This second issue on HIV/AIDS, comprising six papers, focuses on the role of community-based organizations in HIV/AIDS prevention and patient care, on a bilateral research program, and on the epidemic among Ethiopians during the Diaspora. The first four papers examine the suitability and track record of community-based organizations in developing and participating in HIV/AIDS preventive activities and programs. For the purpose of this issue, community-based organizations include government institutions, civil society groups, and individuals that have started or are planning HIV/AIDS programs in their communities, or are considered potential partners.
The fifth paper in this collection describes a bilateral HIV/AIDS research program, illustrating the complexity and long-term commitment of such collaborations and the need for multidisciplinary research. The last paper provides the first review of the occurrence and risk pattern of HIV/AIDS among Ethiopian immigrants and refugees of the Diaspora, especially in the United States.
In addition to highlighting the contributions in this issue, this introduction will address the limitations of the papers in both special issues on HIV/AIDS in Ethiopia, 7.1 and 7.2, and provide an overview of further research needs, emphasizing the major role of poverty and gender issues in the spread of the epidemic and the need for an expanded research program.
In the first paper of this second issue, Helmut Kloos and Damen Haile Mariam review the literature to briefly evaluate the potential contribution of [End Page 1] community-based organizations in HIV/AIDS prevention, control, and patient care. These organizations, which have been considered the key to controlling the epidemic (UNAIDS 2000), include the kebele (cooperative urban neighborhood association), traditional birth attendants, community health agents, health extension workers, the iqqub mutual aid associations, home-based care for people living with HIV/AIDS (PLWHA), anti-AIDS clubs, traditional healers, and poverty reduction programs.
Despite their meager performance record to date, the kebeles and iddirs (burial associations) are identified as two of the most promising organizations, assuming that bureaucratic bottlenecks can be overcome to create an enabling environment. Field studies by social and behavioral scientists are urgently needed to more fully evaluate the potential strengths and constraints facing these and the other organizations, including poverty reduction programs, in order to strengthen their potential and expand programs to the national level.
The second paper focuses more specifically on one kind of community-based organization, the iddir. Alula Pankhurst and Damen Haile Mariam assess the historical development, social functions, and recent expansion of the iddir into the health area, including HIV/AIDS prevention. Their review of the literature indicates that iddirs have become polyethnic and highly adaptable multifunction organizations in recent times, and lately have ventured into health activities. Pankhurst and Haile Mariam's survey of 120 iddir leaders from 28 weredas (districts) in Addis Ababa reveals the strong response of iddirs to increased mortality among their members and points to the potentially disastrous effects of the epidemic on the continued viability of these associations. Initiatives to form kebeleiddirs, in order to build on strengths and overcome the impediments inherent in both institutions, bode well for their involvement in HIV prevention. The authors' conclusion that involving iddirs will be beneficial only if programs are developed and carried out in a sensitive and participatory manner should be considered by donors and government health officials planning and implementing collaborative interventions.
The contribution by Feiruz Surur and Mirgissa Kaba describing their pilot awareness and prevention project demonstrates the suitability of Muslim and Orthodox Christian leaders as partners in anti-HIV programs and identifies lingering faith-based impediments at the community level. Achievements recorded [End Page 2] during the workshops in four important areas of HIV prevention—agreement of most leaders to support condom promotion programs; their advocacy role in eliminating harmful practices; their proactive role in passing on information to other religious leaders, schools, and the general population in public places; and their willingness to go outside their areas to advocate against alcohol use and promiscuity—indicate that faith-based organizations in constructive partnerships are able and ready to take on issues they tended to avoid in the past.