Forward
Almost 18 years have past since the emergence of the HIV/AIDS epidemic in Ethiopia. In 1985, the national response to the epidemic was initiated promptly with the establishment of a taskforce on HIV/AIDS. Subsequently, in 1987, the Department of AIDS Control was established in the Ministry of Health and a national program to prevent and control HIV/AIDS was launched. These activities were followed by a number of sero-surveys across the country, to map out the extent of the epidemic.
Given the startling figures of morbidity and mortality and socio-economic suffering of our people, the need to scale - up an extraordinary response and bring about a tangible impact on the epidemic is overwhelming.
So, the current National AIDS activities must be expanded dramatically to curtail spread of this scourge and our government is enhancing its unprecedented leadership in fighting HIV/AIDS by coordinating all sectors, by building up partnership and acting in synergy with all stakeholders to ensure large scale, sustained and more effective and efficient multi-sectoral campaign with a shared vision and common goal to hold back spread of HIV/AIDS, and substantially reduce new HIV infections, provide a continuum of care for those infected and affected by HIV/AIDS, significantly reduce its impact on human suffering and arrest the further reversal of our peoples' socio-economic development.
This consorted, integrated and un-abating effort needs to be supported and guided by a clearly targeted, well-designed and analyzed surveillance studies, surveys and researches in order to have a shared analysis and shared perspective on gaps, and have shared priorities and proper allocation and utilization of resources towards identified problems and risk behaviors, as successful HIV prevention depends on changing risk behaviors.
By using reliable methods, behavioral surveillance surveys can be used to track HIV risk behaviors overtime as part of an integrated surveillance system by monitoring various aspects of the epidemics.
Therefore, in 2001, Ethiopia, in collaboration with national and international partners, started to implement Second Generation HIV Surveillance. The Second Generation HIV Surveillance system stresses the need to design a surveillance system that is appropriate to the stage of the country's HIV epidemic. In particular, it emphasizes the importance of using behavioral data to inform and explain trends recorded in HIV infection amongst a population, and advocates for the increased use of behavioral data in planning, implementing and evaluation of appropriate responses to the epidemic.
Round One of the Behavioral Surveillance Survey (BSS) in Ethiopia, in ten target populations, was conducted in 2002 with sample size around 27,000. This Baseline survey provides, in many instances for the first time, representative population-based data on the socio-demographic characteristics and behavioral risk of target groups. For tracking behavior helps us to evaluate the achievements of our programs and change in behavior will help to explain changes in HIV prevalence, the survey will assist the Federal Ministry of Health of Ethiopia to develop relevant and targeted communications and interventions that can materialize in the desired behavioral change. Furthermore, when BSS data and biological surveillance system data are combined; a clear focus for HIV/AIDS interventions will become apparent.
The Ministry of Health is fully committed to working with national and international partners to utilize the findings of this survey. We believe this first baseline survey result will be useful to inform the design and implementation of subsequent rounds of BSS.
I am delighted to launch this Round One BSS (Behavioral Surveillance Survey) report for Ethiopia. We thank those all who supported and participated in the production of this timely report. The Ministry of Health recommends the document to be utilized by all relevant bodies working on HIV/AIDS in Ethiopia.
Thank You,
Acknowledgements
The Department of Community Health (DCH), AAU/EPHA, implemented the study.
We would like to acknowledge the support given by the MoH, HAPCO, MoND, Regional HIV/AIDS Prevention and Control Secretariats and regional health bureaus. This study was realized with major financial support from USAID. And technical support from FHI and additional financial support from UNICEF and SC-USA. The printing cost of this research was covered by HAPCO.
Our deepest gratitude goes to all the Staff of National HAPCO for all rounded support from the inception to the completion of the 2002 BSS. In particular our thanks goes to Ato. Negatu Mereke, Head of HAPCO and Dr. Tekelu Belay, Advocacy, Mobilization and Coordination Department Head.
The BSS team would like to thank all the study participants who gave their time and shared their experiences and knowledge, namely: the youth from the respective regions; truckers, minibus and intercity bus drivers and their associations; the farmers of Butajira and pastoralists of Borena; female sex workers; management and employees of the Akaki Textile Factory; and members of the uniformed services. We would also like to thank the Ministry of Education and all the schools that participated in the survey, the Administration of the Southern Technology Faculty Campus, the Mental Health Project, the Department of Psychiatry, ESTC, the Road Transport Authority and Taxi Owners’ Association in Addis Ababa, DKT–Ethiopia, EHNRI and the management of the Akaki Textile Factory.
Furthermore, we would like to thank the data collectors, supervisors and wereda/kebele administrators in the respective regions, who worked hard and responsibly, in order to accomplish the data collection and maintain the quality of data.
We thank the following experts for their invaluable comments and suggestions during implementation and review of this research: Dr Damen H/Mariam (DCH), Dr Dangnachew H/ Mariam (former Head of NAC), Dr Endalamaw Abera (WHO), Dr Yetnayet Asfaw (private consultant), Ato Mirgissa Kaba (UNICEF), Mr Mohammed Ali Bhuiyan (SC-USA), Dr Asegid Woldu (MoH), Dr Gail Davey (DCH) and Dr Ahmed Ali (DCH).
Finally, our special thanks go to Ms Francesca Stuer, Country Director FHI Ethiopia and FHI-Staff for their unreserved administrative support throughout the implementation of the study and Ms Jeanette Bloem (Secheba Consultants, Lesotho) for her extensive technical input. Last but not least, our heart felt thanks go to Ato Ali Beyene (EPHA) for facilitating the financial administration.
Abbreviations
|
AAU |
Addis Ababa University |
|
AC |
Administrative council |
|
AIDS |
Acquired immunodeficiency syndrome |
|
BCC |
Behavioral change communication |
|
BSS |
Behavioral surveillance |
|
CSA |
Central Statistical Authority |
|
DCH |
Department of Community |
|
DHS |
Demographic and health survey |
|
EC |
Ethiopian calendar |
|
FGD |
Focus group discussion |
EHNRI |
Ethiopian Health and Nutrition Research Institute |
|
ENARP |
Ethio-Netherlands AIDS Research Project |
|
EPHA |
Ethiopian Public Health Association |
|
ESTC |
Ethiopian Science and Technology Commission |
|
ETB |
Ethiopian birr |
|
FGAE |
Family Guidance Association of Ethiopia |
|
FHI |
Family Health International |
|
FSW |
Female sex worker |
HAPCO |
HIV/AIDS Prevention and Control Office |
|
HIV |
Human immunodeficiency virus |
|
IDI |
Individual in-depth interview |
|
IDU |
Injecting drug user |
|
IEC |
Information, education and communication |
|
ISY |
In-school-youth |
|
MoH |
Ministry of Health |
MoND |
Ministry of National Defense |
NGO |
Non-governmental organization |
|
OSY |
Out-of-school youth |
|
PA |
Peasant association |
PLWHA |
People living with HIV/AIDS |
PPS |
Probability proportional to size |
SC–USA |
Save the Children–USA |
SNNPR |
Southern Nations and Nationalities Peoples Region |
STI |
Sexually transmitted infection |
UDA |
Urban dwellers association |
UNAIDS |
United Nations Program on HIV/AIDS |
UNICEF |
United Nations International Children’s Fund |
USAID |
United States Agency for International Development |
WHO |
World Health Organization |
VCT |
Voluntary counseling and testing |
Definitions
Definitions of terminology
Aba Geda–
A Borena leader who is elected by a panel of elders; elections take place every eight years. An Aba Geda carries out social, economic, ritual and political activities that help to keep peace amongst the Borena pastoralists. (The term Geda may also be spelt Gada).
Ethiopian Calendar (EC)–
Ethiopia follows the Julian calendar, which consists of 13 months; 12 months with thirty days each and a thirteenth month of five days, six in a leap year. The calendar is seven or eight years behind the Western (Gregorian) calendar. The Ethiopian New Year begins on the first day of the month of Meskerem, which falls on September 11th on the Gregorian calendar.
Female sex worker (FSW)–
Female who sells sex for money.
Kebele–
The lowest administrative unit in Ethiopia. In urban areas it is also called an urban dwellers association (UDA) whilst in rural areas it is also called a peasant association (PA).
Mass media–
Radio, television and printed media.
Region–
Regions are national states that together form the Federal Democratic Republic of Ethiopia. There are ten regions and one administrative council (AC). In this study, region refers to regional capital or major urban cities of the region.
Wereda–
An administrative unit (equivalent to a district).
Zone–
Consists of a number of weredas.
Operational definitions
Buying and selling–
Used to convey the retail trade e.g. the buying and selling low-cost goods (chiricharo).
Commercial sex–
A sexual relationship where money was paid in exchange for sex (paid sex).
Commercial sex partner–
A partner who was paid money in exchange for sex.
Comprehensive knowledge about HIV/AIDS–
Respondents were considered to have comprehensive knowledge about HIV/AIDS if they knew about the three HIV/AIDS prevention methods and had no misconceptions about HIV transmission.
Consistent condom use–
Used a condom every time sexual relations took place.
Drugs–
Drugs considered in this study were stimulants other than alcohol e.g. khat (Catha edulis), shisha, hashish (marijuana), Mandrax, cocaine, crack and benzene.
Ever drug use–
Ever in ‘lifetime’ use of any of the drugs listed in the definition above.
Informal employment–
Employment was considered informal when: 1) the establishment/activity was not a corporate type of enterprise; 2) the establishment/activity was not registered by any legal authority (i.e. was unlicensed); 3) individuals were self-employed; or 4) an employer/establishment/activity did not keep a complete book of accounts. Informal employment was typically short-term and low-income e.g. daily laboring or domestic work.
Involvement with community HIV/AIDS interventions–
Included: participation in anti-AIDS clubs; contact with an outreach worker; discussion with a peer educator; participation in social events with an HIV/AIDS theme; discussion about HIV/AIDS with friends, sexual partners, families or other community members; and contact with HIV/AIDS support groups.
Knowledge about HIV prevention–
Respondents were considered to be knowledgeable about HIV prevention if they correctly identified the three major ways to prevent HIV transmission i.e. abstinence, being faithful to one uninfected partner and condom use.
Misconceptions-
Respondents were considered to have misconceptions about HIV/AIDS transmission and prevention if they agreed to any the following six incorrect statements about HIV/AIDS: a mosquito bite can transmit HIV; sharing a meal with someone who is HIV positive can transmit HIV; a healthy-looking person cannot be infected with HIV; eating raw meat (raw kitfo) prepared by an HIV-infected person can transmit HIV; eating an uncooked egg laid by a chicken that swallowed a used condom can transmit HIV; and drinking local hard liquor and eating hot pepper can protect from HIV.
Multiple sexual partners–
More than one sexual partner.
Non-commercial partner–
Used for youth – any partner other than a commercial partner.
No incorrect beliefs about HIV/AIDS transmission–
Respondents were considered to have no incorrect beliefs about HIV/AIDS transmission if they correctly rejected statements expressing the three most common misconceptions about HIV: a mosquito bite can transmit HIV; sharing a meal with someone who is HIV positive can transmit HIV; and a healthy-looking person cannot be infected with HIV.
Non-paying partner–
Sex partners of a FSW who did not pay money in exchange for sex.
Non-regular partner–
Non-regular partners included two groups: (a) sexual partners who had been together for less than 12 months, were not married, had never lived together and did not make any payment for sex; and (b) sexual partners who had been together in a relationship for more than 12 months but had never married or lived together.
Paying client–
Sex partner of a female sex worker (FSW) who paid money in exchange for sex.
Regular alcohol use–
Use of alcohol at least once a week amongst those who ever drank alcohol.
Regular khat use–
Use of khat at least once a week amongst those who reported ever having chewed khat.
Regular partner–
Spouse or cohabiting (live-in) sex partner.
Risky sex–
Any unprotected sex (i.e. sex without a condom) with any partner other than a regular partner.
Shisha–
A mixture that may include tobacco, honey, hashish and spices; it is smoked from an oriental tobacco pipe, which has a long, flexible tube that draws the smoke through a water-filled container.
Uniformed services–
Included only the ground force and air force.
