PROJECTIONS ON THE DEVELOPMENT OF HIV/AIDS EPIDEMICS IN ETHOPIA

SUMMARY: The accumulated global experience on the duration of HIV latency period and the rates of annual progression to clinical AIDS provided the basis on which to formulate projections on the development of the HIV/AIDS epidemic. Using the data available for 1989 on HIV prevalence in the adult population of Ethiopia and the computer model developed by the WHO Global Programme on AIDS, projections of the epidemic in this country were made. Conservative estimates on the number of STDs infected persons and AIDS cases indicate that Ethiopia is one to three years behind the most AIDS affected countries of Africa in the development of HIV I AIDS epidemic. According to the estimates the national AIDS case surveillance network was able to identify about 10% of the cases which have actually occurred. The progression of the epidemic is threatening, and it requires mobilization of all sectors of the society in order to affect HIV transmission

PROGRESSION OF HUMAN IMMUNODEFICIENCY VIRUS EPEDEMIC IN ETHIOPIA

SUMMARY: A series of HIV sero-prevalence surveys have been carried out in Ethiopia within the framework of the medium term plan for AIDS Control. The surveys were designed to monitor progression of the HIV epidemic in the populations experiencing various risk behaviours as well as in the general population. Sex workers were represented by 2056 randomly selected females practicing multi-partner sexual contact (MPSC) in seven urban areas in 1988, and by 1987 persons in 1989. Similarly, 995 employees of thee Ethiopian Freight Transport Corporation (EFTC), (drivers, assistants, and technicians) were tested in 1988, and 555 in 1989. A survey was also conducted in December 1989 among 318 out patients in Assela Hospital. The average HIV prevalence rate in the country in 1988 among MPSC females was 18.5%. In the second year the average prevalence rate in the seven towns increased to 29.2%. This showed a progression rate of 57.8% in a 12 months period. The progression rates were higher in the initially low prevalence areas and vice versa (r = -0.92). Among the EFTC employees the rate of progression was 33.0% in the drivers and 78.0% in the technicians (initial prevalence rates were 17.3% and 4.1% respectively). The sero-conversion rate was 7.2 % among these EFTC workers within 12 months. No HIV sero-positive person was found among 300 hospital outpatients in Assela hospital in the 1985-86 survey while by the end of 1989 3.5% of the same population group were infected. The results of consecutive testing of blood donors also indicated that HIV prevalence has been increasing steadily, though at a lower rate than among those groups who practiced risk behaviour. These studies indicate that HIV infection is progressing among the urban population in Ethiopia. There is an urgent need for intensive health education aimed at changing sexual behaviour and at promotion of condoms in order to decrease further spread of HI

PREVALENCE OF HIV -1 INFECTION AMONG OUT PATIENTS OF ASSELA TOWN, ETHIOPIA, 1989

Several surveys in Ethiopia, among population groups practicing risky sexual behaviour, demonstrated a rapid progression of the HIV -1 epidemic. Among females involved in multi-partner sexual contacts (MPSC), the HIV prevalence rates rose from 18.5% in 988, to 29.2% in 1989 (1); among the long distance truck drivers the rate has also been increasing (2). As no comparative study was made in the general population of Ethiopia, a serosurvey was initiated in Assela town in December, 1989. Three years earlier (1985 -1986) during a survey aimed at determining hepatitis B prevalence, 300 outpatients of Assela Hospital were also tested for HIV-l infection (3). Two specimens were found repeatedly reactive for HIV-l by ELISA test, but the confirmatory tests Western Blot (WB) gave negative results. The present survey was designed to use the same methodology and sample selection as in the previous survey. All persons in the age group 15 to 40 years applying for medical aid during morning sessions of the outpatient department of Assela hospital, gave 5ml of blood, with no linkage to personal identification. Collection of blood samples continued until the number of persons in the study equaled the target number of the survey conducted in 1985 -1986

SEXUAL BEHAVIOURS AND SOME SOCIAL FEATURES OF FEMALE SEX WORKERS IN THE CITY OF ADDIS ABABA

SUMMARY: In July 1989 during a survey for HIV infection in Addis Ababa, 2663 randomly selected females working at bars, tej (local wine) houses, tella (local beer) houses, and private redlight houses, who practiced multi-partner sexual contacts (MPSC) were interviewed. The study showed that 7.1% of the adult female population of the capital city regularly practiced multipartner sexual contacts. More than 85% of them were not married as a result of past divorces. 52.2% of the group had practiced MPSC for less than 2 years and 16.3% for 2-4 years. 98.1% of females practiced peno-vaginal sex only, 1.7%, in addition occasionally practiced peno-rectal, and 0.2% peno-oral sex. Females practicing MPSC in red-light houses had more sexual partners and they were at a higher risk of acquiring sexually transmitted diseases. 17.7% of all groups combined reported experiencing one or more episodes of Sill; gonorrhea being the leading cause

PROFILE OF AIDS CASES IN ETHIOPIA

SUMMARY: After the first AIDS case was identified in Ethiopia in February 1986, 636 cases have been reported through November 1990. A marked increase in the number of cases was noted from year to year during the five years: 0.3% of all cases were reported in 1986, 2.7% In 1987, 13.4% in 1988, 28.5% in 1989 and 55.2% up to end of November 1990. The large majority of the patients (87.6%) were diagnosed in Addis Ababa hospitals; the remainder were reported from regional hospitals. 445(70.0%) of all patients were males; 191 were females; with a male to female sex ratio of2.3:1. The average age for both sexes was 31.1 years with 32.9 years for males and 26.9 years for females. Sexual contact with multiple partners, history of Sills, and injections received outside of medical institutions, were the three major risk factors identified in 61.3%, 45.6% and 7.9% of the patients respectively. Of the three major clinical features of the WHO case definition, marked weight loss (failure to thrive), was found in 581 (91.4%) of the patients, prolonged fever > 1 month in 542 (85.2%) cases and chronic diarrhea in 296 (46.5%) of the patients. Generalized lymphadenopathy, persistent cough for over 1 month, and generalized pruritic dermatitis were the common minor symptoms identified. It was documented that 361 (60.1 %) of the patients were alive; 163 (27.2%) died

SURVEILLANCE ON AIDS CASES IN ETIllOPIA

SUMMARY: The surveillance system for AIDS cases was introduced in Ethiopia at the beginning of 1989. This was preceded by the preparation of clinical surveillance guidelines and training for physicians at the national and regional levels. The guidelines contained descriptions of the referral system, the activities to be carried out, and recording/reporting forms to be used for this purpose. The trained physicians were given the responsibilities of carrying out the surveillance in their respective hospitals and to maintain regular reporting on the activities .A review of the surveillance activity of the last two years, revealed that 526 (82.7 %) of the patients were reported in 1989 and 1990, after the introduction of the system. Moreover, there was marked improvement in the quality of the reports on the patients. However, from the report presented by different supervisory AIDS, it was identified that the surveillance system was not properly introduced in several health institutions outside Addis Ababa. This indicates the need for regular training and support to the physicians involved in AIDS case surveillance, and for periodic revision of the surveillance system

SOME FACTORS PROMOTING SEX EMPLOYMENT IN ETHOPIA

Extensive surveys on HIV prevalence have been carried out in urban settlements of Ethiopia in 1988 -1989, among females involved in multi-partner sexual contacts (MPSC) (1,2). Pre- and post-test counselling was a permanent component of these surveys. Through individual interviews preceding blood drawing, valuable information was collected on the social status and STD/pregnancy protection practiced by the target group (3,4). The questionnaire however did not cover several important subjects such as factors provoking prostitution and economic status of the MPSC females. In order to obtain this information, a limited scale survey was carried out in three cities: Addis Ababa, Assela and Nazareth in 1989, among 339 MPSC females selected at random (113, 128 and 98 individuals in each town respectively)

PREGNANCY/STD PROTECTIVE MEANS USED BY HIV FEMALE SEX WORKERS IN ETHIOPIA

SUMMARY: In 1988 and 1989, 2663 women in Addis Ababa and 6564 women in 23 other towns of the country practicing multi-partner sexual contacts (MPSC) were interviewed during sero-prevalence surveys for HIV infection. Outside the capital city 42.2% (n=2771) of the women reported using oral contraceptives always or often and only 1.8% of all women in the study always or often used condoms. The results were similar in the capital city. The study indicated that condoms and spermicides known to protect from sexually transmitted disease (STD) and HIV infection were very rarely used by the females practicing MPSC in urban areas of Ethiopia. Since the use of condoms by the study groups was low in general, no significant difference in the frequencies of STD was found between females using them often and non-users. Immediate intensive actions should be directed at the provision of condoms and intensified education aimed at behavior change in order to decrease transmission of HIV

HIV-1 INFECTION AMONG EMPLOYEES OF THE ETHIOPIAN FREIGHT TRANSPORT CORPORATION

SUMMARY: In the study on HIV-l infection conducted in July 1988, 995 long distance truck drivers, their assistants, and lorry technicians employed by the Ethiopian Freight Transport Corporation (EFTC) were enrolled. 89.4% of trips made by the drivers were along the Addis Ababa -Assab road. The HIV prevalence rates were 13% among 468 drivers, 12.9% among 209 drivers assistants, and 4.1% among 318 technicians. The prevalence rate among those who served for < 5 yrs was 4.7% (n = 297) .Those who served longer in the Corporation (82.9% of whom are drivers) had a mean prevalence rate of 12.5% (n=698). Drivers had more sexual partners and more frequently experienced sexually transmitted diseases than the technicians. The study indicated that the long distance truck drivers in Ethiopia practiced frequent contacts with female sex workers. They were at a significantly higher risk to acquire HIV infection than the technicians employed at the same corporation

HIV-1 INFECTION AND RELATED RISK FACTORS AMONG FEMALE SEX WORKERS IN URBAN AREAS OF ETHIOPIA

SUMMARY: A total of 6234 female sex workers practicing multi-partner sexual contacts (MPSC) from 23 urban areas of the country were tested for Human Immuno deficiency Virus type 1 (HIV1) infection, in 1988. The sample size ranged from 99 persons in Moyale, to 386 in Asmara. The mean age of the individuals studied was 24.2 years (ranging from 21.5 years to 27.1 years in the different towns). The HIV-1 prevalence rates varied from 1.3% (n=318) in Massawa, to 38.1% (n=312) in Dessie town; the mean for all towns being 17%. The highest prevalence rates were found in the towns along the road from Addis Ababa to Assab, in Bahr-Dar , Dessie and Mekele. The lowest prevalence rates were recorded in three towns of northern Ethiopia. This study indicated that Hiv-1 is widely spread in the urban areas of Ethiopia affecting female sex workers mainly in the 15-29 years age group. Previous episodes of other sexually transmitted diseases, and frequent change of sexual partners were identified as possible risk factors for HIV infection. Frequent mobility of these females may have played a significant role in HIV transmission between the towns