In Ethiopia, HIV disclosure is low

In Ethiopia, where more than 1.2 million people are infected with HIV, disclosure of infection by patients is important in the fight against the disease. A new study led by a Brown sociology researcher investigates HIV-positive status disclosure rates among men and women in Africa's second most populous country.

In the December 17 issue of AIDS Care, Ayalu Reda, a sociology graduate student, and colleagues from Jimma University in Ethiopia found that among a sample of 1,540 patients receiving antiretroviral treatment in eastern Ethiopia, a majority (66 percent) disclosed their HIV-positive status to their spouse, while fewer disclosed to siblings (17 percent) and other relatives (16.8 percent). A small number of patients (11.6 percent) did not disclose their infection status at all. None of the patients had disclosed to all of their family members.

Unmarried and illiterate patients had higher levels of nondisclosure. Reda said he was prompted to conduct the study after working in Ethiopian hospitals and seeing many patients refuse to use local medical centers, opting to be treated farther from home.

“We suspected that this may be related to the fact that patients did not disclose their infection status to family members and did not want to risk being seen taking medications in nearby centers,” Reda said. This study’s low disclosure rates confirmed his suspicions, highlighting a lack of awareness about the virus and a pervasive stigma surrounding those who are infected.

Ethiopia has a large and very vulnerable population, with an estimated 15 percent of the population living below the poverty line. HIV/AIDS is one of the key challenges for the overall development of Ethiopia, as it has led to a seven-year decrease in life expectancy and a greatly reduced workforce.

Ethiopia faces an epidemic among sub-populations and geographic areas, with an estimated overall HIV prevalence rate of 1.4 percent, based on testing a sample of 5,780 men and 5,300 women age 15 to 49 who gave informed consent. Within the individual regions, this testing found the prevailing rate varied from 0.2 in the SNNPR to a high of 6.0 percent in the Gambela Region. While previous estimations were higher, expansion of surveillance data and improved analyses resulted in significantly lower estimations for 2005. Based on the same survey, HIV prevalence has declined to about 3.2% to 4.7% percent in urban areas.

“This will create significant obstacles to the life-long treatment process and the prevention of the spread of the virus. It may also increase drug resistance. Concerted counseling efforts need to be instituted to create a supportive environment whereby patients could successfully disclose their infection without fear of discrimination,” Reda said.

Two HIV prevalence rates had been determined following national exercises conducted in Ethiopia. One of these used the population-based method and the other used sentinel surveillance based on ANC (ante-natal care) for pregnant women. The two exercises produced HIV prevalence estimate results in 2006 consisting of 1.4% for E-DHS and 3.5% for ANC. Over the past year, intensive discussions among the implementing entities and the national authorities in Ethiopia adopted both exercises as valid in the unique context of each exercise’s methodological aims, assumptions and limitations. The Federal HIV/AIDS Control Office (FHAPCO) initiated a Task Force to attempt to reconcile these two estimates with a view of establishing one single estimate, hence the development of this