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Problem Statement: The rapidly growing literature on HIV/AIDS in Ethiopia has failed to examine the epidemic, its impacts, and the national prevention and control program in their socioeconomic, cultural, and political contexts.
Objectives: This paper reviews the epidemiology, driving forces, and impacts of the epidemic at the societal level and evaluates prospects for prevention and control.
Methods: The literature was reviewed through online searches of PubMed/ National Institute of Health, Medscape, and PAHA (Partners Against HIV/AIDS in Ethiopia) databases; unpublished sources were obtained from the Ministry of Health and other Ethiopian institutions, United Nations organizations, as well as the Centers for Disease Control and Prevention (CDC) and nongovernment organizations.
Results: Since the rapid spread of HIV infection in the 1980s and 1990s—primarily by commercial sex workers, truck drivers, and soldiers along major transportation routes—children, adolescents, and the general population have increasingly become infected. While the epidemic has spread rapidly in the slowly in rural areas, surveillance activities remain underdeveloped. Thus, the fragmentary data on the occurrence and impact of HIV/AIDS are speculative, and planning and implementation of prevention and control programs have been hindered. Available data show that knowledge levels about HIV/AIDS and use of condoms have increased in towns, and a few populations with declining risk behavior have been identified in Addis Ababa, although a high degree of denial, discrimination, and high-risk behavior persist.
Little is known about the situation in rural Ethiopia. Poverty, war, gender inequities, traditional practices, and political problems have all inhibited the effectiveness of prevention and patient care/support programs. The socio-ecnomic impacts of HIV/AIDS are severe and increasing, and a sharp decline in population growth is anticipated. The national HIV/AIDS prevention program is briefly reviewed, and prospects for decentralized, multisectoral, and community-based planning and implementation of prevention and patient support strategies are examined.
Conclusion: The HIV/AIDS epidemic has become a major threat to Ethiopian society. Limited administrative capacity and persisting economic, behavioral, and attitudinal problems at all levels of society need to be improved rapidly, and the Ministry of Health's Multisectoral HIV/AIDS Strategic Plan should be implemented on schedule to reverse the epidemic. Emerging behavioral changes associated with declining HIV rates in selected urban populations similar to those reported from Uganda and other countries with successful prevention programs give rise to guarded optimism, assuming that these changes can be achieved in the broader population.