HIV/AIDS has had a significant impact in Ethiopia, with an estimated 1.1 million people living with HIV/AIDS. The epidemic is largely driven by socio-cultural factors and lack of knowledge. Ethiopia has implemented a national response including developing policies, guidelines and strategic plans to coordinate prevention, care, and treatment efforts across multiple sectors. Major achievements include expanding access to antiretroviral therapy and other HIV services. However, challenges remain in fully addressing the epidemic.

1. Overview of HIV/AIDS
In Ethiopia
Unit 1
HIV Care and ART: A Course for
Pharmacists by Salahadin M.Ali

2. Overview of HIV/AIDS 2
Learning Objectives
■ Describe global & national HIV/AIDS
epidemiological profile
■ Describe the Ethiopian National AIDS Policy
■ Describe the Ethiopian National Strategy for
Prevention and Control of HIV/AIDS
■ Understand Implementation status of HIV/AIDS
program in Ethiopia

3. Global and National Summary of
HIV/AIDS Epidemic

4. Overview of HIV/AIDS 4
Global Summary of the HIV/AIDS Epidemic
December 2007
■ People living with HIV/AIDS: 33.2 million (30.6–36.1million)
■ Adults: 30.8 million (28.2–33.6 million)
– Women: 15.4 million (13.9 - 16.6 million)
■ Children under 15 years: 2.5 million (2.2 - 2.6 million)

5. Overview of HIV/AIDS 5
Estimated PLHIV by End of 2007:
33.2 Million (regional distribution)
North America
1.3 million
Caribbean
230,000
Latin America
1.6 million
Western Europe
760,000
North Africa
& Middle East
380,000
Sub-
Saharan
Africa
22.5
million
Eastern Europe
& Central Asia
1.6 million
East Asia & Pacific
800,000
South
& South-East Asia
4.0 million
Australia
& New
Zealand
75,000

6. Overview of HIV/AIDS 6

7. Overview of HIV/AIDS 7

8. Overview of HIV/AIDS 8
The Proportion of Female in PLHIV

9. Overview of HIV/AIDS 9
Global Summary of the
Epidemic, December 2007
■ People newly infected with HIV: 2.5 million (1.8-
4.1 million)
■ Adults: 2.1 million (1.4 - 3.6 million)
■ Children under 15 years: 420,000 (350,000 – 540,000)
■ Every single day over 6,800 persons infected
with HIV and MTCT contributed over 1600 every
day

10. Overview of HIV/AIDS 10

11. Overview of HIV/AIDS 11
Trend of the AIDS Epidemic in Female,
(1990-2007)

12. Overview of HIV/AIDS 12
Global & Sub-Saharan Africa Trend of the AIDS
Epidemic(1990-2007)

13. Overview of HIV/AIDS 13
Global Summary of the
Epidemic, December 2007
■ AIDS deaths in 2007: 2.1 million (1.9 – 2.4 million)
■ Adults: 1.7 million (1.6 – 2.1 million)
■ Children under 15 years: 330,000 (310,000 – 380,000)

14. Overview of HIV/AIDS 14
Estimated Adult and Child Deaths from HIV/AIDS end of
2007: 2.1 Million (regional picture)
North
America
21,000
Caribbean
11,000
Latin
America
58,000
Western
Europe
12,000
North Africa
& Middle
East
25,000
Sub-Saharan
Africa
1.6 million
Eastern Europe
& Central Asia
55,000
East Asia
& Pacific
32,000
South
& South-
East Asia
270,000
Australia
& New Zealand
1,400

15. Overview of HIV/AIDS 15
Global Summary of ART, December 2007
■ PLHIV accessing ART in low and mid income
countries has increased dramatically
■ ART 2003: Around 0.4 million
■ ART 2005: Around 1.3 million
■ ART 2007:Around 3million

16. Overview of HIV/AIDS 16

17. Overview of HIV/AIDS 17

18. Overview of HIV/AIDS 18
Scale up of ART
1. 2003: Around 0.4 million
2. 2005: Around 1.3 million
3. 2007:Around 3million

19. Overview of HIV/AIDS 19
The Essential findings of Epidemic
Current epidemiologic assessment findings
■ The global prevalence of HIV is remaining at the same level
■ There are localized reductions in prevalence in specific
countries
■ A reduction in HIV-associated deaths
■ A reduction in the number of annual new HIV infections
globally e.g. in 2004 estimate was over 13,500 per day
however in 2007 it is over 6,800 per day which might
attribute to different reasons

20. Overview of HIV/AIDS 20
The Essential findings contd.
■ Women and young(15-24) are disproportionately affected
by HIV/AIDS and the figure keeps on increasing
■ Even though the HIV prevalence stabilized in Sub-
Saharan Africa, the actual number of people infected
continues to grow because of ongoing new infections and
misconception on the increasing access to ART.
■ In 2007: more 68% of all people HIV-positive, 1.7 million
people new infection, 76% of all AIDS deaths live in Sub-
Saharan Africa
■ The southern Africa sub region is the hardest hit of the
sub-Saharan Africa by the pandemic, e.g., 8 countries
>15%

21. Overview of HIV/AIDS 21
The Essential findings contd.
The global and regional trends suggests the pandemic has
formed two broad patterns:
1. Generalized/high level epidemics sustained in the
general populations of many sub-Saharan African
countries, especially in the southern part of the continent
and
2. Concentrated/low level epidemics occurs in the rest of
the world among populations most at risk, i.e., MSM,
Injecting drug users, sex workers and their sexual
partners.

22. Overview of HIV/AIDS 22
Overview of HIV/AIDS in Ethiopia

23. Overview of HIV/AIDS 23
Historical Overview of HIV/AIDS
in Ethiopia
■ The beginning of the HIV in Ethiopia was assumed
1982 (urban 1982 & rural 1984)
■ 1984: The first evidence of HIV infection in Ethiopia
■ 1986: The first two AIDS cases reported to the
Ministry of Health
■ 1989: HIV/AIDS surveillance started
■ At present there are 115 surveillance sites (Urban:
40, Rural: 75)

24. Overview of HIV/AIDS 24
The Facts: HIV in Ethiopia (2)
■ National HIV prevalence rate: 2.3 % in 2009
■ Female: 2.8%
■ Male: 1.8%
■ Urban HIV seroprevalence rate: 7.7%
■ Rural HIV seroprevalence rate: 0.9%
■ Addis Ababa seroprevalence rate: 8.5%
■ HIV infections occurring among adults between
15-49 years: more than 85%

25. Overview of HIV/AIDS 25
The Facts: HIV in Ethiopia (3)
■ 1.1million living with HIV/AIDS
■ 73,000 children (<15 years)
■ 131,145 New Infection (2009)
■ Annual HIV Incidence in 2009= 0.28%
■ 336,160 ART need in 2009
■ 44,751 AIDS deaths in 2009
■ HIV seems to be driving the TB epidemic (figure)
■ Life expectancy decreased due to AIDS= 3.9 years (2007)
Source: MOH/Policy Project: Aids in Ethiopia, 5th ed., July, 2004

26. Overview of HIV/AIDS 26
The Est. Distribution by Age of PLHIV
Age Distribution of PLHIV Estimate (AIDS 6th Report)
0% 6%
3%
1%
85%
5%
0%
Age 0-4 5-9 10-14 15-49 50-64 >65
Ref: AIDS 6th Report

27. Overview of HIV/AIDS 27
The Estimated Distribution of PLHIV by Sex &
Age (AIDS 6th Report)

28. Overview of HIV/AIDS 28
1. Socio-cultural Norms and Practices
■ Unprotected Sexual practice & concurrent multiple sexual practice
■ Low socio-economic status of women
2. Low condom use
3. Low level of comprehensive knowledge (EDHS 2005
F=16%, M=30% )
4. High rural-urban migration
5. Economic and Education
Therefore: We Need SOCIAL TRANSFORMATION:(BPR)
Why High Spread of HIV in Ethiopia?

29. Overview of HIV/AIDS 29
Impact of HIV/AIDS in Ethiopia

30. Overview of HIV/AIDS 30
Impacts of HIV/AIDS
HIV/AIDS has deep-rooted and whole negative
impact on
1. Economical( household, national, global)
2. Social
3. Political
4. Health Related

31. Overview of HIV/AIDS 31
Impacts
1. Economic (1)
A. Impact on Urban and Rural Households
■ Loss of income resulted from
■ Loss of labor as it affects the productive age groups
■ Loss of skilled manpower and knowledge
■ Loss of land
■ Loss of remittances
■ Reduction in savings and investment because of
■ Expenses for treatment, funeral, teskar
■ Need to sell livestock to meet expenses
■ Need to sell houses and resources

32. Overview of HIV/AIDS 32
Impact
1. Economic (2)
B. Impact on Industry
■ Loss of workers
■ Expenses for recruiting and training replacements
■ Reduced productivity in cases of skilled workers or managers
■ Lost work days due to sickness
■ 30 - 240 days per year
■ Lost work days due to funeral leave
■ Increased health care costs
■ 50% illness due to AIDS
■ Loss of skilled professionals

33. Overview of HIV/AIDS 33
Impact
2. Health
1. Suffering from broad OIs and suffer from diseases
2. Increase the prevalence of TB, e.g., in 2005 32%
of 141,000 TB cases accounted for HIV/AIDS and
in 2010 is 30% of 163,000 cases
3. High bed occupancy rate and chronic cases
increment
4. Decrease life expectancy at Birth
5. High health related costs

34. Overview of HIV/AIDS 34
National Response

35. Overview of HIV/AIDS 35
National Responses
1. Establishment of national and regional offices that
can respond to the pandemic
2. Development of policy, guideline and M&E tools
3. Capacity building (HR, Infrastructure, Systems)
4. Mobilization of Resources (GFATM, PEPFAR, UN
organization, World Bank, multilateral and
bilateral organizations)
5. Scale up of the prevention, care and treatment
services

36. Overview of HIV/AIDS 36
National Response (2)
■ National HIV/AIDS Task force established in 1985
■ National AIDS Control Program (NACP) established in MOH in 1986
■ HIV/AIDS Surveillance Activity started in 1989
■ HIV/AIDS Policy formulated by MOH and adopted by the Council of Ministers in
1998
■ Created an enabling atmosphere for HIV/AIDS prevention and control
■ Supplemented existing Health Policy, Women’s Policy, and Education and Training
Policy
■ Called for a multi-sectoral response
■ Guaranteed rights of PLHIV
■ HIV/AIDS Prevention & Control Office (HAPCO) established June 2002 and
regions also established a coordinating body after working as National
HIV/AIDS Council Secretariat NACS (since April 2000)
■ ARV Drugs Supply & Use Policy formulated July 2002

37. Overview of HIV/AIDS 37
National Response (3)
■ HAPCO Primarily responsible for
■ Resource Mobilization
■ Advocacy
■ Coordination of the sectoral responses
■ National Fund raising and grant proposal were successful &
able to win GFATM R2, R4, R7 and Rolling Continuation
Chanel (RCC)
■ The resources used for health system strengthening,
infrastructure, training and program management

38. Overview of HIV/AIDS 38
National Response (4)
■ HIV/AIDS Strategic plan for five years (2004 –
2006, 2007-2010) and new SPM onboard
■ Social mobilization & community involvement
■ Community ownership through the CC approach
■ Scaled up HIV/AIDS Programs
■ AIDS fund was initiated
■ Free ART program was scaled up
■ Free HCT services, PMTCT, OI and STI

39. Overview of HIV/AIDS 39
Policy on HIV/AIDS of the FDRE,
August 1998
 The Major objective is to provide an enabling
environment for the prevention and control of
HIV/AIDS in the country. And it emphasizes that
 HIV/AIDS is development problem and hence need multisectorial response
 The need to increase awareness and involvement of women (IEC/BCC)
 The need of multi source funds to mitigate the problem
 The need for holistic approach to provide care and treatment for PLHIV
 Cognizant the human right of PLHIV
 The catastrophic of the epidemic to the next generation that the
government wants to stands for

40. Overview of HIV/AIDS 40
Policy on HIV/AIDS
■ The HIV/AIDS Policy guide Prevention and Control
of HIV/AIDS
■ What are the prevention and Control activities?

41. Overview of HIV/AIDS 41
Policy on HIV/AIDS (Prevention Strategies)
1. Social mobilization (IEC/BCC)
2. HIV counseling and testing
■ Voluntary (VCT)
■ Provider initiated Testing and Counseling (PITC)
3. STI prevention and control
4. Condom promotion and Proper use
5. Infection prevention (IP) and Universal Precaution (UP)
6. Prevention of mother to child transmission (PMTCT)
7. Post exposure prophylaxis (PEP)

42. Overview of HIV/AIDS 42
Policy on HIV/AIDS
(Care, Rx and Support Strategies)
1. Care and Treatment
■ Palliative care
■ Community home based care
■ Opportunistic infection treatment
■ Tuberculosis treatment
■ Treatment of AIDS patients
2. Support for
■ Orphans and vulnerable children (OVC)
■ People living with HIV/AIDS (PLWHA)

43. Overview of HIV/AIDS 43
The Ten National HIV/AIDS
Intervention Strategies

44. Overview of HIV/AIDS 44
HIV/AIDS Intervention Strategies (1)
1. Targeted & Synchronized Social Mobilization
2. Established Implementation M-sms to support the Health
Network & continuum of Care Model
3. Expanded Comprehensive & Stdzed Prevention
Responses with in the health sector to avert new
infections
4. Accelerated enrollment in Comprehensive HIV/AIDS care
& Rx through established M-sms for intra-and inter-facility
linkages
5. Expanded HIV/AIDS services delivery capacity through
human resource development & adequate infrastructure
including equipment

45. Overview of HIV/AIDS 45
Eth HIV/AIDS Intervention Strategies (2)
6. Ensured Continuous supply of quality assured drugs &
medical supplies with appropriate pharmaceutical
services
7. Strengthen Lab capacity & ensured continuous supply of
all lab commodities
8. Strengthening M& E, IT, Operational Research & quality
assurance
9. Strengthened decentralized Roadmap management and
Coordination
10. Developed M-sms for Sustainability

46. Overview of HIV/AIDS 46
Ethiopian National ART Guidelines

47. Overview of HIV/AIDS 47
Table 2: First line Regimen for Adult and Adolescent
Recommended ARV Regimens for Adults and Adolescents:
One of the following should be used unless there are
contraindications:
Preferred :
 TDF+FTC(3TC) +EFV = triple FDC
 ZDV+3TC+EFV = combivir + EFV
 ZDV+3TC+NVP = triple FDC
Alternatives:
 D4T/3TC/EFV= double FDC(d4T/3TC)+ EFV
 TDF/3TC/NVP
 D4T/3TC/NVP= triple FDC
 ABC/3TC/EFV
 ABC/3TC/NVP
 ABC/3TC/ZDV= combivir + ABC

48. Overview of HIV/AIDS 48
Table 9: Second line Regimen for Adults and Adolescents

49. Overview of HIV/AIDS 49
The summary of different regimens
■ Refer to the table that summarizes the different
special scenarios and the regimens to be used in
those conditions (Participant Handbook)
Refer also the recent Guidelines

50. Overview of HIV/AIDS 50
HIV/AIDS Programs Major
Achievements; Challenges and
Initiatives to Address the
Challenges

51. Overview of HIV/AIDS 51
Major Achievements (1)
■ Formulated National HIV/AIDS Policy
■ Established National Coordinating body
■ Produced six editions of “AIDS in Ethiopia”
■ Formulated National ARV policy (revised and published in January
2005)
■ Developed SPM for HIV, e.g., Five-year strategic plan developed,
revised & updated
■ Drafted a Roadmap to accelerate access to HIV/AIDS care and
treatment
■ Developed M&E framework
■ Developed Robust Logistics Systems for HIV/AIDS commodities
(special of its kind)

52. Overview of HIV/AIDS 52
Major Achievements (2)
■ Key guidelines developed:
■ HIV Surveillance Guideline
■ HIV Surveillance Training Manual
■ Voluntary Counseling & Testing Guideline
■ AIDS Case Management Guideline
■ STI Management Guideline
■ Home-Based Care Guideline
■ Private HIV Labs Licensing Guideline
■ PMTCT Guideline
■ Home Care Training Manual
■ Counseling Training Manual
■ ARV Guideline
■ Universal Precautions & Post Exposure Prophylaxis

53. Overview of HIV/AIDS 53
Major Achievements (3)
■ Integrating HIV/AIDS into health programs:
■ Reproductive health
■ Mother and child health
■ Hospital hygiene
■ Health education
■ Integrated disease surveillance
■ TB/HIV Initiative

54. Overview of HIV/AIDS 54
Major Achievements (4)
■ Prevention, Diagnostics and Treatment centers as
of end of June 2009
1. 1525 HCT sites established
2. 115 (40 urban +75 rural) Sentinel Surveillance
sites established
3. 837 PMTCT sites established
4. 448 ART sites established

55. Overview of HIV/AIDS 55
HAART and Progress
 In July 2003, the government adopted the policy of ARV
drug supply and use; and subsidized cost ART was started
in some hospitals (Zewditu Hospital).
 In January, 2005 the government launched the free ARV
treatment initiative.
 Free based ART program was started in March, 2005.
 As of end of June 2009 more than 206,628 people Do
access ARV
Major Achievements (5)

56. Overview of HIV/AIDS 56
Trend on Service Expansion (HAPCO June
2009)
837
3
484
129
184
408
719
353
272
93
1525
1336
1005
775
658
0
200
400
600
800
1000
1200
1400
1600
1800
2004/05 2005/06 2006/07 2007/08 2008/09
#
of
Health
facilties
PMTCT ART VCT

57. Overview of HIV/AIDS 57
VCT trends (HAPCO June 2009)
436,854
564,351
1,922,666
4,559,954
5,800,248
-
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
Number
of
People
counseled
&
tested
per
year
2004/5 2005/6 2006/7 2007/8 2008/9
Year
Trend of Counseling and testing, 2004/5-2008/9

58. Overview of HIV/AIDS 58
Care and Treatment Trends
321548
387000
180477
206628
132239
153000
161529
39489
13773 24236
95,908
8276
3880
72,100
18594
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
2005 2006 2007 2008 2009
#of
people
Ever Enrolled Ever Started Currenlty on ART
Adult & Children Accessing ART & Chronic Care

59. Overview of HIV/AIDS 59
Challenges related to ART
 Shortage and high attrition of Human resources for health
 Increased number of LFU cases
 Non-adherence to care & Rx
 Inadequate Linkage between the various HIV services
 Stigma and discrimination
 Inadequate behavioural change
 Limited Financial Resources
 Lack of Comprehensives Data System

60. Overview of HIV/AIDS 60
Initiatives in addressing the challenges
 Task-shifting- to create better access to services
 Introduction of Simplified Rx approaches & DF(FDC)
 Clinical Mentoring to maintain quality
 Targeted and synchronized social mobilization
 Adherence and Retention support
 Realizing the Health net-work model
 Targeting at most at risk population groups
 Positive living (Prevention with Positives)
 Resource Mobilization and Coordination

61. Overview of HIV/AIDS 61
Key Points (1)
■ AIDS is a global, regional, and national crisis
■ Sub-Saharan Africa (>68%) is the most hit region
and female are highly affected (>60%)in this region
■ There are generalized/high level and
concentrated/low level epidemic and Ethiopia is in
state of generalized epidemic
■ The national HIV seroprevalence rate in Ethiopia is
2.3 % for 2009, and above 85% of HIV infections
occur among adults 15-49 years of age.

62. Overview of HIV/AIDS 62
Key Points (2)
■ HAART started in 1996 worldwide, however,
started in 2003 in Ethiopia.
■ Ethiopia has managed to test, and enroll more
people in short time and expected to go more to
reach UA
■ There are numerous guidelines, clear policy
direction, capacity building and service expansion
in Ethiopia.
■ There are 206,628 people on ART as of June 2009
and expected to increase to 397,818 (UA) by Dec
2010

63. Overview of HIV/AIDS 63
The Red Ribbon is the global symbol for solidarity
with HIV positive and people living with HIV/AIDS
and it unites the people in the common fight
against this disease.