Why should we care about HIV/AIDS among Ethiopians?
By:Tadesse Wuhib, MD, MPH
Interim Coordinator, Partners Against HIV/AIDS in Ethiopia (PAHA Ethiopia)
twuhib@bellsouth.net   PAHAEthiopia@hotmail.com
http://PAHA.listbot.com     http://PAHA.ooi.net

In this short article, I was asked to address why we should care about and join the fight against HIV/AIDS and how we can join the fight as an individual and/or in a group setting. The reasons outlined in this article make HIV/AIDS an emergency – threatening Ethiopia's present and future – requiring an emergent action. Anyone who cares about him/herself, Ethiopia and Ethiopians should care about HIV/AIDS.

Firstly, we should care because HIV/AIDS is Ethiopia's #1 public health problem with impacts in the social, economic and health spheres. As such, it will affect most of us personally either directly or indirectly. Secondly, for those living in the developed world, treatment is now available that allows individuals infected with the virus to live a productive and fulfilling life for many years. Thirdly, for those of us interested in giving back to Ethiopia, the disease has provided an opportunity for us to help our people as demonstrated by the group known as Partners Against HIV/AIDS in Ethiopia (PAHA Ethiopia or PAHA).

HIV (Human Immuno-deficiency Virus) is the virus that causes the disease known as AIDS (Acquired Immuno-deficiency Syndrome). AIDS is characterized by a severely weakened immune system resulting in a wide range of serious illnesses and eventual death. HIV (among Ethiopians) is transmitted mainly through heterosexual contact. It takes an average of 4-10 years from the time one acquires the virus to develop AIDS. There is no cure or vaccine available and thus prevention is the only effective way to stop the virus.

The article is organized in four parts:

1. Reasons why we should care about HIV/AIDS and the opportunities that HIV/AIDS provides to the Ethiopian Diaspora
2. What you can do about the HIV/AIDS problem among Ethiopians
3. Partners Against HIV/AIDS in Ethiopia (PAHA)
4. Summary

I. Reasons why we should care about HIV/AIDS and the opportunities that HIV/AIDS provide to the Ethiopian Diaspora

The reasons include:

1. HIV/AIDS is Ethiopia's #1 public health problem resulting in significant amount of morbidity and mortality. The Joint United Nations Program on HIV/AIDS (UNAIDS) ranked Ethiopia 16th according to percent of the adult population (15-49) infected -- 9.3% -- by the end of 1997. Ethiopia has the third largest population of HIV-infected individuals in the world; currently, 3 million Ethiopians are living with HIV accounting for 21% and 4.5% urban and rural population aged 15-49 respectively. AIDS has already killed one million Ethiopians and continues to do so currently at a rate of 1 every 2 minutes (about 35 a day in Addis Ababa alone).  New infections occur at even higher rate than deaths rates; about 100 get newly infected in Addis Ababa alone.

2. AIDS has far-reaching effect beyond the infected individual distinguishing it from many other diseases. AIDS has created and will continue to create a tremendous burden on health care, social structure, child survival and to negatively impact economic development. This is mainly because it selectively affects the economically productive age group (15-49) which also happens to be the group with families. Of the number of reported cases, 93% are between 15 and 49 years of age. Thus, it has grave consequences to children, the economy, social structure/fabric and others. As a result of the epidemic, already, 140,000 children have been infected, 700,000 children have been orphaned, life expectancy have dropped from 51 to 41 and social/governmental institutions have been stretched. If nothing is done, 10 years from now, the Ministry of Health predicts that about 60% of males aged 15-49 would be dead, and ~2 million children would be orphaned. We will be living with the impacts of HIV/AIDS far into the future.

3. HIV has a long incubation period. Infected individuals live on average 4 to 10 years before they manifest symptoms. Thus, in a country where diagnostic tests are scarce and not widely available to the general public, infected individuals spread the disease to others for a long time without even realizing it.

4. The country has not yet been able to get a handle on the disease. Effective control measures (at least proven to be effective in the Ethiopian setting) do not yet exist to my knowledge (unlike malaria for example). Treatment, cure, and vaccines are not available. Prevention is further hampered by the cultural norms such as the fact that sex is not a topic openly discussed (including parent to child, in schools,…) and wshima/kemit/extramarital affairs….types of practices seem acceptable and in some areas part of the culture.

5. Treatment is available for those HIV infected individuals living in the developed world. AIDS has also infiltrated Ethiopians in the Diaspora though actual numbers are not known as of yet. Last week, a courageous Ethiopian from Colorado by the name of Mr. Ataklit Berhe became the first Ethiopian in North America (probably in the Diaspora as a whole) to publicly reveal his HIV status so as through his example others could be saved. Anti-HIV drugs have been shown to be effective at prolonging the period of time between HIV and AIDS and between AIDS and death. Now, HIV-positive individuals are able to live a productive and fulfilling lives. Thus, it is important for all of us to know our HIV status so we can receive these treatments if infected; the sooner one receives treatment, the longer one lives. PAHA has gotten permission to analyze the HIV/AIDS data reported to the United States to determine the number of Ethiopians who are currently living in the US with HIV/AIDS for purpose of community education.

HIV/AIDS provides several opportunities for the Diaspora to get involved and contribute positively to their country. These include:

6. HIV/AIDS should, at lease theoretically, be a uniting disease because it affects everyone. HIV/AIDS in Ethiopia has been reported among all ethnic groups and from every region. Moreover, because of its huge and widespread magnitude, it will be with us for many years to come affecting many of us personally. That is, for those of us interested in developing a model of how we can give back to our community/country from wherever we might be, it would give ample time to create and develop a workable and effective model. Chances are good that people will not give up until the disease is controlled.

7. HIV/AIDS affects many sectors of society so it brings in other non-traditional partners into the health sector. Many areas such as Faith-based Organizations, educators, economists, businesspersons, have not been partners in the health sector in the past at least in the setting of the Ethiopian health system. I believe that health should be every citizen's business NOT just that of health care workers.

8. HIV/AIDS is a pandemic. That is, the world is interested and resources are available. Again, this provides an opportunity and makes it easier for those of us in the Diaspora interested to link friends of Ethiopia, institutions and others with Ethiopia to create a truly functional network.

II. What you can do about the HIV/AIDS problem among Ethiopians

There are several things at an individual and group level that one can do to contribute to the reduction of the HIV/AIDS disease burden.

A. As an Individual:

1. Educate yourself about HIV/AIDS and how you can protect yourself from acquiring the disease.

2. Practice abstinence. If you are going to engage in a sexual act, practice safe sex such as using a latex condom (male or female) consistently and correctly (i.e., every time).

3. Educate your family and friends, i.e., share what you have learned with those who reside where you are and those in Ethiopia especially the young about HIV transmission and on how they can protect themselves from the disease.

B. In a group:

1. Join an organization that is working on HIV/AIDS problem among Ethiopians like Partners Against HIV/AIDS in Ethiopia described below. It is possible, at least with PAHA, to contribute/help your country and people without leaving your home and from your desk.

2. If you belong to an organization -- social or political or other -- propose to include HIV/AIDS as one of the activities for the organization to address.

III. Partners Against HIV/AIDS in Ethiopia (PAHA Ethiopia)

Because of the reasons described above, concerned Ethiopians and friends of Ethiopia in the Diaspora came together and established a global internet- and city-based organization named Partners Against HIV/AIDS in Ethiopia (PAHA). PAHA is currently in the process of establishing itself as a non-profit organization based in Washington, D.C., home to the largest number of Ethiopians outside of Ethiopia.

PAHA is a voluntary, NON-GOVERNMENTAL, NON-POLITICAL, and humanitarian organization that aims to facilitate the fight against HIV/AIDS in Ethiopia, by Ethiopians and friends of Ethiopia, individually and in people's chosen groups. It was created to provide EACH individual a chance to contribute towards reducing the burden of this disease. Though PAHA chose a humanitarian platform, it respects members' rights to engage in political activities outside of PAHA. PAHA believes that we can differ in our political affiliations and views but can at the same time unite in matters of importance to our country and people.

PAHA's overall vision is to make Ethiopians free of the virus. The overarching goal is to save lives by halting the spread of HIV/AIDS and sharply reducing its devastating impact on quality of life and socioeconomic development. PAHA aims to be the best advocate of the people affected and in danger of being affected and to respond in the most effective and efficient manner to the needs.

PAHA is established based on two premises: 1. There are Ethiopians and friends of Ethiopia who love and want to help Ethiopia and 2. They have the potential to do so. These premises are currently being realized. Over the last 10 months of PAHA's existence, it has grown to 325 listserve members. Members come from over 80 international and national organizations, businesses and universities and reside in 22 countries (Australia, Belgium, Canada, Denmark, Ethiopia, Finland, Germany, Ghana, India, Italy, Japan, Kenya, Namibia, Norway, South Africa, Sweden, Switzerland, Taiwan, U.A.E, U.K., U.S. and Zimbabwe).

PAHA has also established City Groups to provide opportunity to those individuals without e-mail/internet to get involved in PAHA and outlets for coordinating local events, disseminating information about HIV/AIDS, PAHA, action plan, projects,...in those locales; 10 City Groups (Addis Ababa, Atlanta, Bay Area, Minneapolis, Los Angeles, New York, Boston, Toronto, London, Greensboro) are currently at various stages of formation.

PAHA is inclusive of all no matter what the individual's background is (nationality, race/ethnicity, gender, age, field of interest, employment). Current members include: a high school, college and graduate (medical) students; university faculty; public health practitioners; physicians; medical residents; musicians; professors; minister; restaurant owners; pharmacists; writers (newspaper, magazine); engineers; computer system operators; accountants/businessmen; and people in industry, government and non-profit organizations.

PAHA attempts to bring to bear the intellectual, material, financial, and physical potentials of the Diaspora in the fight against HIV/AIDS among Ethiopians. Specific Diaspora assets include technical expertise and support; current information and research findings; network of professionals and institutions; opportunity for collaborative action; opportunity to tap into existing resources; monetary resources; access to leading Ethiopian artists; access to institutions (international and national organizations, NGOs, Universities, Colleges,…) and others.

PAHA has conducted an assessment survey among Non-Governmental Organizations working on HIV/AIDS in Ethiopia and has started its outreach by providing HIV/AIDS information for Ethiopians in Diaspora by being present at different events including the 1999 North America Ethiopian Soccer Tournament held in Dallas, conducting radio interviews (VOA to Ethiopia, DC, Minneapolis and Atlanta) and sponsoring Town Hall meeting (DC and currently being planned in Atlanta and Bay Area). PAHA has established an information resource center in Addis Ababa in collaboration with local non-governmental organizations. The list of Organizations working on HIV/AIDS in Ethiopia will soon be available on PAHA's web site.

PAHA has developed an Action Plan to help its members and working partners to combat this dreadful problem strategically and in more structured manner. It has currently begun the process of incorporation beginning with election of Board of Directors. In collaboration with other organizations, detailed project plans are currently being developed in the following areas:

1. Information, Education and Communication Campaign in Ethiopia: TV/Radio Drama Series, radio-call-in-show, AIDS Telephone Hotline and Newsletter;
2. Addressing the needs of people living with HIV/AIDS: supporting the Dawn of Hope, an organization based in Ethiopia formed by people living with HIV/AIDS;
3. Targeting the Youth: establishing and supporting anti-HIV/AIDS Clubs;
4. Addressing the Needs of Ethiopian Children Orphaned by AIDS;
5. Elimination of childhood AIDS in response to Elizabeth Glaser Pediatric Foundation Call for Action (using Nevirapine and other methods);
6. Establishing and maintaining HIV/AIDS Information Center in Ethiopia;
7. Supporting HIV/AIDS clinics in Ethiopia;
8. Addressing the needs of Ethiopians living outside of Ethiopia and;
9. Conducting Annual Ethiopian Diaspora Summit on HIV/AIDS (this year in Toronto).

PAHA aims to coordinate its efforts in mobilizing resources, filling technical gaps, supporting networking, policy advocacy (speaking out publicly, loudly, frequently) and sharing of lessons learned between and among partners. As much as possible, PAHA aims to use and reinforce existing mechanisms and structures avoiding duplication (the reason for doing the NGO survey) while increasing synergy to minimize administrative and organization-related costs. It will support only those goals and activities with agreed upon measurable, specific and time-phased objectives with milestones and indicators of achievement as well as evaluation component.

You can join PAHA by visiting the group's list serve home page at http://PAHA.listbot.com where you can also review archived messages. You can also visit our library at PAHA Library and our web site under construction at http://PAHA.ooi.net to review and download documents on the status of the epidemic in Ethiopia. You can also write to PAHA at PAHAEthiopia@hotmail.com or directly to me at twuhib@bellsouth.net.

IV. Summary

HIV/AIDS is an emergency. Since the diagnosis of the first case of HIV in 1986 in Ethiopia, the disease has progressively compounded causing tremendous amount of morbidity and mortality and negatively impacting the social, economic and health sectors. Unless current trend is averted NOW, the disease will continue to affect the population in its prime and working life eroding the already depleted economy of the country. Mr. Ataklit Berhe's recent heroic public revelation of his HIV status brought to life what was already known that HIV has also infiltrated Ethiopians in the Diaspora.

Concerned Ethiopians and friends of Ethiopia established an internet-and city-based non-governmental, non-political, voluntary humanitarian partnership named Partners Against HIV/AIDS in Ethiopia (PAHA). PAHA has developed an action plan to combat this dreadful problem strategically and currently is in the process of establishing itself as a non-profit organization. Given that we can't wait for a perfect political climate in regards to emergency problems such as this and of the need for a united effort, PAHA adapted a humanitarian platform and utilizes the internet technology to establish and strengthen a global network. This online network currently links over 300 health professionals and lay members from 22 countries.

PAHA's experience in mobilizing individuals and educating and promoting preventive strategies at policy and grassroots level is an innovative approach to virtual public health education and policymaking venture. In so doing, PAHA is also providing "the brain drain" in the Diaspora an opportunity to contribute positively to the creation of a better life for their families, friends, and relatives they left behind and set examples for the future generation. The development of this functional model, the PAHA Movement, will have applications and implications to other areas particularly for Ethiopians and friends of Ethiopia who wish to give back to Ethiopians in Ethiopia and in their midst.