GLOBAL AIDS SITUATION AND PROJECTIONS TO THE YEAR 2000

As of 1 June 1990, a cumulative total of 263,051 cases of AIDS were reported officially to the World Health Organization from 156 countries (Table 1). Of reported cases, 61.1 % are from 44 countries in the Americas; 24.6% from 51 African countries; 13.3% from 29 European countries; and the remaining 1 % from 32 countries throughout Asia and Oceania. However, reporting is incomplete; the actual cumulative global total of AIDS is estimated at over half a million, more than three times the number reported, (Global AIDS fact file June 1990). Nevertheless, it is the epidemiology of HIV infection which provides a more complete and current view of the Pandemic. At the beginning of this decade, about l00,(XX) persons worldwide were infected with HIV .During the n1980s, between 8 and 10 million people became infected

SURVEILLANCE OF HUMAN IMMUNODEFICIENCY VIRUS INFECTION IN ETHIOPIA

Surveillance is an important component of any public health program. Data collection on die occurrence of a disease, consolidation of the data, analysis, interpretation and regular dissemination of die information to the staff involved in disease control programmes are important functions of surveillance. The ultimate objective of disease surveillance is to determine die extent of infections and die risk of disease transmission so that control measures can be applied effectively and efficiently. Surveillance data must, therefore, be current and complete in order to disclose die occurrence and distribution of disease. Various sources of data may be used for surveillance. Both passive and active surveillance are important in an epidemiological system as one can supplement the other

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

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

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

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

DEVELOPMENT AND MANAGEMENT OF THE AIDS CONTROL PROGRAMME IN ETHIOPIA

Realizing the enormous implications of AIDS (acquired immuno-deficiency syndrome) in terms of human suffering, social effects, and costs for health services, the National Task Force on the Prevention and Control of HIV -infection and AIDS in Ethiopia was established, in 1985 -prior to the first laboratory diagnosis of HIV or reported AIDS case. The Government of the PDRE recognized the extraordinary dimensions of the threat of AIDS to the national health, and responded with full commitment and support from the onset of the Programme onward.Initially, measures focused on the development of a National Policy on AIDS, specific operational guidelines, a situational analysis of the problem, and, an assessment of the existing capability to cope with the problem. In collaboration with experts from the Global Programme on AIDS (GP A), the Ethiopian Short Term and Medium Term Plans for the Prevention and Control of AIDS were developed in March and May of 1987, respectively. National strategy required the development of a strong and comprehensive National AIDS Prevention and Control Programme; the highest priority was given to national programme development

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)