MARCH Outcome Evaluation
Changes in sexual behaviours have been advocated to reduce the spread of HIV in the developing world, where heterosexual sex is the most common mode of HIV transmission (Cleland et al, 1992; Merten et al, 1994; UNAIDS, 1999). In fact, safer sexual behaviour remains the single most effective method of preventing HIV infection in such settings. The effectiveness of these changes is supported by data from Thailand and Uganda, where both HIV prevalence estimates and prevalence of risky sexual behaviours decreased in the past decade (Nelson et al, 1996; UNAIDS, 1998; Kilian et al, 1999; Kamali et al, 2000). It has become clear that effective HIV risk reduction interventions extend beyond basic information giving and help: sensitize people to personal risk, improve couples communication, increase individual’s condom use skills, the perception of lower risk practices as an accepted social norm, and help people receive support and reinforcement for their efforts at changing (Kelly, 1995). These principles form the foundations of successful HIV prevention strategies, but differences in individual, social, cultural and economic conditions dictate different design and implementation of programs (UNAIDS, 1999).
The HIV epidemic started in the mid-80s in Ethiopia. The first sera with HIV antibodies date back from 1984, and the first AIDS cases were diagnosed in 1986 in Addis Ababa, the Capital City (Hailu et al, 1989; Lester et al, 1988). Two years later in 1988, high rates of HIV prevalence were detected among long distance truck drivers (13%) and commercial sex workers (17%) residing along the main trading road of the country (Mehret et al; 1990b; Mehret et al, 1990a). Since then the epidemic has expanded at a fast rate throughout the country. According to UNAIDS, at the end of 2004, an estimated total of 1.5 million adults and children were living with HIV/AIDS in Ethiopia (MOH, 2004). AIDS is now the leading cause of mortality in the age group 15-49, killing adults in the most productive and reproductive phases of their lives. Life expectancy in Ethiopia is being reversed as a result of AIDS and expected to drop to 46 years instead of 53 years in 2001, and 50 years instead of the expected 59 years in 2014 (Mekonnen et al, 2002; MOH, 2002). The primary
Addis Ababa and West Hararghe