TOWARD EQUAL ACCESS:
ENSURING HIV/AIDS SERVICES FOR ALL
By Yonatan Tamiru, Specialist II, Communication, PSI Ethiopia
The collective efforts of the global community in the fight against HIV/AIDS have been both commendable and profoundly effective, resulting in a 60% reduction in new HIV infections since the peak in 1995. Governments, health workers, international aid organizations, humanitarian groups, and public institutions have all played a critical role in reaching vulnerable communities worldwide and enabling this progress through their collaboration.
However, as we progress towards last mile efforts in ending the HIV epidemic, innovation to drive equity in HIV/AIDS services access, ensuring no sub-populations are left behind will be essential. The global HIV burden shows clear disparities in terms of gender, age, and social background. According to UNAIDS, women and girls are disproportionately affected, accounting for 63% of new HIV infections in Eastern and Southern Africa in 2021. Furthermore, only around 41% of married women aged 15 to 24 in sub-Saharan Africa can make their own decisions about their sexual health, increasing their vulnerability to HIV.
Men and boys also face major challenges in the fight against HIV. Harmful gender norms discourage men from seeking treatment, resulting in lower treatment rates for men than for women. While 80% of women living with HIV received treatment in 2021, only 70% of men did.
Adolescent boys and young men in sub-Saharan Africa are also less likely to access HIV prevention services, further exacerbating inequalities. These inequalities underscore the need for a more inclusive approach that addresses the specific needs of different population groups to maintain momentum in the fight against HIV/AIDS.
The 2020 report by the Ethiopian Institute of Public Health highlights a critical gap in HIV knowledge and access to services that mainly affects the 15–35 age group — the population group most burdened by HIV/AIDS. Despite the high vulnerability of this group, there are still regional differences in HIV/AIDS knowledge, which are mainly influenced by unequal access to media and digital communication tools. Communities lacking these resources do not have access to important HIV information, which has a significant impact on their health behaviors and ultimately affects national efforts to improve case detection and treatment rates.
As Ethiopia strives to reach its target of ending HIV/AIDS by 2030, it is critical to address inequities promoting the knowledge gap, and consequently HIV services access. It is necessary to ensure that all regions, especially underserved areas, have access to accurate information and health resources.
The USAID MULU Key Population Activity implemented by Population Services International (PSI) addresses this urgent issue of equitable access to HIV services, focusing on AGYW, ABYM (Adolescent Boys & Young Men), FSWs and People Who Inject Drugs (PWID) both of whom are otherwise stigmatized in HIV services access within the framework of the public sector and other high-risk men such as clients of sex workers. The initiative aims to provide peer-led, stigma-free comprehensive HIV education, prevention, care and treatment services. Trained peer educators engage directly in their communities and provide tailored support and information using a peer-to-peer counseling manual in an understandable and accessible way.
A key element of the initiative is the establishment of drop-in centers — community-based facilities where people can access essential HIV services without making an appointment. These centers are designed to prioritize the needs of the target population and ensure that services are provided in a client-friendly and welcoming environment. This approach is particularly beneficial for people from low economic backgrounds at higher risk due to their interaction with key populations.
The activity also utilizes various communication channels, including social media, to improve knowledge about HIV among this age group. The program uses various digital tools to ensure that the information is easily accessible and engaging for the target group of 15 to 35-year-olds. (Refer the pictures)
Achieving equity in HIV/AIDS services requires innovation and dedicated efforts to reach every community effectively. By addressing the specific needs of the 15–35 age group through these targeted strategies, we can make significant progress toward the UNAIDS 95–95–95 targets. Supporting such initiatives is essential to advance public health goals and create a more equitable and informed world.
Innovation drives programming within the USAID MULU Key Population Activity
Key and Priority populations particularly require “thinking beyond business as usual” given the uniqueness of key behavioral determinants of enhanced HIV risk. Over the years, the USAID MULU Key Populations Activity, in collaboration with Ethiopia’s federal MoH structures, has been a national leader in implementing innovative HIV programming for key and priority populations (KP/PP). Through its network of 28 Drop-In-Centers (DICs), the Activity has supported tailored peer-led community outreach services, enhanced access to HIV testing for vulnerable communities, linkage into care for those testing HIV positive, and also used human-centered design approaches to drive uptake of biomedical HIV prevention interventions such as oral PrEP among HIV negative individuals among these vulnerable groups.
With more continued USAID investments in the community delivery platforms, PSI, through the USAID MULU KP Activity hopes to continue supporting the Ministry of Health in meaningfully impacting Ethiopia’s efforts to end the HIV epidemic.
