Building the Assets to Thrive: Addressing the HIV-related Vulnerabilities of Adolescent Girls in Ethiopia

Despite decades of investment and dramatic progress against HIV, adolescent girls remain at disproportionate risk of infection. Population Council research shows that the best way to protect girls and young women from HIV and other bad outcomes is to reach them early—before they experience irreversible events like HIV infection or unintended childbearing—and with enough health, social, and cognitive assets to make a measurable difference in their lives. This book is a comprehensive review of three programs launched by the Population Council and the Ethiopian government. Two of the programs work to reduce Ethiopian girls’ HIV risk by providing out-of-school adolescent girls in urban slums and married adolescent girls in rural areas with adult female mentors, education on HIV and AIDS and related issues, non-formal education, and links to health services. The third program focuses on husbands, promoting care-giving to wives and children and addressing extramarital partnerships, alcohol abuse, and violence. The Council’s experiences in Ethiopia show that when HIV prevention programs are shaped by evidence and designed for replication and scale-up, they can reach large numbers of the people at greatest risk and increase their ability to avoid infection

From research, to program design, to implementation: Programming for rural girls in Ethiopia—A toolkit for practitioners

This toolkit describes how to build or improve programs for rural adolescent girls in Ethiopia with a view to increasing the number of programs available and making them relevant and context-appropriate. The toolkit describes a process of program development that is grounded firmly in an evidence base. Chapters begin at a starting point of research to identify and describe girls, followed by program development emanating from data, to implementation guided by ongoing monitoring and evaluation

Tap and Reposition Youth (TRY): Providing Social Support Savings and Microcredit Opportunities for Young Women in Areas with High HIV Prevalence

This document describes providing social support savings and microcredit opportunities for young women in areas with high HIV prevelence. Tap and Reposition Youth (TRY) was a multiphase microfinance initiative which aimed to reduce adolescents' vulnerabilities to adverse social and reproductive health outcomes, including HIV infection, by improving their livelihoods options. The project was launched in low-income and slum areas of Nairobi, Kenya, where rates of HIV infection are high and where young women are disproportionately affected. TRY targeted out-of-school adolescent girls and young women aged 16-22. Through continual review and modification, the TRY microfinance model evolved from a limited savings and credit model, to one that expanded upon social support, such as friendship and mentorship

Commercial sex workers in five Ethiopian cities: A baseline survey for USAID Targeted HIV Prevention Program for most-at-risk populations

This report presents findings from a baseline survey of commercial sex workers (CSWs) that was undertaken in five Ethiopian cities. 2,050 CSWs were interviewed for the survey. CSW were disproportionally young and came from extremely disadvantaged backgrounds. Most respondents also cited negative working standards from another profession, or family responsibilities as reasons leading to sex work. Condom use was very high but use may be inconsistent or over-reported and should be studied further. Findings also propose additional advocacy for positive peer support groups, more HIV testing for at-risk populations, and addressing violence among CSWs and other Ethiopian women

Kalkidan (\u27Promise\u27): Addressing marital transmission of HIV in Ethiopia

This program brief describes a Population Council initiative in three low-income areas of Ethiopia. Kalkidan (Amharic for “Promise”) is a three-year program designed to increase discussion and information-sharing on HIV and related topics between marital partners; to promote HIV prevention and health service utilization within marriage, including prevention of mother-to-child transmission (PMTCT) of HIV; and to build husbands’ support of their wives, as well as investment in their health and that of their children. Kalkidan recruits and trains community-based mentors to lead parallel discussion groups of husbands and wives, who periodically come together for joint sessions. The Population Council is measuring changes associated with Kalkidan through a pre- and post-intervention survey that will measure the impact of the project on the knowledge, attitudes, and beliefs at the population level

Kalkidan (‘Promise’) preventing marital transmission of HIV in urban Ethiopia

Most mainstream HIV-prevention programs focus on increasing knowledge related to HIV transmission and risky sexual behaviors. These initiatives often do not take into account gender issues or power dynamics, nor do they address the risk that marital partners face within their relationships. Such programs assume that marriage is a safe haven for women and that their HIV risk is minimal. In response, the Population Council launched the “Kalkidan” project to enhance couple communication, promote HIV prevention within marriage, reduce stigma and violence, and increase demand for HIV information and services, including prevention of mother-to-child transmission—which will collectively contribute to HIV-negative women remaining negative. Kalkidan (Amharic for “Promise”) was a community-based initiative launched for husbands and wives in low-income areas of urban Ethiopia. Respected local leaders were recruited from the project communities to serve as mentors. Eligible participants were invited to single-sex groups led by a same-sex mentor. Groups met weekly, and were periodically brought together for collective discussion. As this document details, the groups’ aim was to enhance couple communication, promote HIV prevention, reduce stigma and violence, and increase demand for HIV information and services

Supporting married girls: Calling attention to a neglected group

In the next ten years, if current patterns continue, more than 100 million girls will marry before the age of 18, according to Population Council analyses of United Nations country data. Child marriage—any marriage that occurs before age 18—is considered a human rights violation by international convention. Marriage transforms virtually all aspects of girls’ lives. Typically, girls who marry are moved from their familial home and village, lose contact with friends, initiate sexual activity with someone they barely know, and soon become mothers. In Bangladesh, Burkina Faso, Ethiopia, India, Nigeria, and elsewhere, the Council is undertaking research to better understand the situation of married girls and to more adequately meet their unique social, health, and development needs. Promoting Healthy, Safe, and Productive Transitions to Adulthood Brief No. 3 outlines Council initiatives to increase understanding of the transition to marriage, to expand married girls’ opportunities, to increase their access to health services, and to develop appropriate health information messages, especially as related to first pregnancy and birth and to HIV and AIDS

Evaluation of health and education impacts of a girls’ safe spaces program in Addis Ababa, Ethiopia

Approximately one in eight of the world’s population is a girl or young woman aged 10–24 and attention is increasingly focusing on the central role of adolescent girls in achieving global health and development goals. Areas of focus by the development field include girls’ education, health, child marriage, and the experience of violence. This study analyzes the educational and health impacts of a program for slum-dwelling girls, including child domestic workers and rural-urban migrants. Established in 2006, Biruh Tesfa (Bright Future) aimed to increase social networks and support for the most marginalized girls in the poorest urban areas of Ethiopia. In 2013, Powering Up Biruh Tesfa was a new initiative to expand the Biruh Tesfa model in Addis Ababa, Ethiopia’s capital, and focus attention on measuring learning and health outcomes. This report provides information on the longitudinal study of girls residing in the expansion sites of Biruh Tesfa and in comparable areas where the program was not implemented. Results indicate that safe spaces platforms can be instrumental in engaging even the most marginalized and isolated girls in both the education and health sectors, while improving learning outcomes

Married Adolescents and Family Planning in Rural Ethiopia: Understanding Barriers and Opportunities

Large numbers of girls in the developing world are married before age 18, an  estimated 100 million girls in the next decade. It is assumed that newly married girls are under pressure to have children early in marriage. However, there is increasing evidence that married adolescent girls have significant levels of unmet need for family planning (FP). This qualitative study explores married girls‘ knowledge and demand for FP, as well as barriers and support. Qualitative data was obtained from girls who married as children in rural Ethiopia. Respondents  demonstrated a high interest in FP, while the power dynamics within arranged marriages were the biggest factor influencing FP use. Disapproval of FP use was considerable among in-laws and community members; however, partner approval was the main determining factor in girls‘ FP use. Some service providers reportedly reinforced this dynamic; some girls reported that they requested confirmation of the husbands‘ approval of FP use. The findings suggest further investment in addressing social norms related to girls‘ status and voice. Keywords: Child marriage, family planning, male involvement, Ethiopi

Migration and child domestic work: Evidence from Ethiopia

Domestic work is frequently the initial survival strategy for rural Ethiopian girls migrating to urban areas. Following migration from rural areas, most girls enter the workforce as domestic workers, because it is a readily available form of work requiring little or no education. In 2015–16, the Population Council undertook a study of migrant, out-of-school girls in urban and rural areas in six Ethiopian regions which demonstrated that this is a common phenomenon. Originating from poor rural areas and armed with little in the way of education, domestic workers receive low pay and frequently work in abusive situations, including sexual abuse. Several programmatic recommendations arise from this study including increased programmatic attention to internal trafficking, specifically the role of brokers who find work for migrant girls