UNAIDS 2014 ETHIOPIA HIV EPIDEMIC PROFILE

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1 UNAIDS 214 ETHIOPIA HIV EPIDEMIC PROFILE

2 214 ETHIOPIA Overview The Federal Democratic Republic of Ethiopia is a country located at the horn of Africa. According to population projections the total population was around 84 million in 212, making it the second most populous country in Africa. 1 In 213, adult HIV prevalence was estimated at 1.2% [ %]. Antenatal clinic (ANC) sentinel surveillance data show that HIV prevalence among pregnant women declined from 5.7% in 23 to 3.3% in 27 and to 2.3% in Despite the declining trend in HIV prevalence, significant challenges still remain in addressing the HIV epidemic, including emerging and growing populations at high risk of infection, associated with economic development activities, as well as the large population of pregnant women living with HIV, and low coverage of prevention of mother-to-child transmission of HIV (PMTCT) and paediatric treatment in the country. 3 Table 1 HIV epidemic indicators People living with HIV 88 [79 98 ] 79 [72 89 ] New HIV infections Adult 15+ new HIV infections AIDS-related deaths HIV prevalence (adults aged 15-49) HIV incidence (adults aged 15-49) Children (-14 years) living with HIV Children (-14 years) newly infected with HIV Adults 15+ living with HIV Women 15+ living with HIV HIV prevalence among young women (15-24 years) HIV prevalence among young men (15-24 years) New HIV infections among young women (15-24 years) New HIV infections among young men (15-24 years) HIV-positive incident TB cases* Percentage of men circumcised (adults aged 15-49) 26 [2 35 ] 8 9 [ ] 61 [5 73 ] 1.5% [ %].2% [.1.4%] 26 [22 3 ] 17 [14 2 ] 62 [56 7 ] 39 [35 45 ].3% [.3.4%].2% [.2.3%] 2 2 [1 4 ] <1 [<5 18] NA NA 21 [15 32 ] 13 [ ] 45 [36 55 ] 1.2% [ %].3% [.2.5%] 2 [17 23 ] 8 3 [ ] 59 [54 67 ] 37 [34 42 ].5% [.4.6%].4% [.3.5%] 3 3 [ ] 1 4 [<1 2 5] 23 * 91.8% (EDHS 211) Sources: UNAIDS 213 HIV estimates 4 ; * WHO Global TB report 213; Global AIDS Response Progress Report (GARPR), Central Statistical Agency, Summary and Statistical Report of the 27 Population and Housing Census, Projection Population Census Commission, Federal Republic of Ethiopia, July Antenatal Surveillance Report, Ethiopian Public Health Institute, Ethiopia Global AIDS Response Progress Report UNAIDS 214 Gap Report and unpublished estimates of the Gap Report. 2

3 Fig. 1 HIV prevalence by geographical region Tigray Afar Amhara Benishangul G. Dire Dawa Addis Ababa Harari Gambella Oromia Somali SNNPR -2% 2-5% >5% Source: Ethiopia Demographic & Health Survey (EDHS), 211 Table 2 HIV prevalence among populations at high risk of infection Population group Sex workers Truck drivers Prisoners HIV Prevalence 23.7%* (214, national survey) 4.9%* (214, national survey) 4.2% (213, national survey) * Unadjusted prevalence. Table 3 HIV programme data Number of adults living with HIV receiving ART June Number of children living with HIV receiving ART Adult ART coverage (of all adults living with HIV) 34% [3 38%] 5% [45 55%] Child ART coverage (of all children living with HIV) 5% [4 6%] 9% [8 11%] Number of women receiving PMTCT services Number of women needing PMTCT services 44 2 [ ] 33 [28 39 ] PMTCT coverage 15% [13 18%] 55% [47 65%], Global AIDS Response Progress Report (GARPR), 213; and Federal Prevention and Control Office (HAPCO) programmatic data. 3

4 HIV trend data Fig. 2 Number of people living with HIV Millions The number of people living with HIV decreased from 1.42 million in 2 to 79 in 213. Fig. 3 Number of new HIV infections Thousands New HIV infections declined to 21 people in 213, from a peak of about 22 people per year in Fig. 4 Number of AIDS-related deaths Thousands HIV-related deaths declined by almost two thirds from 125 in 24 to 45 per year in 213. Fig. 5 Prevalence (%) among young people (15 24) men women Prevalence among young women fell from about 3.% in 1997 to.5% in 213. Fig. 6 Fig. 7 ART coverage (%) of all people living ART coverage (%) of children living with HIV with HIV About 4% of all people living with HIV received antiretroviral therapy in 213. Less than 1% of children living with HIV received treatment in

5 Fig. 8 PMTCT coverage (%) Fig. 9 Number of new child HIV infections Thousands The proportion of HIV-positive pregnant women who receive antiretroviral drugs for the prevention of mother-to-child transmission of HIV reached 55% in 213, but remains low. Number of new child HIV infection declined from a peak of 53 infections in 1999 to 8 3 infections in 213. Table 4 HIV knowledge, attitude and practice Men Women Total Percentage of young women and men aged who correctly identified ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission and prevention Percentage of young women and men aged who have had sexual intercourse before age 15 Percentage of adults aged who had sexual intercourse with more than one partner in the last 12 months Percentage of adults aged with more than one sexual partner in the past 12 months who reported the use of a condom during last intercourse Percentage of sex workers reporting the use of a condom with their most recent client Percentage of men reporting the use of a condom the last time they had anal sex with a male partner Percentage of women and men aged who received an HIV test in the last 12 months and who know their results 34.2% 23.9% 1.2% 1.9% 3.5%.4% 15.5% 47.% 98.4%* 2.7% 2.% 28.4% 6.7% 1.8% 19.5% 98.4%* 2.3% Source: Ethiopia Demographic and Health Survey (EDHS), 211; *Preliminary sex worker surveillance data, Global AIDS Response Progress Report (GARPR),

6 Fig. 1 Gender equality Present at national level Integrating services for sexual and reproductive health and for HIV HIV plans and budgets in ministries responsible for gender Women living with HIV participated in response review Qualitative assessments conducted Available on project basis Disaggregated data available (age and sex) Women living with and affected by HIV participated in CEDAW monitoring Health sector policy on gender-based violence Response budget for women s organization Data available on gender-based violence and HIV National response gender review undertaken Social protection includes women living with HIV Not Available Funding gender-equity programmes for men and boys Data on resources used for women s programmes Female condoms procured and distributed Source: Scorecard on gender equality in national HIV responses, 213. Spending on HIV response Amount spent annually on HIV programmes - Fiscal year 211/12: USD 45 million Fig. 11 Spending proportions by source of funds US$ Millions External Private Public 13% 1% EFY4(211/12) 86% Source: Ethiopia NASA report 211/12. Fig. 12 Spending priorities by sources of funding US$ Millions Research Enabling environment Social protection & social services ( excluding OVC ) 1% 9% 8% 7% 25 Human Resource Development & Capacity Building 6% Public Private External EFY 24 Total Source: Ethiopia NASA report 211/12. National System Strength & Programme Coordination Orphans and vulnerable children (OVC) Treatment Prevention 5% 4% 3% 2% 1% % Public Private External EFY 24 Total 6

7 Commitment to HIV prevention, treatment and care The Government of Ethiopia launched the PMTCT acceleration plan in 212 followed by the national strategy for elimination of MTCT in 213, demonstrating high commitment and leadership towards the elimination of paediatric infections and reduction of maternal mortality. Ethiopia has adopted WHO Option B+ to prevent mother-to-child transmission. The country also adopted the 213 WHO treatment guidelines recommending the initiation of treatment for adults living with HIV with CD4 count<5 cells/µl, and treatment for all children living with HIV under 15 years. Following the success and review of the implementation of the second multi-sectoral HIV response strategic plan (21/ /15), Ethiopia is currently developing its national strategic plan for the HIV response for the period based on the investment case framework. Achievements/progress in the national HIV response High level political commitment has been demonstrated by the government. The HIV response remains a top priority in Ethiopia s development agenda as clearly stated in its Growth and Transformation Plan. Moreover, the government has mainstreamed HIV in all public and non-public sectors through assigning key HIV focal persons, allocating up to 2% of sector budgets to HIV activities and establishing AIDS funds through the contribution of government employee salaries. HIV prevalence among pregnant women has fallen significantly from 5.7% in 23 to 2.3% in 212 according to ANC sentinel surveillance data. Antiretroviral therapy (ART) coverage rates among all adults living with HIV has increased from 34% in 21 to 5% in 213. The number of AIDS-related deaths has fallen from 125 in 24 to 45 at the end of 213. Challenges in the national HIV response Ethiopia needs to intensify its response to effectively reach HIV discordant couples. There is also a need to scale up programmes to reach various populations at high risk of infection. Strategic information and data on key populations also needs to be improved. PMTCT coverage is still low despite increasing access to ANC services and expansion of PMTCT sites. Significant missed opportunities and loss of women and children at every step of the PMTCT cascade is observed. Key bottlenecks in the expansion of PMTCT services include the need to increase the demand and quality of services. Poor adherence to treatment regimens and limited capacity for laboratory screening and point of care monitoring pose significant challenges to scaling up and improving retention of people living with HIV in care and ART services. Paediatric treatment coverage (of all children younger than 15 years living with HIV) in 213 was still very low at 9.%. The country is experiencing significant challenges in identifying older children/adolescents living with HIV (survivors from vertical transmission). More focus is needed to reach children, particularly orphans and vulnerable children. Much of the direct HIV investment in Ethiopia is still donor driven, and 86% of current HIV financing is external (NASA 211/12). There is need to increase both the domestic and private sector contributions, and to use available resources more efficiently. 7

8 UNAIDS Country Office PO Box 558 Economic Commission for Africa Old Building, 2nd Floor Addis Ababa Ethiopia Tel: UNAIDS Regional Support Team Eastern and Southern Africa Merafe House, 11 Naivasha Road Sunninghill 2157 Johannesburg Republic of South Africa Tel: unaids.org

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