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

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

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

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

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

PREVALENCE OF STD AND STD RELATED RISK FACTORS IN SEX WORKERS OF ADDIS ABABA

ABSTRACT: The distribution and frequency of some Sills among 282 female sex workers in Addis Ababa randomly selected out of a larger group subjected to HIV serosurvey was studied. Demographic and social information, clinical examination including use of speculum and laboratory detection of Sill pathogens were performed following an informed consent of all participants. An alarmingly high prevalence of Sills was found in the study population. Gonorrhoea was detected in 78 subjects (30.1%), trichomoniasis in 62 (23.9% ), vaginal candidiasis in 51 (19.7% ) and out of 203 sera studied 76 (37.4% ) were positive for syphilis. The duration in sex work was found to have a significant association with seropositivity for syphilis (p < 0.001). Neither the marital status nor regular intake of oral pills influenced the prevalence of Sills. Further laboratory investigation on a broader panel of STDs along with KAPB studies for assessment and evaluation of social and behavioral determinants related to sex work are recommended

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 SOME RELATED RISK FACTORS AMONG FEMALE SEX WORKERS IN ADDIS ABABA

SUMMARY: A sero-epidemiological survey on HIV-l infection was carried out in July 1989, among four groups of female sex workers randomly selected in Addis Ababa. The four groups were comprised of: bar girls, tej (traditional wine) sellers, tella (traditional beer) sellers and females in red light houses. Sera were tested by ELISA and confirmed y western blot. The mean age of the 2617 females studied was 31.2 years, and the prevalence rate for HIV-1 was 24.7%. Persons in the 15-24 age group were affected more frequently. The highest prevalence (43.8%) was found among the females in red light houses. Females with relatively larger number of sexual partners and those who had previous exposure to STDs, had a higher prevalence of the infection. The survey revealed that HIV-1 is highly prevalent among females practicing multi-partner sexual contact (MPSC) in Addis Ababa, and the infection concentrates in the central areas of the city

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