risks among Men having Sex with Men in Addis Ababa, 2006
9 Plummer FA, Negelkerke NJ, Moses S, et al. The importance of core group in the epidemiology and control of HIV-1 infections. AIDS 1993
10 Yemane B, et.al, 2007
11 Ibid.
12 Mapping and census of Female Sex Workers in Addis Ababa undertaken by Family Health International (FHI) – Ethiopia in collaboration with the Addis Ababa City Administration Heath Bureau,
2002
13 Ibid
11