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The Organization of the Fight against HIV/AIDS in Ethiopia: Rallying around Afflictions
Abstract
This article views the organization of the fight against HIV/AIDS in Ethiopia as the complex result of the interplay between government strategies and the efforts of affected people themselves to face their condition by seeking care and support. Focusing on the formation of the associations of people living with HIV/AIDS in Addis Ababa and Gondär, I show that the fight against the disease involves both a personal battle and the collective mobilization of HIV-positive people to rally around their afflictions as a mode of self-empowerment, public education, and the socialization of risks. In particular, I analyze the continuities and discontinuities in terms of mutual help association members, the self-confession of HIV/AIDS, and traditional forms of solidarity and other forms of public expression with regard to sexually transmittable diseases, like syphilis, that are attested to in historical sources.
... The first HIV from stored serum samples and clinically overt AIDS case were detected in 1984 and 1986, respectively [38]. Ethiopia declared AIDS epidemic in 2000 [39], and established councils across various sectors at the national level to prevent and control the expedited dissemination of HIV [39]. Antiretroviral therapy provision began in 2003, and free ART became available since 2005 [40]. ...
... The first HIV from stored serum samples and clinically overt AIDS case were detected in 1984 and 1986, respectively [38]. Ethiopia declared AIDS epidemic in 2000 [39], and established councils across various sectors at the national level to prevent and control the expedited dissemination of HIV [39]. Antiretroviral therapy provision began in 2003, and free ART became available since 2005 [40]. ...
Background
Mainstreaming HIV and AIDS across sectors is crucial to close the disparities in service provision and coverage. However, evidence has shown that certain social groups are left behind in receiving HIV/AIDS services. The objective of this study was twofold: to understand the reasons behind the existing inequities and to explore challenges of equity in HIV/AIDS services in the Amhara region of Ethiopia.
Methods
Twenty-two adults (aged 26–57 years) from eighteen sectors that are mainstreaming HIV and AIDS were purposefully selected until the point of saturation and participated in a semi-structured in-depth interview conducted between January 20 and February 17, 2023. Interviewees were asked to describe their mainstreaming experiences in equitable HIV/AIDS services, reflect on the challenges and barriers that impede equitable service provision, or explain the reasons behind the existence of inequity in HIV/AIDS services. The interviews were audio recorded, transcribed, translated, and iteratively analysed, with early analysis informing subsequent interviews. An inductive-reflexive thematic analysis was conducted, whereby themes and subthemes were identified, and the relationships between subthemes and patterns were critically reviewed.
Results
The challenges to equitable HIV/AIDS service provision were grouped into eight thematic areas: (1) changing contexts that shifts public and government attention to emerging diseases, war and political instability, and poverty; (2) leadership-related, such as the lack of supervision and monitoring, not politicising HIV/AIDS (not providing political attention to HIV/AIDS) and weak intersectoral collaboration; (3) financial constraints due to a random budgeting and contract interruption with non-governmental organisations (NGOs); (4) lack of resources due to scarcity and unfair distribution; (5) inadequate skilled personnel due to inadequate numbers and lack of continuous professional and career development; (6) lack of equity-related evidence-based tools and guidelines; (7) inadequate understanding of equity due to lack of training and misunderstanding, and lack of access to equity-oriented tools and guidelines; and (8) cultural norms, values, and perceptions.
Conclusions
This study identified critical challenges faced in the equitable HIV/AIDS services provision. To achieve equity in HIV/AIDS services, mainstreaming sectors need to invest in mechanisms to sustain services in emergency situations; identify effective leaders to maintain collaboration, monitoring, and evaluation; institutionalise responsive budgeting and establish alternative funds to maintain non-governmental organisations initiatives; provide continuous up-to-date training and create a common evidence-sharing platform; implement proper recruitment, education, and professional development of HIV/AIDS focal persons; and promote and practice culturally safe care. It is, therefore, essential to optimise sectors that are mainstreaming HIV/AIDS and incorporate equity considerations in their strategic plans and working guidelines.
Cet article interroge, d’un point de vue anthropologique, la condition de pauvreté de femmes vivant avec le VIH. Après avoir décrit l’enchevêtrement des politiques de lutte contre cette épidémie et des programmes de réduction de la pauvreté, l’auteure étudie les rôles que le VIH a joués tant au plan de l’identification des femmes pauvres et des manières de leur venir en aide qu’au sein de leurs parcours de sortie de la pauvreté. L’article démontre ainsi que les stratégies de prise en charge globale du VIH participent à divers parcours de mobilité sociale, tout en contribuant à des processus de reproduction des inégalités de santé et de diversification de leur expression.
L’auteure étudie les mobilités sociales engendrées par des dispositifs sociosanitaires de prévention et de prise en charge du VIH/sida parmi des femmes séropositives socialement marginalisées résidant dans la ville de Gondär, au nord-ouest de l’Éthiopie. Assujetties à un pouvoir de plus en plus orienté vers la prise en considération des individus se situant aux marges de la société pour faciliter leur autonomisation (empowerment), ces femmes entament des processus de construction identitaire au sein desquels leurs statuts sociaux sont le résultat d’arrangements et de compromis entre des rôles féminins traditionnels et les nouvelles formes de militantisme et de visibilité sociale auxquelles la lutte contre le VIH/sida a donné lieu.
This review describes the evolving AIDS epidemic in Ethiopia and examines its driving forces within the socioeconomic, cultural and political context. The early concentrated epidemic, which infected mostly high-risk males and commercial sex workers has evolved in recent years into a generalized epidemic affecting all segments of the population. Whereas the pervasive impact of societal poverty persists and recent political unrest poses a new threat to prevention and control efforts, the influence of past wars, gender inequality, and various harmful attitudes and practices in HIV transmission and spread is declining, apparently due to recent awareness, prevention and control initiatives and programs. Spread of HIV from urban to rural areas is facilitated by population movements, widespread prostitution in towns, and lack of education. More research on transmission patterns and better HIV and behavioral surveillance systems are needed, especially in rural areas and among different socioeconomic and ethnic groups, to more fully determine the dynamics of the epidemic in Ethiopia's diverse population and to develop effective and sustainable interventions.
Résumé
Cet article étudie la pertinence de la notion d’une « souveraineté mouvante » pour l’analyse de l’humanitaire à travers l’étude d’une petite ONG burkinabè active dans la lutte contre le sida. Il démontre comment cette ONG occupe un espace intermédiaire — une « interzone » — entre les discours des agences de développement et une réalité locale où les besoins matériels sont l’enjeu majeur. Le souci de la communauté internationale de privilégier les personnes vivant avec le VIH dans la lutte contre cette épidémie s’est traduit par un marché local pour les témoignages de ces individus. Le recrutement et la circulation de ces témoignages sert à mobiliser des ressources, mais a également comme effet l’introduction de nouvelles formes de subjectivité. Celles-ci sont interpellées par les différentes relations de réciprocité et d’échanges — des « économies morales » — qui sont tracées par la circulation de ces récits. La négociation de ces économies morales par les acteurs impliqués aboutit à de nouvelles revendications politiques qu’on identifie comme une « citoyenneté thérapeutique » et, possiblement, un nouvel espace politique dans le monde contemporain.
Human rights, health and development represent interdependent sets of values, aspirations and disciplines. Drawing on these domains, this paper offers a theoretical and practical framework for the analysis, application and assessment of health, justice and progress. It provides a simple conceptual framework illustrating the interdependence of these domains and highlights their key features and underlying principles. It then describes the reciprocal interactions between health, development and human rights and suggests how these linkages can be analysed and applied in practice. A Health, Development and Human Rights Impact Assessment (HDHR IA) approach is proposed to guide and monitor policies and programs towards maximising synergy.
The term “global health” is rapidly replacing the older terminology of “international health.” We describe the role of the World Health Organization (WHO) in both international and global health and in the transition from one to the other. We suggest that the term “global health” emerged as part of larger political and historical processes, in which WHO found its dominant role challenged and began to reposition itself within a shifting set of power alliances.
Between 1948 and 1998, WHO moved from being the unquestioned leader of international health to being an organization in crisis, facing budget shortfalls and diminished status, especially given the growing influence of new and powerful players. We argue that WHO began to refashion itself as the coordinator, strategic planner, and leader of global health initiatives as a strategy of survival in response to this transformed international political context.
Nathaniel Pearce (1779–1820) was, according to J. J. Halls, who edited and published his autobiographical writings in 1831, 'one of those remarkable and adventurous beings, whom Nature … seems to take delight in creating'. Having run away to sea twice, deserted from the navy, accidentally killed a man, and briefly converted to Islam, he came into his own as a guide and factotum to British travellers in Egypt. He accompanied Henry Salt's 1805 mission to Abyssinia, where he married a local girl and served the ruler of Tigré until the latter's death in 1816. Pearce's humorous account of his life is particularly interesting in the details it gives of the land and people of Ethiopia, then little known by Europeans. Volume 1 begins the narrative of Pearce's life and his African travels and also contains an account of an expedition to the city of Gondar by his friend William Coffin.
Introduction / Andrew Barry, Thomas Osborne, Nikolas Rose -- Liberal government and techniques of the self / Graham Burchell -- Governing "advanced" liberal democracies / Nikolas Rose -- Liberalism, socialism and democracy : variations on a governmental theme / Barry Hindess -- The promise of liberalism and the performance of freedom / Vikki Bell -- Security and vitality : drains, liberalism and power in the nineteenth century / Thomas Osborne -- Lines of communication
Fondé sur les résultats de deux terrains ethnographiques menés entre novembre 2007 et juin 2009 dans la ville de Gondar, ancienne capitale de l'Éthiopie et chef-lieu du Gondar Zone, cet article offre un aperçu du phénomène de mobilité féminine interne dans le cas spécifique de femmes migrantes vivant avec le VIH.
En appréhendant le parcours migratoire comme un continuum amorcé dans un projet de départ se poursuivant au fil des opportunités et des contraintes (Colloque URMIS 24 et 25 septembre 2009), seront analysées les façons dont les situations de santé individuelles, tant en relation avec le contexte de la santé publique éthiopienne qu'avec les politiques spécifiques du VIH/sida, ont marqué les parcours migratoires de femmes séropositives. Une attention particulière sera consacrée au rôle que la séropositivité au VIH joue, en lien avec la concentration de services sanitaires et sociaux propre à la zone urbaine, dans les processus d'insertion et de réinsertion des femmes dans un nouveau monde social, celui de la ville.
Espace ambivalent et contradictoire de la modernité et de l'émancipation ; lieu d'accès à des services absents de la zone rurale ou à des formes de solidarité alternatives à celles des campagnes : la ville cristallise dans la porosité de ses frontières avec la campagne les rapports de tension entre tradition et innovation. L'étude de cas ici présentée nous permettra, à travers une exploration socialement située des ONG, des associations et de différentes institutions impliquées dans la gestion de l'infection à VIH, de mettre en exergue les dynamiques d'insertion du VIH au sein de l'ensemble de ressources variées qu'une femme séropositive a mobilisées pour faire face à sa situation de marginalisation et d'exclusion sociales.
Recent empirical evidence from Africa suggests that households may not offer all members full protection against shocks. Yet what mechanism drives such an outcome still remains unclear. This chapter explores the role of support networks in coping with health shocks in rural Ethiopia and makes a distinction between the financial and labour needs. Data on 357 households and 670 individuals show financial needs can be met through a range of strategies undertaken by individuals and/or household members, while labour needs are often not cushioned within the household and can only be met through support networks of female relatives. In the absence of such networks, women are frequently not able to cope. These findings suggest that the assumption of full insurance within the household may cover the financial consequences of health shocks but not the labour needs during periods of illness.
The contributions made by political science and social anthropology are used to set ideas and theories about public policy in the light of the fight against AIDS in Africa. Why have studies of Africa in French as well as American political science concentrated so little on public policy? How can the analysis of the fight against AIDS in Africa help reformulate ideas about, and approaches to, public policy? Given that anthropology has contributed more than any other social science to studying AIDS in Africa, what can it propose for a discussion among the social sciences? The Cameroonian situation serves as an empirical example for illustrating various dimensions of the multidisciplinary dialectics between international standards and local forces. Light is shed on the rationales and contradictions, ranging from "global" issues to the interplay of transnational actions, related to this major issue in international relations and contemporary Africa. What does policy analysis tell us about politics? By reassessing the "founding" works that anthropology has used to study AIDS on the continent, the reasons can be discovered for explaining why political science should be involved in this field of research. Far from any interest group, the effort is made to reconstruct the process whereby the work of anthropology on itself and its criticisms of the biological and medical sciences are placed in a history that tells us about the evolution of the epidemic and, too, about the epistemology of the social sciences that study sub-Saharan Africa. Political science and its concepts are used in this study, which is placed in between empirical and modest epistemological goals. A few approaches for understanding politics in relation to AIDS in Africa are proposed.
résumé français/anglais sur http://etudesafricaines.revues.org/document5419.html
Objectives and Methods: The literature is reviewed to briefly examine the potential role of eight community-based organizations and agents as well as poverty reduction programs in the prevention and control of HIV/AIDS in Ethiopia. Particular attention is given to the role of the kebele (cooperative neighborhood associations), traditional birth attendants (TBAs), community health agents (CHAs), health extension agents, anti-AIDS clubs in high schools, traditional healers, home-based AIDS patient care programs, and iqqubs, traditional credit associations, in the prevention of HIV transmission and the care and support of AIDS patients.
Having described and accounted for the rapid growth of interest in medical anthropology over the last decade, the author illustrates how social forces and relations permeate medical anthropology's field. When social conditions are ignored, or deferred, knowledge of medical events, including what happens in the clinic, is distorted. -after Author
During the last two decades, economists have paid increasing attention to the role of informal risk-sharing arrangements as a privileged way through which traditional rural communities can achieve a significant degree of protection against income fluctuations and other hazards beyond their control. This article however argues that when they enter into such arrangements members of these communities are guided by a principle of balanced reciprocity (they expect a return from any contribution or payment they make) rather than by a true logic of mutual insurance. More precisely, they do not conceive of insurance as a game where there are winners and losers and where income is redistributed between lucky and unlucky individuals. None the less, traditional agrarian societies have proven able to develop a restricted range of sustainable forms of mutual insurance that avoid the aforementioned problem.
This paper argues that resettlement affects the way households cope with crisis situations. Information on Zimbabwean households shows that households in resettlement areas are more likely to develop individual strategies, while households in communal areas are more likely to receive assistance from someone in their support network. Quantitative analysis shows these differences can partly be attributed to differences in wealth and kin relationships within villages, while qualitative data suggest there is also a difference in the attitude of resettlement farmers, and attitudes toward resettlement farmers, that might make it more difficult for them access assistance when it is needed.
L'etude des relations entre sante, sexualite et politique, montre comment l'autorite publique deploie une activite croissante dans la gestion des affaires privees des personnes, alors meme que la medecine, se reclamant de la verite scientifique, entreprend de rationaliser et de normaliser les comportements, tant dans le domaine de la sante, que dans celui de la sexualite. Ce domaine est aborde de maniere precise avec l'etude de l'epidemie de SIDA au Congo depuis la fin des annees 1970. Si les pouvoirs publics investissent des moyens humains et financiers importants dans la lutte contre l'epidemie, le discours sur la maladie demeure, quant a lui, entierement « privatise ». On a ainsi affaire a un probleme qui fait l'objet d'une politique publique, sans devenir une question politique ni etre debattu dans l'espace public ; cette realite paradoxale est appelee par l'A. le domaine prive de la sante publique
Income risk is a central feature of rural areas of developing countries. A major topic in development economics is how well households are able to mitigate the adverse effects of income risk. There are several sensible reasons why households will not be able to fully insure consumption against income fluctuations. The well-known problems of moral hazard, information asymmetries, and deficiencies in the ability to enforce contracts may result in incomplete or absent insurance markets. The dearth of formal insurance markets in developing countries is evidence that these problems are considerable. However, a large body of literature indicates that households in developing countries make use of a wide variety of mechanisms, often informal, to at least partially limit consumption risk. A key piece of information required to guide policy design is how, and how well, different households mitigate risk. This paper reviews various strategies for insuring consumption against income fluctuations, and examines evidence on how effectively these strategies work.
7 confirmed cases of Acquired Immune Deficiency Syndrome (AIDS), seen in the Department of Medicine, Yekatit 12 Hospital, Addis Ababa, Nigeria, are presented. These are the 1st cases to be reported in Ethiopia. The ELISA and Western Blot tests were performed at the National Research Institute of Health in Addis Ababa. Attempts to trace possible sexual contacts of 3 cases were unsuccessful. Family members of 2 cases were tested for HIV infection. 3 of the 7 patients presented with tuberculosis, 2 with pneumocystis carinii pneumonia, 1 with generalized lymphadenopathy, and 1 with chronic diarrhea. All had AIDS; 6 of the 7 had 2 major clinical criteria, and all had 2 or more minor clinical criteria. 4 of the patients died. The diagnosis of 7 clinically obvious cases within 1 year in 1 general hospital at a time when it was somewhat difficult to have serological tests performed suggests the urgency of education of hospital workers in the safe handling of blood, blood products and body fluids, and through sterilization of needles and other equipment used by and for all patients.
The competing discourses of HIV/AIDS circulating in sub-Saharan Africa are identified. These are medical, medico-moral, developmental (distinguishing between 'women in development' and gender and development perspectives), legal, ethical, and the rights discourse of groups living with HIV/AIDS and of African pressure groups. The analytical framework is that of discourse analysis as exemplified by Michel Foucault. The medical and medico-moral are identified as dominant. They shape the perceptions of the pandemic, our responses to it, and to those living with HIV/AIDS. However, dissident activist voices are fracturing the dominant frameworks, and are mobilising a struggle for meaning around definitions of gender, rights, and development.
This piece developed out of discussions between the authors at the 12th World AIDS Conference, held in Geneva in 1998. In the sessions on human rights, a number of dele- gates from Asia and Africa experienced some difficulty understanding how they could apply the primarily legal arguments of the UN's HIV/AIDS and Human Rights: International Guidelines to local conditions.' Particularly visible was a confusion about the relevance of international law as well as the difficulty associated with "downloading" a paradigm of human rights located in a Western legal framework into non-Western societies. The piece asserts the enormous importance of human rights issues to HIV prevention and care. It looks fleetingly
There is global consensus on speeding up action against HIV/AIDS to mitigate the impact of the epidemic as rapidly as possible. However there are no common blueprints on how to organize and manage accelerated HIV/AIDS prevention care and support programs to be followed by countries. Countries have tried to develop their intervention measures on the basis of local realities and international experiences available to them. The Ethiopia HIV/AIDS program implementation process involves a high degree of the learning-by-doing approach which capitalizes on positive lessons learned further to speed up action against HIV/AIDS. This article is a modest contribution and an example of what can be done in Africa in response to the epidemic in terms of project preparation and implementation. It is hoped that some of these experiences can provide useful lessons for the preparation and implementation of HIV/AIDS prevention and control programs in other countries. (excerpt)
With increasing demand for services further propagated by population growth and by people's response to newly emerging pathologies, nations in sub-Saharan Africa are faced with insurmountable problems in sustaining their health systems. Realizing the inadequacy of solely relying on the public sector, these countries are seeking alternative mechanisms for health financing. Among the alternatives suggested are risk-sharing mechanisms that include community-based schemes that tap the potential of indigenous social arrangements.
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