HIV/AIDS and Associated Diseases Sensitized Girls = Healthy Generation

S ensitization a n d M obilization o n H IV/A IDS

HIV/AIDS and Associated Diseases XVth Annual Conference and Workshop of the BSE February 25-26, 2005 Addis Ababa

Sensitized Girls = Healthy Generation Sensitization Workshops on HIV/AIDS and College Girls n November 06, 2004 and July 16, 2005 Addis Ababa . ■ In* • iciiUurai R. tse r .fi CsniruJ LIBRARY ‘T’C TC K'ih'b-'t't'l' n.+

Organized by ThcFBfotogical Society of Ethiopia %

In Collaboration with UNFPA, Addis Ababa University, Kotebe College of Teachers’ Education, Awoliya College, Central Health College, Queens College, Unity University College

Edited by Seyoum Mengistou Ensermu Kelbessa Mekuria Lakew S ensitization a n d M obilization on h i v /AIDS

HIV/AIDS and Associated Diseases XVth Annual Conference and Workshop of the BSE February 25-26, 2005 Addis Ababa

Sensitized Girls = Healthy Generation Sensitization Workshops on HIV/AIDS and College Girls November 06, 2004 and July 16, 2005 Addis Ababa

Organized by The Biological Society of Ethiopia

In Collaboration with UNFPA, Addis Ababa University, Kotebe College of Teachers1 Education, Awoliya College, Central Health College, Queens College, Unity University College

Edited by Seyoum Mengistou Ensermu Kelbessa Mekuria Lakew BSE (2005). Sensitization and Mobilization on HIV/AIDS 1. HIV/AIDS and Associated Diseases: Proceedings of a National Workshop at the XV‘h Annual Conference, Feb. 25-26, 2005. 2. Sensitized Girls = Healthy Generation: Proceedings of Sensitization Workshops on HIV/AIDS, Nov. 06, 2004 and Jul. 16, 2005. The Biological Society of Ethiopia. Addis Ababa.

Publisher: The Biological Society of Ethiopia PO Box 31819 Addis Ababa, ETHIOPIA Phone: 251 11 157 3422; Fax: 251 11 155 2350 Email: [email protected]

Edited by: Seyoum Mengistou (PhD) Ensermu Kelbessa (PhD) Mekuria Lakew (PhD)

A ssistant Editors and Layout Design'- Abebe Ameha (MSc) Delelegn Woyessa (BSc) PART - 1

Welcoming Address

Tuberculosis and HIV collaboration...... 1-6 Zerihun Tadesse Parasites and HIV...... 7-16 Am ha Kebede Opportunistic fungal infections in HIV/AIDS patients in Ethiopia...... 17-20 Yimtubezinash Woldeamamiel HIV/AIDS and immunity (Abstract only)...... 21 Tsehaynesh Mess el e HIV/AIDS and antiretroviral therapy in Ethiopia (Abstract only)...... 22 Da wit Wolday Closing remarks on the Conference of the Biological Society of Ethiopia...... 23-25 Zerihun Woldu Conference Program ...... 27-30

PART - 2

Epidemiology of HIV infection in Ethiopia...... 31-34 Amha Kebede The youth and anti-AIDS movements in Addis Ababa University...... 35-40 Mehari Getaneh Required services and facilities for HIV/AIDS prevention and control at college campuses...... 41-42 Semira Afendi HIV/AIDS and gender problems of female students in Addis Ababa University...... 43-44 Addishiwot Girina HIV/AIDS and reproductive health issues among Ethiopian youth...... 45-47 Tesfanesh Belay Educated girls: Are they really sensitized?...... 49-51 Mitiku Woldegiorgis General Discussion: Phase - I...... 53-56 Afework Bekele (Chairperson) Prevention and control of HIV/AIDS in college campuses...... 57-58 Mahbuba A wo I m.9 (Reproductive Health)...... 59-68 Molla Zeleke Views of college girls...... 69-77 Melat Abera, Tinebeb Tesfaye, Nitsihina Getinet and Ikram Beshir Seman General Discussion: Phase - II...... 79-84 Semira Afendi (Chairperson)

Annex 1: About the EJBS Annex 2: About the BSE Annex 3: Booklets Published by the BSE ACKNOWLEDGEMENTS:

The Biological Society of Ethiopia (BSE) is very grateful to the United nations Population Fund (UNFPA), the Ethiopian Science and Technology Commission (ESTC), Addis Ababa University, the Ethiopian Agricultural Research Organization (EARO), Kotebe College of Teachers’ Education, Awoliya College, Central Health College, Queens College and Unity University College for their financial, material and logistic assistance in organizing these Workshops. PART - 1

HIV/AIDS AND ASSOCIATED DISEASES

XVth Annual Conference and Workshop

The Biological Society of Ethiopia

February 25-26, 2005 Faculty of Science, Addis Ababa University Addis Ababa Sensitization and Mobilization on HIV/A IDS Pictures WELCOMING ADDRESS BY THE PRESIDENT OF THE BIOLOGICAL SOCIETY OF ETHIOPIA

Dr. Yalemtsehay Mekonnen

Dear distinguished invited guests, participants and respected members of the Biological Society of Ethiopia: It gives me a pleasure and honor to welcome you all to the 15lh Annual Conference of the BSE. I believe that most of us know about the status of our country with respect to HIV AIDS pandemic. Presumably, the majority of us in this assembly hall are aware of the biology, ways of transmission and prevention mechanisms of HIV/AIDS. 1 can dare say that someone close to us has been victimized by the disease. We the BSE, EC members have strong conviction that girls at higher learning institutions need be a point of focus in the fight against AIDS; they are the models and educated mothers of future Ethiopia. Thus, we have developed a project proposal that focuses on college girls of the country. One of the main objectives of the project is to organize successive sensitizing workshops for these target groups under the main theme "Sensitized Girls = Healthy Generation". This is believed to be a contribution to the World AIDS Campaign 2004 that has a thematic focus on Women, Girls, HIV and AIDS. The UNFPA has solicited the fund for the planned workshops. Todate, two successive Workshops have been organized in the Faculty of Science, on 171" July and 6th November 2004. Over 500 girls from AAU and Kotebe College of Teachers Education participated in the workshops. In line with our plan, the main theme of this Conference is "HIV/AIDS and Associated Diseases”.- The Conference will include plenary lectures, paper and poster presentations, Session on "Sensitized Girls - Healthy Generation ", a special Business Session and a visit to an HIV/AIDS orphans center in Addis Ababa. The presentations will take place in parallel sessions, each focusing on different areas of biological sciences. The General Assembly will ratify the revised draft of the bylaws of the BSE during the special Business Session. Finaly, the Executive Committee and the Secretariat Office of the BSE would like to thank UNFPA, the Dean's Office of the Faculty of Science, the Department of Biology, the resource persons and all those who are presenting papers. Wishing all of you an enjoyable conference attendance and participation. Thank you for listening. Sensitization and Mobilization on HIV/AIDS Pictures TUBERCULOSIS AND HIV COLLABORATION

Zerihun Tadesse (PhD)1

BACKGROUND

The diseases of tuberculosis (TB) and HIV are inextricably linked. Tuberculosis is the leading cause of death amongst people with an HIV infection, and HIV, through the reduction of immunity, fuels the TB epidemic. Thus, HIV prevention and care must be a priority concern of TB Programmes and TB care and prevention should be a priority concern of national HIV/AIDS control programmes. Objectives of TB/HIV collaboration: ■ Reduce HIV incidence among TB patients; 0 Reduce TB incidence among PLWHA; and ■ Improve the care of people who are infected with both TB and HIV. These objectives are achieved through strengthening of the existing TLCP strategy by provision of additional TB/HIV collaborative activities together with the HIV/AIDS Prevention and Control Programme. The new strategy for TB control in high HIV prevalent populations includes additional interventions against tuberculosis: intensified case-finding, cure And TB preventive treatment. The strategies against HIV include: B Condoms promotion and distribution * Management of Sexually Transmitted Infections (STIs), 0 Harm reduction of Injection Drug Users (IDU) ■ Prevention of Mother to Child Transmission (PMTCT) B Anti- Retroviral Treatment (ART).

TB/ HIV Co-Infection Infection with HIV destroys the immune defence mechanism of the body and is therefore an important risk factor for the development of TB. In non-HIV infected persons, the risk of development from latent TB infection to disease is 5 to 10% during the entire lifetime of that person. For an HIV-infected person the risk of developing TB is higher than 50% for the remaining life time of that individual (5- 15% for each year alive).

1 Ministry of Health, Addis Ababa, Ethiopia. HIV/AIDS and Associated Diseases Zerihun Tadesse

Mechanisms |n the development of HIV-associated TB: • Re-activation of latent TB infection (acquired prior to HIV infection); • Rapid progression to disease, following recent TB infection; and • Re-infection with another strain of M. tuberculosis.

HIV is the most powerful known risk factor for re-activation of latent tuberculosis infection to active disease. In general tuberculosis occurs in the early stages of HIV-infection, often before other opportunistic infections occur. The combination of proven HIV-infection and clinical tuberculosis defines the diagnosis of AIDS. As a result of the interaction between HIV and TB the number of TB cases occurring in the population at large is increasing (5-10% per year) which consequently leads to an increase in the transmission of TB within the community. In Ethiopia, where 4.4% of the adult population is HIV-positive (MOH 2004), around 50% of TB patients in Addis Ababa are HIV-positive (in rural areas this is estimated to be 20-30%). This close association has also resulted in worsening of the stigma surrounding both diseases. HIV increases the rate of recurrent TB, which may be due to either endogenous reactivation (relapse) or exogenous re-infection. In addition to this interaction, it appears that TB in an HIV-positive person accelerates the progression of HIV- infection by stimulation of HIV virus replication. HIV not only increases the number of TB cases, but also alters the clinical course of TB disease. As HIV- related immuno-suppression increases, the clinical pattern of TB disease changes, with increasing number of smear-negative pulmonary FB and extra-pulmonary TB cases. TB is more likely to be disseminated and more difficult to diagnose as immuno-suppression progresses._____

Facts about TB/HIV: ■ TB is the leading cause of HIV-related morbidity and mortality. ■ HIV is the most important factor fuelling the TB epidemic in Africa up to 50% of HIV-infected people develop TB. ■ In sub-Saharan Africa 40 to 80% of TB patients are HIV- positive.

2 Proceedings of a National Workshop (BSE, February 2005)

GONOSIS OF TB IN PEOPLE LIVING WITH HIV/AIDS (PLWHA)

The clinical presentation of TB patients with HIV-infection mainly depends on the stage of HIV infection and can broadly be classified as early and late presentation. The smear-positivity rate among HIV-positive TB patients is the same as among HIV-negative TB patients, except in the advanced stages, when there is a tendency to develop smear-negative TB. In the early stages of HIV-infection the clinical presentation is almost indistinguishable from that in HIV-negative TB patients. However, in the advanced stages, the presentation can be atypical and extra- pulmonary forms like TB pleurisy, miliary TB and TB lymphadenitis occur with a relatively higher frequency. In any case, sputum smear examination remains the fundamental tool of investigation. If the sputum smear remains negative, a chest X- ray (CXR) is of additional value in the diagnosis. However, the appearance of the CXR may not be-typical for TB. There are many other lung conditions in HIV- positive patients that are indistinguishable from TB on the CXR. At laboratory level difference between stages of HIV infection is determined by counting CD4 cells or total lymphocytes. Especially in the advanced stage of HIV-infection TB tends to present as: ■ disseminated with absence of cavitation; 0 abnormalities in the lower rather than in the upper lobes; and ■ enlargement of the hilus is another common feature.

The following table summarizes differences in presentation between early and late stages of HIV-infection: Stage of HIV-infection TB & HIV Early stage Late stage'/ clinical AIDS Clinical picture Cough > 2 weeks Dry cough, not productive Productive sputum Upper lobe infiltrates, Lower lobe infiltrates, no cavitation X-ray appearance cavitation, nodular or often mediastinal lymphadenopathy patchy shadows and/or pleural effusion; Sometimes miliary or interstitial pneumonia Sputum smear Often positive (> 80%) Often negative (< 50%) In general the diagnostic process is the same as described in the chapter Tuberculosis, following the same flow charts for smear-positive and smear- negative TB. If there is suspicion of TB a patient has to be investigated for TB and if diagnosed to have TB an HIV test is recommended. Similarly it is strongly recommended that HIV positive clients at a VCT centre should be screened for symptoms and signs of active TB, as many of them may have early clinical tuberculosis.

3 HIV'/AIDS and Associated Diseases Zerihun Tadesse

MANAGEMENT OF TB AMONG PLWHA ISONIAZID PREVENTIVE THERAPY (IPT)

TB disease is one of the major opportunistic infections that cause death among PLWHAs. All newly-identified HIV -infected adults in HIV counseling and testing centers (VCT) are generally screened for symptoms ( prolonged cough > 2 weeks), followed by sputum smear microscopy and in some cases chest radiography. After ruhng out active TB, PLWHAs are considered for IPT (for details see TB/HIV Implementation Guideline). Where HIV prevalence is high among cases with smear positive PTB, children of index cases may be at risk of both TB and HIV if the index case is a parent. It is important to ask whether HIV status of index case and child contact is known and if not. Consider HIV testing. If the child contact is HIV- infected and otherwise well, 'hen consider EPT for all ages including those 5 years and older. IPT must not be given to any child, who has active or possible TB (for details see TB/HIV Implementation Guideline).

Co-trimoxazole Preventive Therapy (CPT) It is well-documented that administration of CPT decreases morbidity and mortality among HIV-infected TB patients. Co-trimoxazole has been considered standard of care for this category of patients and is generally given to HIV positive TB patients (for details see TB/HIV Implementation Guideline).

Treatment of TB in PLWHA The treatment of TB in PLWHA is essentially the same as in HIV-negative patients. It is well tolerated and the outcome of treatment is equally successful, particularly in patients early in the course of HIV infection. In PLWHA, TB treatment must be commenced without any delay. Due to HIV-related complications, predominantly in the first months of TB treatment, there is a higher mortality and morbidity in HIV-positive TB treatment. These complications can be prevented to a large extent by prescribing Co-trimoxazole (2 tablets or one double strength tablet daily) to all HIV-positive TB patients irrespective of the stage of HIV infection, but also by encouraging earlier presentation to health services, using communication and social mobilization strategies.

TB Treatment and Anti-Retroviral Therapy (ART) TB treatment and ART together gives rise to a number of potential problems, such as drug interactions, increased risk of adverse effects and increased frequency of “Immune Reconstitution Inflammatory Syndrome” (IRIS).

4 Proceedings of a National Workshop (BSE, February 2005)

Options for ART in patients with TB Possible options for ART in patients with TB include: 0 Do not start ART until completion of TB treatment. " Do not start ART until the completion of the initial phase of TB treatment and, then, use Ethambutol and Isoniazid in the continuation phase. B Treat TB with a Rifampicin-containing regimen as indicated in national ART guideline.

TB AND HIV COLLABORATIVE ACTIVITIES

The following activities are recommended and have already begun in Ethiopia in a limited number of health facilities. Building on the experience from these HFs, it is envisaged that expansion will take place, in particular in the context of increase access to ART.

A) TB prevention and control for PLWHA Intensified TB case-finding

B Isoniazid preventive treatment for PLWHA with latent tuberculosis.

B) HIV/AIDS prevention, health promotion and treatment for TB patients

■ Provision of widely available HIV testing and counselling and HIV prevention methods. ■ Increasing access to services to diagnose and manage STIs and Ois. ■ Cotrimoxazole preventive therapy at least during TB treatment. B Referral for PLWHA to HIV/AIDS care during/after TB treatment, including provision of ART.

C) TB/HIV activities to strengthen health system

■ Routine offering HIV testing to tuberculosis patients. ■ Establishment of a national TB/HIV advisory committee. B Monitoring and evaluation of TB/HIV activities & Joint TB/HIV resource mobilisation. ■ Joint TB/HIV capacity building, including training, communication and social mobilisation. ■ Community involvement in collaborative TB/HIV activities. e Operational research to enhance collaborative TB/HIV activities.

5 HIV/AIDS and Associated Diseases Zerihun Tadesse

SURVEILLANCE OF HIV PREVALENCE AMONG TB PATIENTS

Knowing the proportion of HIV prevalence in TB patients assists and informs the TB and HIV/AIDS Programmes in planning and implementing activities to address both HIV/AIDS and TB. Routine offering of HIV testing with adequate information on the benefits for the TB patient knowing his/her HIV status (e.g. availability of CPT and possibility of ART) is more effective and will eventually reduce the stigma surrounding both diseases In places, where CPT is available and where ART becomes increasingly accessible it is strongly recommended to routinely offer an HIV test to every TB patient, after providing adequate information on the benefits of knowing his/her HIV status.

REFERENCES

FMoH (2000). TB/HIV Implementation guideline, Addis Ababa, Ethiopia. IMAI (2005). HIV Care Modules. Integrated Management of Adult Illness: Ethiopia Edition. WHO (2004). Interim Policy on Collaborative TB/HIV Activities (WHO/HTM/TB 330). WHO (2004). Scaling up Antiretroviral therapy in resource-limited settings: treatment guidelines for a public health approach 2003 revision. (ISBN 924 159155 2). WHO (2004). TB/HIV, A Clinical Manual. Second Edition. (WHO/HTM/TB/2004.329)

6 PARASITES AND HIV

Amha kebede 1

SUMMARY

Parasitic infections are prevalent in developing countries where the HIV/ADDS epidemic is becoming more and more a serious burden aggravating the already overstretched socio-economic problem. Nowadays opportunistic protozoan parasites, like cryptospordium, microsporidium and Isospora, are highly associated with chronic diarrhea among HIV/AIDS patients. Even though there is conflicting evidence as to the exact role of helminthiasis on HIV/ADIS epidemics, their effects appear more indirect than being an opportunistic parasite. There is no direct evidence that soil transmitted helminths could be opportunistic. However, there are studies indicating a significant correlation between the number of eggs excreted and HIV plasma viral load where treatment of the worms decrease the viral load.

INTRODUCTION

HIV infection is highly prevalent in many developing countries, becoming a significant threat socially and economically. UNAIDS estimated that 40 million individuals globally were living with HIV/AIDS and that 20 million have died of AIDS-related diseases (UNAIDS, 2001). Like many other developing countries, the prevalence of HIV infection in Ethiopia has increased significantly in the last few years. In 2003 in Ethiopia, about 1.5 million people are thought, to live with HIV/AIDS, making the overall prevalence 4.4%. Among many other infections, intestinal parasites cause a great deal of morbidity and mortality in human immunodeficiency virus (HlV)-positive individuals worldwide (Chaisson et al., 1998). In developing countries due to higher prevalence of infection in the general population, prevalence of parasitic infections is appreciably higher among AIDS patients. Particularly, infections with helminths and opportunistic protozoan parasites have been shown to be highly associated with AIDS patients. HIV/AIDS patients commonly suffer from infections of the gastrointestinal tract. It has been estimated that 30-50% of patients with AIDS in the developed countries, and about 90% in developing countries, suffer from chronic diarrhea (Smith et al., 1992). In sub-Saharan African countries chronic diarrhea associated with significant weight loss (‘slim disease’) is often the presenting illness of HIV-1 infected individuals. This kind of syndrome in association with a positive HIV-1

1 Ethiopian Netherlands AIDS Research Project, P.O. Box 1242, Addis Ababa. Email: [email protected] HIV/AIDS and Associated Diseases Amha Kebede serology test is an AIDS-defining illness (WHO, 1986; Dallabetta and Miotti, 1992). According to the World Health Assembly (WHA) in 2001, two billion people were infected by soil-transmitted helminths and schistosomiasis, worldwide (Anonymous, 2001). This shows that helminthic infections affect more than a third of the world’s population. Soil-transmitted helminthic infections include Ascaris lumbricoides, the hookworms Necator americanus and Ancylostoma duodenale, Trichuris trichiura, and Strong}!aides stercoralis. All these parasitic infections are substantially associated with conditions of poverty, overcrowding and lack of hygiene and sanitation. Humans and helminthic infections have evolved together for a very long time, whereas HIV/AIDS is relatively a new disease. The prevalence of both diseases is increased by poor socio economic status of a given community. Some studies have shown that HIV could take advantage of immunological and host-parasite relationships that have stabilised as a result of evolution (Viney, 2002). This review highlights the importance and impact of major opportunistic intestinal protozoans and helminthic parasites on the epidemiology and pathogenesis of HIV/AIDS worldwide and in Ethiopia.

PROTOZOAN PARASITES AND HIV/AIDS

The impact of emerging opportunistic protozoan parasites, such as Cryptosporidium, Cyclospora, Microsporidia, and Isospora, on patients with AIDS is severe. This has come to be the case since the early stage of the HIV/AIDS epidemic. Diagnosis of these parasites cannot be made clinically unless specific faecal examination is carried out. There is a wide variation in infection rate of intestinal parasites in patients with AIDS and chronic diarrhea ranging from 40% to 83%, and the parasitic agents differ markedly from region to region. Detection of intestinal protozoan parasites in HIV-related diarrhea is significantly higher compared to other intestinal parasites including helminths (Prassad et al., 2000).

CRYPTOSPORIDIOSIS

Cryptosporidiosis is an AEDS-defming illness involved with chronic diarrhea and it is the most common cause of enteric disease in HIV/AIDS patients (WHO, 1986). C. parvum is specially common in patients with AIDS whose CD4+ counts are <200 cells/jj.1. Transmission occurs through fecally contaminated waters used for drinking. It is caused by a protozoan parasite infecting the gastrointestinal tract epithelial cells. Many species of Cryptosporidium exist that infect humans and a wide range of animals. Most of the time, patients present with profuse watery diarrhea, malabsorption and weight loss. Diagnosis is by demonstration of oocysts in stool (Ziehl-Nelsen or modified Kinyoun AFB stain). The organism can also be demonstrated on small bowel biopsy Worldwide, the prevalence of Cryptosporidium in AIDS patients is reported to be . 10-20% (Mitra et al., 2001). The most prevalent species causing disease in

8 Proceedings of a National Workshop (BSE, February 2005) humans is C. parvum. Different studies from Ethiopia, on the other hand, indicate a much higher frequency of cryptosporidiosis ranging from 11% to 40% (Mengesha, 1994; Fisseha et al., 1998; Awole et al., 2003; Endeshaw et al., 2005). Even though Cryptosporidium is one of the most commonly identifiable pathogen in patients with AIDS-related persistent diarrhea, there is no treatment for it (Sanchez-Mejorada and Ponce de Leon, 1994). Initial management should therefore include rehydration, either orally or intravenously.

MICROSPORIDIOSIS

Human microsporidiosis represents an important and rapidly emerging opportunistic disease, occurring mainly, but not exclusively, in severely immunocompromised patients ' with AIDS. Cases of microsporidiosis in immunocompromised persons not infected with HIV as well as in immunocompetent persons have also been reported. The clinical manifestations of microsporidiosis are very diverse, varying according to the causal species, with diarrhea being the most common. The prevalence of Microsporidia among AIDS patients ranges from 3% to 50% (Dallaabbetta and Miotti, 1992). The most important species causing diarrhea are Enterocytozoon bieneusi (90%) and Encephalitozoon intestinalis (10%). Microsporidium has been identified in up to 30% of AIDS patients with pathogen negative diarrhea. Microsporidia was the most common pathogen (27% of cases) in a study conducted in Thailand among HIV-infected patients with diarrhea, followed by Cryptosporidium (9%) and Isospora (4.5%) (Punpoowong et al., 1999). A marked geographical variation with contrasting prevalence rates is shown by many studies worldwide. This emphasizes the need for thorough investigation of these patients to identify pathogens for proper management. In general in Africa, there is scanty information on microsporidiosis among HIV/AIDS patients due to lack of sensitive techniques and expertise. A recent study from Ethiopia indicates that intestinal microsporidiosis is a common cause of chronic diarrhea and severe weight loss in advanced AIDS patients (Endeshaw et al., 2005). In this study by PCR, out of 243 diarrhea stools, 39 (18.2%) were positive for intestinal microsporidial infection where Enterocytozoon bieneusi constitute the large majority (76.9%) while Encephalitozoon intestinalis make up 15.4% and three cases were double infection. Light microscopic examination of the stained clinical smears, especially fecal samples, is the easiest and quickest method of diagnosing microsporidial infections even though it does not allow identification to species level. The most widely used staining technique is Chromotrope 2R method or its modifications. This technique stains the spore and the spore wall a bright pinkish red. The technique, however, is lengthy and time consuming and requires about 90 minutes. Molecular methods (mainly Polymerase Chain Reaction, PCR) are very promising techniques for the diagnosis of microsporidiosis. PCR is available only in research laboratories and

9 HIV/AIDS and Associated Diseases Amha Kebede

has been successfully used for the diagnosis of Enterocytozoon bieneusi and Encephalitozoon intestinalis. The treatment of choice is Albendazole for E. intestinalis while there is no treatment for E. bieneusi.

Isospora belli This is a protozoan parasite with biology and clinical presentation similar to Cryptosporidium. I. belli infects the epithelial cells of the small intestine and is the least common of the intestinal opportunistic parasites that infect humans. Infection causes acute, nonbloody diarrhea with crampy abdominal pain, which can last for weeks and result in malabsorption and weight loss. In AIDS patients, the diarrhea can be severe. Diagnosis is made with modified Kinyoun AFB stain of stool, revealing characteristic oocysts. Trimethoxazole is the drug of choice. In developed countries Isospora is infrequently associated with diarrhea due to AIDS (about 1.5%), but it was commonly isolated in patients with AIDS and persistent diarrhea in developing countries, such as Brazil (9.9%), Zaire (12%), Zambia (16%) and Haiti (12 %) (Dallaabbetta and Miotti, 1992). In Ethiopia very few reports of Isosporiasis exist and the prevalence among HIV/AIDS patients ranges from 7.4% (Awole et al.y 2003) to 22.5% (Endeshaw et al, 2005).

Cyclospora This protozoan parasite has been relatively recently identified as a unicellular coccidian parasite. Cyclospora caytanensis appears to be responsible for all human cases. After an average incubation period of 1 week, symptomatic infections typically manifest as watery diarrhea, which can be severe among AIDS patients. Untreated infections typically last for 10-12 weeks and may follow a relapsing course. The most common clinical features caused by this parasite include watery diarrhea, fatigue, anorexia, weight loss, and upper intestinal pain. Infections, especially in disease-endemic settings can be asymptomatic. The prevalence of Cyclospora appears to be rather high in Haiti (11%) compared to US and Tanzanian patients with AIDS and chronic diarrhea where it is reported quite rarely (<1%) (Dallaabbetta and Miotti, 1992). There is a paucity of information about cyclospora infection in AIDS patients in Ethiopia with only with a single report of 3.7% (Awole et al, 2003) A common source of infection appears to be contaminated water. Currently, the most practical diagnostic method consists of identification of oocysts in stool specimens by light microscopy. The recommended treatment for cyclosporiosis is a combination of two antibiotics, Trimethoprim-sulfamethoxazole.

AMEBIASIS

Previous studies have suggested that the pathogenicity of E. histolytica may be enhanced by immunosuppression, as was seen in patients receiving corticosteroids. It is well known that HIV infection can result in the impairment of cell-mediated

10 Proceedings of a National Workshop (BSE, February 2005) immunity; thus, patients with HIV infection may be more likely to have a protracted course if infected by pathogenic amebas. A number of investigations, however, have shown that cases of invasive amebiasis are rarely or never reported in HIV-infected patients (Sturgess et al, 1992; Lucas, 1994; Fatkenheuer et al, 1997). There is no clear explanation why invasive amebiasis is rare in HIV-infected patients despite their declining T-cell immunity, the major immunity against E. histolytica infection (Salata and Ravdin, 1986; Li and Stanley, 1996). The difference in geographic distribution of morphologically indistinguishable pathogenic (.E. histolytica) and nonpathogenic (E. dispar) amebas may provide some clues (Sargeunt and Williams, 1978; Clark and Diamond, 1991; Gonzalez- Ruiz and Wright, 1998). A study conducted in two cohort sites by the Ethio-Netherlands AIDS Research Project indicated that E. histolytica/E. dispar, with a prevalence of 25.4%, to be the only parasite with significant association with HIV infection (Fontanet et a l, 2000). An extensive study, however, with more sensitive and specific tests such as PCR consistently show that E. histolytica is over diagnosed among HIV/AIDS patients while finding of high number of E. dispar was not unusual (Kebede et al, 2003).

IMPACT OF SOIL-TRANSMITTED HELMINTHIC INFECTION ON THE HIV/AIDS PANDEMIC

The pathogenesis of AIDS in Africa appears to be highly associated with chronic immune activation caused by endemic infections, particularly helminthic infections (Bentwich et a l, 1995). There are strong evidences suggesting that immunoloigcal responses to various helminths may predispose to HIV/AIDS and tuberculosis. It is a well-established fact that individuals with helminthic infections can be chronically immune-activated and to have a very pronounced T helper type 2 (TH2) immune profiles (Borkow and Bentwich, 2000). Thus, higher HIV plasma viral load reported in sub-Saharan Africa could be- associated with helminthic infections and also the more rapid spread and progression of AIDS in Africa. Chronic activation of Th2 lymphocytes and their cytokines, as well as other participating cells in the immune response to adult helminths or larvae are suggested to provide conducive condition for infection by HIV and progression to AIDS (Bentwich et a l, 1995). The efficacy of potential vaccines against HIV will be impaired by worm infections, which bring about continuous or frequent cross regulation, or suppression, of cellular immunity with eventual anergy, or exhaustion. The host’s immune response for helminthiasis in hyperendemic areas is usually maintained due to frequent exposure to infection and reinfection. Immunosuppression and anergy can result from continual immunological activation. Different studies have shown that the chronic immune response to

11 HIV/AIDS and Associated Diseases Amha Kebede helminthiasis could be adversely influencing the epidemics of HIV/AIDS and TB (Borkow et al., 2000; Fincham et al., 2003). Prevention and de-worming of helminthic infections is strongly recommended to improve the situation. Even though antihelminthic treatment lowers HIV plasma viral load in general, a study conducted in Kenya showed HIV plasma viral load did not decrease significantly after treatment of schistosomiasis in people heavily and dually infected with HIV and S.mansoni (Lawn et al., 2000). A recent epidemiological study also in Uganda indicated that helminth infection was not associated with faster progression of HIV disease in coinfected adults (Brown et al., 2004), which is in sharp contrast with the previous observations by Bentwich et al ( 1995). Thus, the epidemiological observation on the absence of a detrimental effect of helminths on HIV progression and the suggestion that the decrease in CD4+ cell count is greater after the treatment of some worms challenges the dogma that helminths, if found, should be treated in co-infected adults. The idea that HIV infection spreads and progresses faster in developing countries is still controversial, mainly due to the paucity of well-controlled longitudinal studies. Nevertheless, there is compelling evidence that high plasma viral loads are associated with increased HIV transmission and faster progression. Although there may be other potential factors that could contribute to the increase in HIV plasma viral load, it may well be that helminthic infections in themselves, mainly through the-immune activation that they cause are sufficient to be a major factor for the observed HIV plasma viral increase (Wolday et al., 2002). This observation is supported further by previous studies among HIV-negative and HIV-positive Ethiopian immigrants to Israel, where helminthic infections were associated with chronic immune activation that decreased after treatment of the helminths (Bentwich et al., 1996; Kalinkovich et al., 1998). These findings are in line with previous studies showing the mutual interactions between HIV infection and other concurrent infections such as tuberculosis, leishmaniasis, and probably malaria (Bentwich et al., 1999; Wolday et al., 1999; Berehe et al., 1999). The case o f S. stercoralis as an opportunistic parasite is not clear as this helminth can multiply prolifically in the human host by means of auto-infection (Fincham et aL. 2003). Except one report of a significantly greater prevalence of rtron^loadiasis in HIV-positive patients (Gomez Morals et al., 1995), others have found no evidence that S stercoralis is an opportunist in HIV infection (Lindo et aL, 1998; Karp and Neva, 1999). As the pathology linked to auto-infection by S. stercoralis could be way serious, especially m immunocompromised hosts, more research is dearly necessary to clarify this condition. CONCLUSION

HIV/AIDS suffer from opportunistic parasites in the course of their infections. The m o s t important opportunistic infections usually associated with chronic diarrhea are Cryptosporidium, kiicrosporidium . Isospora and Cyclospora. Accurate diagnosis of these p a n s h e t is important fo r proper management of AIDS

12 Proceedings of a National Workshop (BSE, February 2005) patients. The role of helminths, on the other hand, is still debatable, birt many studies indicate that they have an indirect role in disease progression by immune activation than being opportunistic parasites.

REFERENCES

Anonymous. Fifty-fourth World Health Assembly WHA54.19. Agenda item 13.3, 22 May (2001). Schistosomiaasi and soil-transmitted helminth infections. Ninth Plenary Meeting. A54/VR/9. Awole, M., S. Gebre-Selassie, T. Kassa and G. Kibru (2003). Prevalence of intestinal parasites in HIV infected adult patients in South Western Ethiopia. Eth.J.Hlth.Devpt. 17: 71-78. Bentwich, Z., A. Kalinkovich, and Z. Weisman (1995). Immune activation is a dominant factor in the pathogenesis of African AIDS. Immunol. Today. 16: 187-191. Bentwich, Z., Z. Weisman,.and C.e.al. Moroz (1996). Immune dysregulation in Ethiopian immigrants in Israel: relevance to helminth infections? Clin.Exp. Immunol. 103: 239-243. Bentwich, Z.e.al. (1999). Can eradication of helminthic infections change the face of AIDS and tuberculosis? Immunol.To day. 20: 485-487. Berhe, N., D. Wolday, and A.e.a. Hailu. (1999). Viral load and response to antileshmanial chemotherapy in co-infected patients. AIDS. 13:1921-1925. Borkow, G., Q. Leng, Z. Weisman, M. Stein, N. Galai, A. Kalinkovich, and Z. Bentwich (2000). Chronic immune activation associated with intestinal helminth infections results in impaired signal transduction and anergy. J.Clin.Inves. 106: 1053-1060. Brown, M., M. Kizza, C. Watera, M.A. Quigley, S. Rowland, P. Hughes, J.A.G. Whitworth, and A. Elliott (2004). Helminth infection is not associated with faster progression of HIV disease in coinfected adiilsts in Uganda. J. Infect. Dis. 190: 1869-1879. Bundy, D.A.P. and N.R. De Silva. (1998). Can we deworm this wormy world? Br.Med.Bull 54:421-432. Bundy, D.A.P., A. Sher and E. Micahael (2000). Good worms or bad worms: Do worm infections affect the epidemiological patterns of other diseases? Para.Today. 16: 273-274. Chaisson, R.E., J.E. Gallant, J.C. Keruly and R.D. Moore. (1998). Impact of opportunistic disease on survival in patients with HIV invection. AIDS. 12: 29-33.

13 HIV/AIDS and Associated Diseases A^iha Kebede r Conteas, N.C., W.G.O. Berlin, L.R. Ash and J.S. Peruth (2000). Therapy for human gastrointestinal microsporidiosis. Am.J.Trop.Med.Hyg. 63: 121- 127. Dallabetta, G.A. and P.G. Miotti (1992). Chronic diarrhea in AIDS patients in the tropics: a review. Tropical Doctor. 12. 3-9. Endeshaw, T., Kebede, A. J.J. Verwej, D. Wolday, A. Zewide, K. Tsige, Y. Abraham, T. Messele, A.M. Polderman, and B. Petros (2005). Detection of intestinal microsporidiosis in diarrhoeal patients infected with the human immunodeficiency virus (HIV-1) using PCR and Uvitex-2B stain. Eth.Med.J. 43: 97-101. Fatkenheuer, G., G. Arnold, H.-M. Steffen, C. Franzen, M. Schrappe, V. Diehl, and B. Salzberger. 1997. Invasive amoebiasis in two patients with AIDS and cytomegalovirus colitis. J. Clin. Microbiol. 35:2168-2169. Fincham, J.E., M.B. Marku, and V.J Adams (2003). Could control of soil- transmitted helminthic infection influence the HIV/AIDS pandemic. Acta Tropica. 86: 315-333. Fisseha, B., B. Petros, and T. Woldemichael (1998). Cryptosporidium and other parasites in Ethiopian ADDS patients with chronic diarrhea. E.Afr.Med.J. 75: 100-101. Fontanet, A.L., T. Sahlu, T.R. Wit, T. Messele, W. Masho, T. Woldemichael, H. Yeneneh and R.A. Coutinho (2000). Epidemiology of infections with intestinal parasites and human immunodeficiency virus (HTV) among sugar-estate residents in Ethiopia. Ann.Trop.Med.Parasitol. 94:269-278. Gomez Morales, M.A., C. Atzori, A. Ludovisi, P. Rossi, M. Scalgia, and E. Pozio (1995). Oppotrunistic and non-opportunistic parasites in HIV positive and negative patients with diarrhoea in Tanzania. Trop.Med.Parasitol. 46: 109-114. Gonzalez-Ruiz, A. and S.G. Wright (1998). Disparate amoebae (editorial). Lancet 351: 1672-1673. Kalinkovich, A., Z. Weisman, and Z.e.a. Greenberg. (1998). Decreased CD4 and increased CD8 counts with T cell activation is associated with chronic helminth infection. Clin.Exp.Immunol. 114:414-421. Karp, C.L. and F.A. Neva (1999). Tropical infectious diseases in human immunodeficiency virus-infected patients. Clin.Infect.Dis. 28: 947-965. Kebede, A., Jaco Verweij, Wendelien Dorigo-Zetsma, Eduard Sanders, Tsehaynesh Messele, Lissete van Lissehout, Beyene Petros, and Polderman Ton (2004). Overdiagnosis of amoebaisis in the abscence of Entamoeba histolytica among patients presenting with diarrhoea in Wonji and Akaki, Ethiopia. Trans. R. Soc. Trop. Med. Hyg. v •.

14 ______Proceedings of a National Workshop (BSE, February 2005)______

Lawn, S.D., D.M. Karanja and P.e.al. Mwinzia (2000). The effect of treatment of schistosomiasis on blood plasma HIV-1 RNA concentration in coinfected individuals. AIDS 14: 2437-2443. Li, E. and S.L. Stanley (1996). Protozoa: Amebiasis. Gastroenterol Clinics North Amer. 25: 471 Lindo, J.F., J.M. Dubon, A.L. Ager, E.M. de Gourville, H. Solo-Gabriele, W.I. Klaskalla, M.K. Baum and C.J. Palmer (1998). Intestinal parasitic infections in human immunodeficiency virus (HlV)-positive and HIV- negative individuals in San Pedro Sula, Honduras. Am. J. Trop. Med. Hyg. 58:431-435. Lucas,-S.B. (1994). Missing infections in AIDS. Trans. R. Soc. Trop. Med. Hyg. 84(s): 34-38. Markell, E.K. (1993). Macroscopic and microscopic examinations of fecal specimens. In Medical Parasitology. E.K. Markell and M. Voge, editors. Saunders, W.B., Philadelphia. 441-445. Mengesh, B. (1994). Cryptosporidiosis among medical patients with aAIDS in Tikur Anbessa Teaching Hospital, Ethiopia. E. Afr. Med. J. 71: 376-378. Mitra, A.K., C.D. Hernandez, C.A. Hernandez, and Z. Siddiq. (2001). Management of diarrhea in HIV-infected patients. Int. J. STD AIDS 12: 630-639. Mukhopadhya, A., B.S. Ramakrishina, G. Kang, A.B. Pulimood, M.M.Z.A. Mathan and D.C. Mathai (1999). Enteric pathogens in southern Indian HIV-infected patients with and without diarrhea. Indian J. Med. Res. 109: 85-89. Prassad, K.N., V.L. Nag, T.N. Dhole, and A. Ayyagari. (2000). Identification of Enteric Pathogens in HIV-positive Patients with Diarrhoea in Northern India. J. Hlth. Pop. Nutr. 18: 23-26. Punpoowong, B., P. Viriyavejdeul, M. Riganti, E. Pongponaratn, U. Chaispi and Y. Maneerat (1998). Opportunistic protozoa in stool samples from HIV- . infected patients. S. East Asian J. Trop. Med. Pub. Hlth. 29: 31-34. Sanchez-Mejorada, G. and S. Ponce de Leon. (1994). Clinical patterns of diarrhea in AIDS: etiology and prongnosis. Rev. Invest. Clin. 46: 187-196. Smith, P.D., T.C. Quinn, W. Strober, E.N. Janof and H. Masur (1992). Gastrointestinal infections in AIDS. Ann. Intern. Med. 116: 67 Stanley, S.L., Jr. (1996). Progress towards an amebiasis vaccine. Parasitol Today 12: 7-14. . Sturgess, I., S.M. Greenfield, J. Teare and M.J. O'Doherty (1992). Ulcerative colitis developing after amoebic dysentry in a haemophiliac patient with AIDS. Gut. 33: 408-410.

15 HIV/AIDS and Associated Diseases Amha Kebede

Tarimo, S.D., J.Z.J. Killeno, A.S. Minj, and I.G. Masmanga. (1996). Prevalence of intetinal parasites in adults patients with entropathic ADDS in North- Eastern Tanzenia. E. Afr. Med. J. 7: 397-399. UNAIDS. Joint United Nations Programme on HIV/AIDS. http//www.unaids.org/epidemic_update/report_dec01/index.html. 2001. Viney, M. (2002). How do host immune responses affect nematode infections. Trends Parasitol. 18: 63-66. Wolday, D., N. Berhe and H.e.a. Akufo (1999). Leishmania-HIV interaction:immunopathogenic mechanisms. Parasitol.Today. 15: 182- 187. Wolday, D., S. Mayaan, Z. Gebremariam, N. Berhe, T. Seboxa, S. Britten, N. Galai, A. Landay and Z. Bentwich (2002). Treatment of intestinal worms is associated with decreased HIV plasma viral load. JAIDS. 31:56-62. World Health Organization (1986). WHO/CDC case definition of AIDS. Week Epidemiol. Rev. 61: 945-950.

16 OPPORTUNISTIC FUNGAL INFECTIONS IN HIV/AIDS PATIENTS IN ETHIOPIA

Yimtubezinash Woldeamanuel (PhD) 1

ABSTRACT

Fungi are of increasing clinical importance, mainly as the causative agents of opportunistic infections in the expanding population of immunocompromised patients. More yeasts and molds are now recognized to cause more superficial and systemic human infections than ever before. Under severe immunosuppresion, most fungi are potentially pathogenic; therefore clinicians must start out with a high index of suspicion in making the diagnosis. Candidiasis is the most frequent mucosal opportunistic infection in HIV-positive patients, and ranks number one among all infections occurring in AIDS cases in Ethiopia. Candida species cause stomatitis, oropharyngitis or esophagitis. In Ethiopian patients, different studies have reported that out of all AIDS cases, 10-20% present with oropharyngeal candidiasis. Another common fungal infection is Cryptococcus which is the most common life-threatening fungal infection in patients infected with the hum an1 immunodeficiency virus (HIV). In Ethiopia the first case was reported in 1992 with subsequent increasing number of reports. In a more recent study, a 7% isolation rate of Cryptococcus neoformans from cerebrospinal fluid specimens was reported in Addis Ababa. Pnuemocyctis jirovecii, causing serious and even life threatening pneumonia, is a frequent pathogen found in HIV positive patients with long lasting respiratory complaints. It is rarely reported in Ethiopia and the few studies diagnosis was based only on clinical grounds. But in a recent prospective study designed originally to study Pulmonary Tuberculosis (PTB) and HIV interaction, examination with nested polymerase chain reaction (PCR) for P. jiroveci showed that 30.3% (36/119) of HIV positive patients negative for mycobacterium culture in sputum were positive for P.jiroveci. Diagnostic tests are not available for Pnuemocystis pneumonia (PCP) in Ethiopia and many patients miss the opportunity for treatment and prevention. Since most of the diagnostic methods for serious fungal infections are not available in our setting, data on other opportunistic fungal infections such as aspergillosis, histoplasmosis and others are lacking and substantial work needs to be done to get the true picture o f the spectrum o f fungal infections in HIV/AIDS patients in Ethiopia. Key words. HIV; Opportunistic fungal infections.

1 Department of Microbiology, Immunology and Parasitology* Faculty of Medicine, Addis Ababa University, P.O. Box 1176, Addis Ababa. HTV/AIDS and Associated Diseases Yimtubezinash Woideamanuel

INTRODUCTION

Candidiasis is the most frequent mucosal opportunistic infection in HIV-positive patients and C. albicans is the most common species isolated (1). It ranks number one among all infections occurring in AIDS cases in Ethiopia (2). Although Candida stomatitis,'oropharyngitis or esophagitis rarely progress to become a life threatening disease, patients with Acquired Immuno-Deficiency Syndrome (AIDS) need long term antifungal treatment so that they can eat without pain and clinical nutritional deficiency can be delayed. The source of infection is usually endogenous since Candida albicans is part of the normal mycoflora, and between 30 to 50 % of healthy people harbor Candida in the mouth (3). This has also been shown in Ethiopia with a 40% frequency of isolation (4). In Ethiopian patients, different studies have reported that out of all AIDS cases 10-20% present with oropharyngeal candidiasis (OPC) (2, 5). In a study done to characterize isolates from HIV/AIDS patients with oral thrush, 85% of the isolates were C. albicans serotype A with a 5% primary resistance to 5-fluorocytoisne (4). Another opportunistic fungal pathogen is C. neoformans, the cause of cryptococcosis, which is the most common life-threatening fungal infection in patients infected with the human immunodeficiency virus (HIV) (6). Clinically, it presents with meningitis or meningoencephalitis and is fatal if left untreated, however cryptococcal infection of many organs has been described. In Ethiopia the first case was reported in 1992 with subsequent increasing number of reports (7,8,9). In a more recent study a 7% isolation rate of Cryptococcus neoformans was detected in cerebrospinal fluid (CSF) (10). Out of 1088 CSF specimens sent to the bacteriology laboratory in Black Lion Hospital, Addis Ababa, 275 were with a request for India ink examination. Out of these 19 (7%) were India ink positive arid subsequently culture positive, and all the isolates were identified as C. neoformans var. neoformans. In the same study, retrospective analysis of the medical records of the patients showed high mortality rate In the adult population in the developed world, the incidence of Pneumocystis pneumonia fPCP) has significantly decreased with the introduction of HAART, but

18 Proceedings of a National Workshop (BSE, February 2005) it remains among the most common AIDS-defining infections especially in developing countries (11). Pnnemocyctis jirovecii the cause of PCP causes serious and even life threatening pneumonia and is a frequent pathogen found in HIV positive patients with long lasting respiratory complaints. It is rarely reported in Ethiopia and the few studies reporting the disease were based only on clinical grounds and not supported by laboratory diagnosis (5,12). In a prospective study designed originally to study Pulmonary Tuberculosis (PTB) and HIV interaction, in sputum analyzed on suspicion of PTB, examination with nested polymerase chain reaction (PCR) for P. jiroveci showed that 30.3% (36/119) of HIV positive patients, negative for mycobacterium culture in sputum, were actually positive for P.jiroveci (13). Laboratory diagnostic tests are not available for Pnuemocystis pneumonia (PCP) in Ethiopia and many patients miss the opportunity for treatment and prevention. Based on the findings of the previous study, there is a need to set up a laboratory diagnostic test for PCP that is suitable for the Ethiopian setting.

Other opportunistic fungal pathogens Many fungi can cause infections in the immunocompromised host. Since most of the diagnostic methods for serious fungal infections are not available in our setup data on other opportunistic fungal infections such as aspergillosis and histoplasmosis are lacking. The lack of reliable and rapid diagnostic procedures is a major obstacle in the successful management of fungal diseases. Clinicians often have to rely on nonspecific signs and symptoms to guide antifungal therapy before laboratory findings become available. Substantial work needs to be done to get the true picture of the spectrum of fungal infections in HIV/AIDS patients in Ethiopia.

REFERENCES

1. Lopez-Ribot J.L, Casanova M, Murgui A, Martinez J.P. (2004), Antibody response to Candida albicans cell wall antigens. FEMS Immunology and Medical Microbiology. 41: 187-196 2. Ministry of Health (2002). AIDS in Ethiopia. Disease Prevention and Control Department, Ministry of Health, Addis Ababa, Ethiopia. 3. Odds, F.C. (1988). Candida and Candidosis: A review and bibliography, 2nd ed. Bailliere Tindall, London. 4. Woldeamanuel, Y, Abate D. (1998). Characterization of Candida albicans isolates from Ethiopian HIV-positive patients. Ethiop. Med. J. 36: 235-243. 5. Kassa, E., Rinke, de Witt T.F. and Hailu et al. (1999). Evaluation of the World Health Organization staging system for HIV infection and disease in Ethiopia: association between clinical stages and laboratory markers. AIDS 13: 381-9. 6. Powderly, W.G. (1993). Cryptococcal meningitis and AIDS. Clin. Infect. Dis. 17: 837-42.

19 HIV/AIDS and Associated Diseases Yimtubezinash Woldeamanuei

7. Gebremedhin, A. (1992). Cryptococcal meningitis in a young Ethiopia woman with AIDS. Ethiop. Med. J. 30: 169-173. 8. Woldeamanuei, Y, Chryssanthou, E., Petrinin, B. and Abate, D. (1996). Cryptococcus neoformans isolated from six Ethiopia HIV positive patients with meningitis [abstract] Ethiop. Med. J. 34: 259. 9. Seboxa, T., Alemu, S. and Assefa, A. (1996). Cryptococcal meningitis in patients with AIDS [abstract]. Ethiop. Med. J. 34: 258. 10. Woldeamauel, Y. and Haile, T. (2001). Cryptococcoisis in patients from Tikur Anbessa Hospital, Addis Ababa. Ethiopia. Ethiop Med J 39: 185-91. 11. Morris, A. Lundgren, J.D. Masur, H., Walzer, P.D., Hanson, D.L., Frederick, T., Huang, L., Beard, C.B. and Kaplan, J.E.(2004). Current epidemiology of Pneumocystis pneumonia. Emerg. Infect. Dis. 10: 1713-20. 12. Lester, F.T., Ayehuni, S. and Zewdie, D. (1988). Acquired Immunodeficiency syndromer seven AIDS cases in Addis Ababa Hospital. Ethiop. MedJ. 26: 139-47. 13. Bruchfeld, J. (2002). Pulmonary tuberculosis and HIV interaction in a setting with a high prevalence of HIV. Clinical Diagnostic and epidemiological aspects. Thesis. Karolinska Instituted ISBN 91 -7349-249- 3. Karolinska University Press.

20 ABSTRACTS OF PRESENTATIONS FOR WHICH FULL PAPERS HAVE NOT BEEN SBUBMITTED

HIV/AIDS AND IMMUNITY

Tsehaynesh Messele (PhD)1

Several studies have been conducted over the past 22 years to understand the pathogenesis of HIV disease from an immunological standpoint. HIV infection is characterized by dynamic and long-lasting interactions between the virus and the immune system. HIV-specific immunity of both humoral and cellular in nature is produced in HIV infection. These include neutralizing antibodies, potent HFV- specific CD8+ cytotoxic T cell responses and HIV-specific CD4+ T cells, which are observed in many individuals infected with HIV at various stages of the disease. Antibody response to HIV-1 appears within days to weeks after infection. HIV-1 infected individuals can produce antibodies to several parts of the virus. Most HIV-infected individuals also rapidly develop HIV-specific cytotoxic response after infection and this CTL response is maintained throughout the asymptomatic stage but often declines with disease progression and at present no satisfactory explanation exists for the decline in HIV-specific CTL response in late disease. The presence of such responses has minimal, if any, effect on disease progression. Although other mechanisms of viral escape are also suggested, the emergence of several variants of HIV-1 (quasispecies) in the course of HIV disease mainly due to an error prone reverse transcription during the virus replication process is indicated to affect CTL recognition. The variation is also manifested in different properties of the virus affecting transmission, cellular tropism and pathogenesis. Activation of all components of the immune system is also the major feature of HIV infection. The abnormal immune activation is shown to have a profound effect on the immune system function. Altogether, the decline in CD4 cells, which are essential for the maintenance of effective immunity, together with other abnormal immunological manifestations, leads to a deterioration of the immune system reflected by occurrences of opportunistic infections and malignancies. Although HFV pathogenesis is understood to some extent, so far there is no clear understanding on the correlates of immune protection and their potential role in vaccine development. This remains to be one of the greatest challenges in HIV/AIDS research. Several aspects of the findings from researches on HIV/AIDS and the immune response will be discussed during the presentation.

1 Ethiopian Health and Nutrition Research Institute, P.O. Box 1242, Addis Ababa.

21 HIV/AIDS and Associated Diseases

HIV/AIDS AND ANTIRETROVIRAL THERAPY IN ETHIOPIA

Dawit Wolday (PhD)1

Effective anti-retroviral drugs are now available, which in various combinations are very effective. Antiretroviral therapy (ART) has transformed HIV/AIDS disease in affluent communities from a death sentence to an issue of chronic disease management. The merits of ART include reducing stigma, promoting behavioral change, potentially directly reducing sexual HIV transmission, prevention of mother-to-chiid transmission and enhancing voluntary counseling and HIV testing (VCT). The vast majority of people living with HIV/AIDS in developing countries have not shared in the dramatically improved prognosis for HIV/AIDS offered by ART. Recent international support and commitment to make HIV treatment available to more people has led to expanded access to antiretroviral drugs in many countries. A major drawback in the introduction of ART in general in Ethiopia has been the lack of policy on ART use. However, in 2002, the Ministry of Health (MOH) issued a policy on supply and provision of antiretroviral drugs in Ethiopia. This policy emphasizes the government’s key role, not only in ART supply, but also in the coordination and facilitation of international collaborations to develop an ART program that is feasible and clinically appropriate for Ethiopia. In February 2003, MOH prepared a guideline for use of antiretroviral drugs in Ethiopia that has been updated at the end of 2005. Since then, training on ART has been given to more than 800 health care workers, comprising of clinicians, nurses, counselors, laboratory technicians and pharmacists. A total of 40 public and private hospitals have started prescribing ART. Moreover, as an initial step towards a National ART programme, the Ministry of Health is taking steps to establish a series of Regional HIV Reference Laboratories to monitor ART treatment on a countrywide scale. With an estimated 2.2 million adults infected with HIV by 2003, the number of HIV-infected persons that require ART has been estimated to be about 250,000. In Ethiopia, National antiretroviral treatment (ART) programme was launched in July 2003. Currently, an estimated 10,000 people living with HIV/AIDS (PLWHA) are receiving ART in several parts of the country. However, after January 24, 2005 when the National ART implementation plan was launched, the number of PLWHA accessing ART will substantially increase. The magnitude of the HIV AIDS epidemic in the major urban settings is somehow stabilizing or showing tendency towards reduction, but in rural settings it is increasing. Although much effort was put to overcome the problems encountered much still needs to be done to strengthen the past efforts, especially reducing the effects in the rural settings. It calls also for efforts of several other national, international and bilateral organizations working together.

1 Ethio-Netherlands AIDS Research Project, EHNR1, P.O. Box 1242, Addis Ababa, Ethiopia.

22 CLOSING REMARK ON THE CONFERENCE OF THE BIOLOGICAL SOCIETY OF ETHIOPIA

Zerihun Woldu (Prof.)1

Ladies and Gentlemen, When the organizing committee invited me to remark on this august conference of the Biological Society of Ethiopia two days ago, I did not hesitate for a minute to accept it since it breaks the old tradition of having a conference closed by dignitaries who are very engaged irr very urgent task of decision making and who often do not have the time to attend the conference and get the chance to highlight on the outcomes of the conference. I therefore feel very honored to be given this task. Let us reflect back on the last two days of this conference. I hope we will recall the many instances' where something that someone else said, some idea that was offered helped us to see something in a different light, helped us to see a different perspective, helped us to discover something new. What a gift we have given to each other in these instances! What a joy to be part of a team where through sharing our thoughts and ideas we can open up new awareness, new landscapes for others? What a joy listening with our hearts and minds to what others say to introduce us to new vistas and new understandings? I would like to thank everyone who contributed to this. It has truly been inspiring to be here and listen to all the experiences and viewpoints that have been raised from so many individuals, organizations and institutions. In our daily lives we often take the perspective of seeing how things fit into our past experience of the world. After all, we tend to make sense of the world by drawing inferences and conclusions from what we observe and categorize, even compartmentalize ideas. Conferences help us see situations with new eyes and examine our world from many different and new perspectives. The theme of the conference, Sustainable Livelihood was a very timely one. The Focus on HIV/AIDS was also the order of the day since the pandemic is claiming millions of lives at a rate of thousands a day and it is doing so in collaboration with many age old diseases which have not received similar attentions. Knowledge on the devastating HIV/AIDS has surely expanded. We are really impressed by the amount of knowledge amassed and we are also glad that we have acquired the state of the art techniques and equipment. We understand that much work has been undertaken on the HIV/AIDS in Ethiopia and around the globe and

1 Department of Biology, Faculty of Science, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia. ______

Ethiopian Institute of Agriculture Research Central LIBRARY eh/l-f-A-.p r u W K/itVi:>z ■ "Vcifw n,'f* fr,,? c ' v- '• HIV/AIDS and Associated Diseases Closing Remarks the risks and impacts are most serious. We acknowledge the outputs of these untiring researchers who have brought the secrets of HIV into light. When Institutions or individuals have conducted studies that address HIV and its interactions with other problems, they have tended to do it in isolation. But it is imperative that future work must extend beyond this in order to be better prepared for combative actions. The crucial next step -of using this knowledge to improve and scale up effective actions has yet to be taken. There are some important gaps pending to be addressed. It is now time to ask what is providing the fertile terrain both for the spread of the virus and for its damaging interactions with abject poverty and food and nutrition insecurity . There is therefore an urgent need to bring researchers and practitioners together to review what we have learnt, and what this means for future policy and programming against the coexistence HIV/AIDS and poverty. I would to lightly point that in order to come to grips with this new universe, and effectively fill these knowledge gaps, bridges need to be built between social scientists, epidemiologists, public health specialists, nutritionists and agricultural economists. Only in this way will the causes and consequences of HIV/AIDS be mapped, ultimately leading to more effective action. The prevalence of other old age diseases such malaria, which are claiming the ives of particularly the rural dwellers who are fully behind the agriculturally lead industrialization, at rate of comparably magnitude if not higher than HIV/AIDS also need similar attention. Environmental degradation and loss of biodiversity, which are in vicious circle with poverty and ultimately with food insecurity, also need attention. In short we need integrated and concerted actions to break the strong chains of poverty and pandemic, chronic, nutritional diseases, which are fettering us from attaining our long standing dreams of sustainable livelihoods. I believe that the outcome of our work in the laboratories and in the fields have resonated well beyond their premises and have rang high-sounding bells. But there is one thing we are not able to do at this time -we are not able to underpin goals with concrete measures. These concrete measures may include 1. Combating the HIV/AIDS-abject poverty nexus by 2010; 2. Working hard on the production of the long awaited vaccine and make it available by 2010; and 3. Obtain socio-cultural renovation.

As an individual I cannot formulate the vision and mission goals of the efforts against poverty and the related HIV/AIDS, but I have my dreams. Let me share with you my dream for the future!

24 Proceedings of a National Workshop (BSE, February 2005)

1. I dream that the vaccine will be available soon to those who are infected by the virus as well as those who are in the risk group as a result of their livelihoods or their behavioral maladjustments can be salvaged. This is only half of the victory. 2. I dream that we all discover what we must do to pull in the same direction to combat poverty I which is the root cause of HIV/AJDS and other diseases. That day Humanity will declare victory over this menace and all other menaces. 3. I dream that the expertise gained on HIV /AIDS, the strong army of personnel fighting HIV/AIDS will be deployed to some other activities and the research laboratories built will phase out to only surveillance centers like those in the smallpox research team. 4. I dream that the HIV/AIDS awareness clubs phase out to other cultural and nature clubs. 5. I dream that orphanages that are helping the heroic daughters and sons of HIV victims be converted into colleges and vocational schools.

Ladies and gentlemen, thank you all for being here,

Now I have to say the final word: - By the power vested on me by the Organizing Committee, I declare this Conference officially closed. All other interactions after this are off the record.

25 Sensitization and Mobilization on HIV/AIDS Pictures Proceedings of a National Workshop (BSE, February 200S)

CONFERENCE PROGRAMME XV‘h Annual Conference of The Biological Society of Ethiopia February 25-26,2005 Faculty of Science, Addis Ababa University

Friday, 25 February 2005 Plenary Sessions I Time (local) Opening Session (Hall B2/2) Presenter 8:30-9:00 AM Registration BSE Secretariat Program overview V/President, BSE 9:00-9:30 AM Welcoming address President, BSE Keynote Address Guest of Honor 9:30-10:00 AM Tea/Coffee Break Special Session (Hall B2/2): Bylaws of the BSE Chairperson: Prof. Shibru Tedla; >. Rapporteur: Ato Getachew Tadesse V/President, BSE Briefing on the need for revising the 10:00-10:15 AM Dr Tilahun bylaws of the BSE T/Himanot 10:15 AM-12:15 PM Discussion and ratification of the bylaws Members of BSE 12:15-12:30 PM Summarization of the bylaws 12:30-2:00 PM Lunch Break Workshop Session (Hall B2/2): HIV/AIDS and Associated Diseases Chairperson: Dr Yared Mekonnen Dr Tsehaynesh 2:00-2:20 PM HIV/AIDS and immunity Messele Dr Abraham Assefa 2:20-2:40 PM TB/HIV: Current research challenges Dr Zerihun Tadesse Opportunistic fungal infections in Dr Yimtubezinash 2:40-3:00 PM HIV/AIDS patients W/Amanuel Association of E. histolytica/E. dispar with CD4 count among HIV/AIDS 3:00-3:20 PM Ato Amha Kebede patients with complaints of diarrhoea from three hospitals in Addis Ababa HIV/AIDS and anti-retroviral therapy in 3:20-3:40 PM Dr Dawit Wolday Ethiopia 3:40-4:00 PM Tea/Coffee Break Discussion on HIV/AIDS and Associated 4:00-5:00 PM Diseases

27 HIV/AIDS and Associated Diseases

Saturday, 26 February 2005 Parallel Sessions Parallel Session I (Hall B2/2). Biomedical Sciences Time (local) Presenter Chairpersons: Prof. Mogessk* Ashenafi and Dr Dawit Abate Identification of Human Immunodeficiency Virus Type 1 (HIV-1) subtype C Gag-Specific 9:00-9:15 AM Aster Tsegaye T-Lymphocyte Responses in HIV infected Ethiopians An in-vitro nematocidal activity screening assay 9:15-9:30 AM Gessesse Assefa for herbal medicines using filiform larvae (L3) Khat chewing habit as possible risk behavior for 9:30-9:45 AM Dawit Abebe HIV infection: Case - control The pnncipal components of immunity to 9:45-10:00 AM Desta Kassa malaria Helicobacter pylori infection and lifestyle 10:00-10:15 AM among dyspeptic patients attending Gondar Feleke Moges University Hospital, Northwest Ethiopia The prevalence of intestinal helminthes among 10:15-10:30 AM Gessesse Assefa diarrhea patients 10:30-10:45 AM Tea/Coffee Break

Parallel Session II (Hall B3/2): Fisheries/Aquatic Sciences ' Zoology Time (local) Presenter Chairpersons; Dr Demeke Kifle / Dr Seyoum Mengistou Riverine fishery survey on Shinfa and 9:00-9:15 AM Gendawuha Rivers in Metema woreda, North Teferi Mekonen Gondar Zone Feeding ecology and reproductive features of 9:15-9:30 AM the African catfish (Clarias gariepinus) in the Belay Abdissa northern part of Lake Tana Macrophyte communities and associated fish 9:30-9:45 AM fauna and zooplankton in the southern part of Alemu Assefa Lake Tana, Ethiopia Preliminary study of cestode and nematode 9:45-10:00 AM parasites of fish on the northern part of Lake Seid Muhammed Tana The study of fish fauna in the dams of Belessa 10:00-10:15 AM Teferi Mekonen woreda, North Gondar Activity patterns of Bohor reedbuck (Redunca Bezawork redunca) in Gaysay-Adelay area of Bale 10:15-10:30 AM Afework Mountains National Park. Ethiopia 10:30-10:45 AM Discussion 10:45-11:00 AM Tea/Coffee Break

28 Proceedings of a National Workshop (BSE, February 20Q5)~

Saturday, 26 February 2005 Parallel Sessions (continued) Parallel Session I (Hall B2/2): Time (local) Biomedical Sciences Presenter Chairptrson: Dr Fassil Assefa Accelerated age-related T cell decline in 10:45-11:00 AM Aster Tsegaye healthy HIV-1 non infected Ethiopians Enterocytozoon bieneusi and Encephalitozoan intestinalis in diarrhoeal patients infected with Tekola 11:00-11:15 AM the Human Immunodeficiency Virus- 1 in Endeshaw Addis Ababa, Ethiopia Preliminary studies on immunopathogenesis of Schistosoma mansoni in Grivet monkeys Workineh 11:15-11:30 AM (Cercopithecus aethiops) vaccinated with 20 Torben Krad Irradiated S. mansoni cercariae Hygine practices associated with intestinal 11:30-1 1-45 AM parasitic infections in under five years old Gessesse Assefa children Antibiotic susceptibility of diarrhea causing 11:45 AM-12:00 bacteria, and the bacteriological quality of Aberra Geyid PM water used for drinking in selected weredas of Ethiopia Efforts of traditional medicine practitioners in Kenya to improve the delivery of traditional 12:00-12:15 PM Meshak Malo medicine in the management and prevention of HIV/AIDS 12:15-12:30 PM Discussion 12:30-1:30 PM Lunch Break Parallel Session I (Hall B2/2): Time (local) Botany Presenter Chairperson: Dr Ensermu Kelbessa Genetic variation in Moringa stenoptela 1:30-1:45 PM germplasm of Ethiopia by using RAPD as Dereje Beyene genetic marker Plant species diversity and environmental Getachew 1:45-2:00 PM factors on vegetation along Kombolcha-Mille Tadesse escarpment in Wello, Ethiopia Ethnobotanical study of wild edible plants in 2:00-2:15 PM Kebu Balemie Derashe and Kucha districts, South Ethiopia 2:15-2:30 PM Discussion

29 HIV/AIDS and Associated Diseases

Saturday, 26 February 2005 Parallel Sessions (continued) Parallel Session II (Hall B3/2): Time (local) Agriculture/Ecology Presenter Chairperson: Dr Teshoine Sormessa Trophic analysis of Lake Awassa using mass- 11:00-11:15 AM Tadesse Fetahi balance Ecopath model The role of coffee shade trees and exotic plant Abiyot 11:15-11:30 AM and rehabilitation of degraded hill slope, Berhanu S/Ethiopia Effects of maize and sorghum cropping systems 11:30-11-45 AM Emana Getu on stemborers and their parasitoids in Ethiopia Integrated Weed Management (IWM) weed 11:45 AM-12:00 PM Girefe Sahile control option in maize (Zea mays) Maize/cowpea under variable densities, 12:00-12:15 PM arrangements and fertilizer rates m semiarid Girma Abebe areas of Ethiopia Diversity, regeneration status and socio Haileab 12:15-12:30 PM economic importance of the vegetation in Zegeye islands of Lake Zeway 12:30-1:30 PM Lunch Break Melaku 1:30-1:45 PM Disposal age and culling in Holstein-Friesians Negash The Role of wild edible plants in food security: Tigist 1:45-2:00 PM A case study in Arsi lowlands, southeastern Wondimu Ethiopia Influence of N fertilization on reduction 2:00-2:15 PM Girefe Sahile parasitism of Orobanche spp in Tomato Invasive alien plant species in Ethiopia: Takele 2:15-2:30 PM Introduction, problems and management Negewo strategy 2:30-3:00 PM Discussion

Plenary Sessions II HIV/AIDS and Women Session (Hall B2/2): Time (local) “Sensitized Girls = Healthy Generation” Presenter Chairperson: Dr Yalemtsehay Mekonnen 2:30-2:50 PM Overview on “Sensitized Girls = Healthy Generation” President, workshops BSE 2:50-3:30 PM Discussion on “Sensitized Girls = Healthy Generation” 3:30-3:40 PM Closing remarks Prof Zerihun ‘ Woldu Extra-Sessions Coordinator: Ato Mulu Bitew 3:45-5:00 PM Visit to an HIV/AIDS orphans Center in Addis Ababa 6:00-8:00 PM Dinner reception

30 PART - 2

SENSITIZED GIRLS = HEALTHY GENERATION

Sensitization and Mobilization Workshops on HIV/AIDS for College Girls in Addis Ababa

The Biological Society of Ethiopia

Phase - I: Addis Ababa University and Kotebe College of Teachers’ Education November 06, 2004 Faculty of Science, Addis Ababa University

Phase - II: Awoliya College, Central Health College, Queens College and Unity University College July 16, 2005 Awoliya College

Addis Ababa Sensitization and Mobilization on HIV/AIDS Pictures EPIDEMIOLOGY OF HIV INFECTION IN ETHIOPIA

Amha Kebede (PhD)1

The human Immunodeficiency virus (HIV) is an RNA virus first discovered in humans in 1983. It causes a damaging effect on the central immune system by selectively killing the T-lymphocytes, monocyte/macrophages, dendritic, langerhan and microglial cells to which it comes upon by binding to a 55kd surface glycoprotein, CD4-molecule and chemokine coreceptors CCR5 and CXCR4. The Structural and genetic composition of HIV consists of an envelope that carries two identical RNA strands. The envelope contains an external and transmembrane proteins termed Gp-120 and Gp-41, respectively. The inner part of the viral membrane is surrounded by p i7 core protein. Inside the envelope is a cone shaped core composed of p24 capsid protein. The capsid besides RNA strands contains protease, integrase and polymerase enzymes. The major characteristic of HIV is its extremely high genetic variability, which is a combined effect of the high recombination and error rate of the reverse transcriptase enzymes and the high replication rate of the virus in vivo. It is responsible for the accumulation of variants during infections. There are two types of the virus: HIV-I and HIV-II. The HIV-I, first described by Barre-Sinoussi et al., (1983), is responsible for the global epidemic while the later described by Clavel et al., (1985), is limited in prevalence (1-15%) and distribution to West African countries. There are three genetically distinct groups of HIV-I: groups M (majority), O (outlier), and N (non-M/O). M-is responsible for the global HIV-I epidemic. Group-0 is represented by a few strains and is localized to Cameroon, Gabon and Equatorial Guinea; Group-N is represented by a few strains in Cameroon. The M-group comprises of at least ten genetic sub types or clades designated A through J, which differ from each other by 30% in the env coding sequences and by 14% in their gag coding sequences. Although there is no country free of the virus, infection is growing most rapidly in the developing countries of South East Asia, Indian subcontinent and sub-Saharan Africa. Each day about 14,000 new infections are believed to occur around the world. Of these, more than 95% are in developing countries. Roughly 14% are children under 15 years of age and the rest are persons of 15-49 years of age. Women constitute 50% of the adult group and 50% of them are between 15-24 years old. sub-Saharan Africa is the hardest hit the epidemic. The prevalence grew from less than 1% in 1984 to 36% in 1999, which is more than 70% of all HIV cases.

1 Ethiopian Nutrition Research and Health Institute (ENRHI), P.O. Box 1242, Addis Ababa, Ethiopia. Sensitized Girls = Healthy Generation Amha Kebede

In Ethiopia, the HIV/AIDS epidemic started relatively late. The first positive sera was discovered in 1984 and the first AIDS case in 1986 However, it grew to infect 74% of commercial sex workers, 14-20% urban pregnant women and 7% of blood donors by the year 2001. Analysis of results of studies in Addis Ababa in 1994 showed a significantly higher prevalence rate among females of age groups 25-39 than males. Similar study on sex workers, showed a prevalence range of 63.8-85.3%. Again the highest infection rate was in age groups 25-29 Those prostitutes bom outside Addis Ababa were relatively more (80.”7%) affected than those from Addis Ababa. Condom utility was in general poor. Studies on police recruits from Addis Ababa revealed that females start sex earlier than males but by the age of 24-25 '.he percentage of infection in both sexes equates to 9.4%. Another study conducted on military recruits from all over Ethiopia and thus was considered to represent the prevalence of the country, showed much higher prevalence of the disease among the urban (7.2%) than rural dwellers. Comparison by administrative regions showed similar picture between urban and rural recruits in all regions. The distinction between them was in the following order: Amhara (10.5%), Addis Ababa (“’.9%), Oromia (6.5%), Tigray (5.3%) and Southern Nation and Nationalities (4.3%). A projection made in 2003 National HIV prevalence expects a slight decrease in 13 to 12.6% urban areas but an increase from 1.9% to 3.4% in rural areas. Considering the fact that over 85% of the people live in rural Ethiopia, the picture suggests extensive spread of the pandemic in the country. The impacts of AIDS are many and touch literary all sects of the society.

A griculture H ealth . . Children

Labour Force * AIDS - W omen

Economic ‘ \ Family Development , Education Security

Different studies have shown that it depends on the physical, mental and the stage Of infection. For approximately 50% of infected persons, the time between viral exposure infected and the appearance of opportunistic infections that characterize AIDS is more than 10 years. It is also much dependent on the time one discovered Proceedings of Workshops on HIV/AIDS and College Girls in Addis Ababa (BSE, 2004/05) that he/she is infected, the psychological support available and the access to good medical care. Taking into account the number of days lost in illness, sick leaves, visit and costs of clinical /hospitals services, the negative economic impacts of HIV on firms is projected to be 8.3% while productivity is expected to fall by up to 50%. HIV is transmitted primarily through sexual intercourse, but also by direct transfusion of infected blood and from an infected woman to her fetus or infant before, during or shortly after birth. The risk of becoming infected through unprotected sexual intercourse depends on four main factors: ■ the likelihood that the sexual partner is infected, ■ the types of sex act that bring sexual secretions into direct contact with mucous membrane lining the rectum, vagina, urethra and mouth, ■ the amount of virus present in blood, semen, vaginal or cervical, and ■ the presence of other sexually transmitted diseases or genital lesions in either partner. In order to prevent HIV infection the following factors influencing the risk of infection should be carefully thought about: ■ the type of partner one chooses should not be a person who has an unknown sexual history to the partner, * the number of sex partners, ■ the sexual behavior one practices-all forms of penetrative sexual intercourse carry a risk, although the risk minimizes when a condom is used, ■ the presence of other sexually transmitted diseases is known to increase the risk of acquiring and transmitting HIV, and ■ if one is not sure about these factors, it is important that one goes for voluntary testing.

SUMMARY AND CONCLUSION

Although there are many claims, curative therapy is not yet possible. The preventive measures based on voluntary counseling and testing have resulted in promising results. The follow up data on sexual behavior and reported sexually transmitted diseases among anti-natal clinic attending women and others in Addis Ababa and Ethiopia have shown a tendency to decline in almost all age groups following the above strategy. However, the most desired strategy of developing vaccine has become a challenge to modem science. The scientific challenges include the variability in the virus,

33 Sensitized Girls « Healthy Generation Amha Kebede lack of immune correlates of protection and limitation of animal models. The logistic challenges are the fact that the study is done in advanced laboratories that want to do clinical trials on humans in developing countries. This has arisen in many cases an ethical issue. Last but not least is the financial challenge. Those that have the money are less interested to invest on third world problems with little future markets. Those that suffer most from the disease cannot afford to spare enough money to develop the science around their problems. THE YOUTH AND ANTI-AIDS MOVEMENTS IN ADDIS ABABA UNIVERSITY

Mehari Getaneh1

INTRODUCTION

Youth are among the highly HIV-infected people in the world. According to United Nations programme on HIV/AIDS (UNAIDS) 2004 report, they account for nearly half of the new HIV infections worldwide. In Ethiopia, the highest prevalence (12.1%) is in the age groups between 15-24 years, followed by adults (6.6%) (AIDS in Ethiopia, 2002). The factors are many and complex. For example, despite better access to education, HIV/AIDS information and reproductive health services, HIV is almost always more prevalent in urban than rural areas. To understand the role of each factor and sum up its effects on a community, requires a cautious interpretation. In females the situation is much worse than in males. The reasons, among others, are lack of information and knowledge., biological factors, gender and cultural norms. Globally, an estimated 7.3 million young women are living with HIV/AIDS much higher compared to 4.5 million young men (UNFPA, 2003). In Sub-Saharan Africa two-thirds of newly infected youth, aged 15-19, are females. Looking to the high-risk age range and evidences from case studies, African universities are labeled as one of the high-risk institutions in terms of HIV. "Sugar- daddy" practices, sexual experimentation, prostitution on campus, unprotected casual sex, gender violence, having multiple partners, and similar high-risk activities are all practiced in all, to a greater or lesser degree. The life style and culture in universities in the context of HIV/AIDS today affirms more risk than safety. Addis Ababa University students are not much different from universities in other African countries. The other source of problem is the fact that most students are brought up in a traditional families that hardly understand, appreciate and give due recognition to the questions of youth in matters related to sex. Thus, lack of proper information, knowledge and skill, on how to protect themselves from HIV/AIDS is a common problem. Addis Ababa University students come from communities of this background. Most of the girls are teenagers and have limited knowledge about their reproductive health in general and HIV risk in particular, and therefore, are easily influenced by peers to enter into unprotected sexual practices. In recognition of the above problems, the Addis Ababa University has signed an agreement for collaboration with African AIDS Initiative International with the aim

1 African AIDS Initiative International Addis Ababa, Ethiopia. Sensitized Girls = Healthy Generation Mehari Getaneh of curbing the spread of HIV/AIDS and mitigating its impact. Based on the agreement, African AIDS Initiative International (AAII) has moved its office to the main campus of the university and has started to coordinate and initiate the involvement of all communities of the university (faculties, administration, student unions, student anti-AIDS movements, other academic staff, etc.). Currently, mainstreaming HIV/AIDS in the curricula of the university, establishing and strengthening anti-AIDS clubs, provision of care and support services, sensitization and education, establishing networks as well as providing voluntary counseling and testing (VCT) services are set as the major tasks to be accomplished in the near future. Despite a number of AIDS education projects, there is still widespread ignorance about the transmission, treatment and prevention of HIV among the student populations. The required level of behavioral change is not yet achieved. Thus, more effort is required to coordinate and bring all members to participate in prevention efforts. To this end, peers trained and organized in all convenient options are recommendable. This presentation intended to give highlights on importance and experiences of anti-.AIDS movements and girls’ clubs of Addis Ababa University and document the achievements so far and what remains to be done in order to break this pandemic and come out victorious.

AAU STUDENTS AND THE HIV/AIDS RISK

Addis Ababa University (AAU) is the first higher institution in Ethiopia. It consists of a college, seven faculties, five schools and four research institutes. The University resides a total of about 14,000 regular students (of which 15% are females) and 10,500 evening students (of which 27.4% are females). Compared to other universities in the country it is believed to be at more risk. To start with, it is located in the capital city where prevalence is the highest and more important in the center of the city surrounded by nightclubs, bars and hotels that are tempting to students. Added to these is the fact that it is composed of young people with diverse cultural, socio-economic and expenence on sex and sexuality. These could partly explain the high risk of exposure of the students to HIV infection. Preventing the university students from HIV infection and enabling them to be academically successful, besides availing care and support services for those infected, demands a continuous effort in educating the community. Creating opportunities where they can meet and discuss with their peers on HIV/AIDS, reproductive health and other related issue requires making educational materials accessible, creating opportunities in which they develop their life skills and share their experience with their peers, other professionals and the international community. To accomplish these, students need to organize themselves at different levels. This is a fact that justifies the organization of girls as an entity and as part of the anti-AIDS clubs and students’ movement in AAU.

36 Proceedings of Workshops on HIV/AIDS and College Girls in Addis Ababa (BSE, 2004/05)

ANTI-AIDS CLUBS (AACS) AND ANTI-AIDS MOVEMENTS (AAMS)

Importance It has time and again been shown that a university is a place where the future manpower is bred. Abandoning this population would mean a huge loss? to the country. It is realization of these facts that an endeavour has been made to establish as many new AACs/AAMs as possible and strengthen and upgrade them to union or association level. At all levels the organizations are expected to deal with those who have the risk or are already victims of HIV/AIDS infection, sexually transmitted diseases (STDs), unwanted pregnancy and other social and health problems. In this effort, establishing and strengthening anti-AIDS clubs and movements for girls is a priority.

Structure AAU-AAMs are organized in 10 faculties under the student guidance and counseling office with no clear working documents and structural relationship between the movements and the office. The office is supposed to play a supportive role and leadership. Every Anti-ADDS Movement has its own structure as a separate entity. Very recently, the movements of AAU have formed a coordinating and facilitating body from the AAMs. The union has now started a horizontal relationship with clubs and movements of other national universities. By virtue of its relative location and experience, the Addis Ababa University Union is privileged to play an active role in bringing together the activities of clubs and movements in the other universities.

Activities The clubs at AAU are actively involved in many programs. Some of the activities they have accomplished could be listed as:

• Organize and conduct welcome programs and orientation to fresh students; * Disseminate information on HIV/AIDS, reproductive health (RH) and related issues; ■ Arrange and facilitate social services and support to the students in and outside campuses, other community of the society like teaching AIDS orphans, assist stick PLWHAS, participate in tree planting, etc.; ■ Organize trainings and workshops on peer education; ■ Participate in training programs and workshops on peer education and club management; ■ Organize panel discussions on HIV/AIDS issues;

37 Sensitized Giris = Healthy Generation Mehari Getaneh

■ Invite prominent figures in life and professional experiences to motivate people for better achievements in life; ■ Organize and conduct gender and dormitory based coffee ceremony programs /discussions; ■ Arrange provision of counseling services and support to students living with the virus; ■ Organize different educational and entertainment program for students and discuss the HIV/AIDS problem; ■ Create conducive environment for behavioral change; and ■ Undertake some community mobilization on HIV/AIDS out of the university compound.

RECOMMENDATIONS

Since AACs/AAMs are not traditional institutions, capacity building in the area of club management and HIV/AIDS including other* reproductive health issues/facilitation of training programs should be their areas of focus. Even though clubs/movements have many problems, they have tried their best and could come up to organizing themselves to a union level. The movements in the different campuses have formed one coordinating body at the university level named ‘Anti- AIDS Movements Union of Addis Ababa University.’ This union is composed of anti-AIDS movement of main campus, Science Faculty, Faculty of Business and Economics (FBE), Yared School, School of Fine Arts, Paulos School of Nursing and Midwife, School of Techno-farm, Faculty of Veterinary Medicine, School of Medical Laboratory Faculty of Technology (both North and South Campuses). The union is expected to be in charge of coordinating the anti-AIDS movements and to accomplish their respective objectives at the university level. In its first assignment of universities’ meeting held recently, this union has got the chance to coordinate and facilitate the clubs/movements of the eight national universities (Mekele, Bahir Dar, Gondar, Alemaya, Arbaminch, Jimma, Addis Ababa and South Universities). However, to realize its objective, the following need to be fulfilled: ■ Securing work places/offices to AAMs/AACS and furnishing and equiping them with the necessary supplies for their activities; ■ Upgrading and revising management guidelines of clubs/movements with special focuses on peer training manuals; ■ Establishing permanent offices a full-time staff at least at the union level; ■ Organizing trainings and workshops for core facilitators, peer educators, club leaders, counselors;

38 Proceedings of Workshops on HIV/AIDS and College Girls in Addis Ababa (BSE, 2004/05)

■ Designing and implementing different life skill training and other programs to clubs/movement; and their members; ■ Assisting in creating vacation/part time job opportunities for their members; ■ Assist students to experience the possible challenges the are likely to meet after graduation before hand; ■ Establishing parallel movements among the academic and administrative staff to integrate with and incorporate in the overall HIV/AIDS prevention and control efforts of the university; and ■ Organize and strengthen work place peer education for the staff members. Students’ clubs and movement have to be strengthened and supported financially, technically and managerially to accomplish their duties and responsibilities for appropriate, participatory and sustainable HIV/AIDS intervention programs. More specifically, the establishment of anti-AIDS clubs of girls will be among the priority areas for addressing the problem more strongly and strategically. Because such clubs will enable to approach the problem using their school age and gender peers as well as to overcome the social and cultural bottlenecks of bringing the required behavioral changes. This will also enable to equip students with adequate knowledge and skill both in club management and reproductive health, including HIV/AIDS. Service (VCT/RH) centers that can provide care and support service to PLHWA; free or subsidized referral services for those who seek care and support services; IEC/BCC materials on HIV/AIDS and RH; male and female condoms; female counselor for girls students and contraceptives should be made available at every convenient places/centers. Gender based resources and training centers including computer network and internet services are needed for both sexes to easily share RH and HIV/AIDS information and education. Establishing girls’ club is necessary for peer education and to disseminate RH and HIV/AIDS information among the girl students. The club members can also be used to distribute condoms and contraceptives to their peers when there is need. Trained girls will also serve as informal counselors of their peers. These clubs by working closely with their corresponding male peers or with Anti-AIDS clubs of respective campuses can easily and friendly channel information, brochures, leaflets and other materials (including male and female condoms and contraceptives) to students. Opportunity to develop their life skills and knowledge on RH, HIV/AIDS, or other relevant areas will be more fertile and easy.

39 Sensitized Girls » Healthy Generation Mehari Getaneh

Baseline study on the knowledge, attitude and practice of students on HIV/AIDS and RH and to identify specific needs and available resource/potentials are necessary for the communities of the university and others. Periodic KAP study to assess what results have been achieved so far and to assess the contributions of all efforts is also recommendable. Regular meetings including organizing panel discussions on every development of RH/HIV efforts are very important to timely identify the strengths and weaknesses as well as to recommend better ways for the challenges ahead.

REFERENCES

Family Health International (FHI)-Ethiopia and Addis Ababa City Administration Health Bureau (2002). Addis Ababa HIV Care and Support Services Assessment, Addis Ababa. Firdissa Jebessa Aga (2004). Higher Institution Response to The Challenges of HIV/AIDS, Institute of Educational Institute, Addis Ababa University (Unpublished). Getachew Dibaba (2002). Integrated Approach to Fight HIV/AIDS-The Gurage Experience, Walta Information Center. MOH (2002). AIDS in Ethiopia, Addis Ababa. MOH and HAPCO, HIV/AIDS Policies and Strategies in Ethiopia. Deferent unpublished works of AAII and UNFPA. UNAIDS (2000) Report on Global HIV/AIDS Epidemics, Geneva, UN AIDS. UNAIDS (2000, 2001,2002). AIDS Epidemic Update, Geneva, UNAIDS. UNAIDS/UNFPA/WHO (2002). Young People and HIV/AIDS Opportunity in Crisis.

40 REQUIRED SERVICES AND FACILITIES FOR HIV/AIDS PREVENTION AND CONTROL AT COLLEGE CAMPUSES

Semira Afendi (S/r)1

INTRODUCTION

HIV/AIDS has become the biggest threat to humanity and development over the last decades. Ethiopia is one of the countries that are most affected by the epidemic. It has a national adult prevalence of 4.4%, of which 12.6% is in urban and 2.6% is in rural areas. The most affected population is the youth between the ages of 15-29 years. The Addis Ababa University at present has a total of about 14000 students of which 2880 are girls. All fall within the high-risk age range of 18-25 years. The girls at the campuses, as is the case in the society, are more susceptible and vulnerable to attack of HIV/AIDS. The reasons among others are lack of adequate information on sexuality, negotiation power on friendship and sexual relationship and shortage of HIV/AIDS related services and facilities around them. Although these precarious campus situations call for a great deal of effort, the only one in place to date is that of anti-AIDS club, and its role on sensitization against HIV/AIDS has been trifle. It is, therefore, the aim of this presentation, to look into the types of services and facilities available at the university right now and make a recommendation on measures required for successful prevention and control of HIV spread, but more among university campus girls.

EXISTING STATUS

In this paper, 'services and facilities' are understood to mean any information education and communication (IE) on HIV/AIDS activities that could protect HIV/AIDS.These include: condom promotion, guidance and counseling, sex education, voluntary counseling and testing (VCT), care, support and treatment for sexually transmitted diseases and opportunistic infections in general and retroviruses in particular. The present status of these services and facilities in all the seven university campuses is more or less the same. They all do not have anything especially meant for girls, like girls club, sex education, female condom, etc. There are anti AIDS clubs that deal with problems of boys and girls alike. The guiding and counseling services at each campus still follow the traditional counseling role on sexually transmitted diseases. They hardly consider the newly emerging social issues such as gender, HIV/AIDS, anti-retroviral treatment (ART)

1 Students Clinic AAU, Ethiopia. Sensitized Girls = Healthy Generation Semira Afendi and associated opportunistic infections. Sex education is a critical gap in the whole education system but it is more felt at higher education institutes. Although not directly focused on girls and of a level that brings the control of? diseases, fair attempts have been made to deliver IEC materials through Anti-AIDS clubs, Non Governmental Organizations and the University clinics. VCT service is newly initiated in partnership with Africa AIDS Initiative as of the 2004/05 academic year. Male condom has been readily accessible, whereas no female condom is as yet available for the giris. Treatment to sexually transmitted diseases is provided, however it was only started at the wake of HIV/AIDS.Tubeculosis (TB) service is provided whether it is due to HIV/AIDS or not. However, there is no Anti-Retro Viral treatment to students who declare their sero positive status. CONCLUSION AND RECOMMENDATION

In general the service and facilities in all the university campuses are at their infantile stages. There are however initiatives that express their growing concern on HIV/AIDS and the need for prevention and control. Looking upon the susceptibility and vulnerability of girls in the campus, it can be said that there is a serious need of establishing facility and services especially meant for girls. Hence, the questions that should be posed today are “What should be done? How to go about it?” To this end, the writer makes the following recommendations: ■ Initiate and support girls’ clubs at different levels within the campuses and then network all campus girls’ mobilizations; ■ Provide sex education for the youth. In particular, girl students in campuses have to be initiated as soon as possible; ■ Provide guidance and counseling services to meet the special needs of girl students; ■ Expand HIV/AIDS prevention, care and support programs including VCT and make them available at all campuses: ■ Establish linkage and partnership with government and non-government organizations to access support on prevention, care, treatment, and ■ Advocate for university leadership commitment to take the recommendations forwarded.

42 HIV/AIDS AND GENDER PROBLEMS OF FEMALE STUDENTS IN ADDIS ABABA UNIVERSITY

Addishiwot Girma

Most of us who had an opportunity to enter primary school and were able to make it to high school always dreamt of joining the universities. Unfortunately, this dream comes to be a reality only for a few. What is even more sad is that, it is only a very small percentage of these lucky students that are females. The university is a new environment for new coming students where many come across experiences they never had encountered before. These include being away from a caring family that directly or indirectly had a great role in their daily activities which leaves them with a big responsibility of taking care of themselves and making decision for themselves. It is also obvious that the way one is brought up has a marked impact on her/his present life style. How to lead a problem-free life is contingent on how we perceive our new environment and the way we react to it. Many students are inexperienced. They face lots of problems but only a few have the courage to confront let alone being able to solve their worries by themselves. The problems stated above are also problems of boys but for many more reasons the problems get harder on female students. Of the many obstacles that hinder female students from achieving their goals, some are mentioned below: ■ Cultural norms of our society have their own influence on every one of us. Specially at times when we have to say “NO” about something we do not believe in. Female students being brought up under strict instruction of the society have a problem of refusing activities they are not willing to do. The following few statements can witness this: ■ Even if they have no intention or plan for it, some girl students accompany guys, who are over with their required daily activity for coffee or tea. ■ Some female students are unable to come up with a right away refusal for sexual requests; they would rather give excuses that can only last for the time being. This fills the boys with hope that one day she will accept, hence, they keep on nagging. ■ Many female students undermine themselves and those of the same sex but give high credit to their boy classmates. Therefore, they directly or indirectly lean on boys for any help especially those of academic matters. This creates an opportunity for the bad boys to accomplish their missions.

1 Student at the Faculty of Science, AAU, PO Box 1176, Addis Ababa. Sensitized Girls = Healthy Generation Addishiwot Girma

■ Peer-pressure from the so-called “civilized" classmates has a great impact on female students. This mostly affects those girls from the countryside or from hard pressing families. For some female students, having the eyes of the opposite sex on them and being appreciated for their body have a tremendous value. Giving up their dignity, they do whatever it takes them to be what is not of any meaning to their lives. Once these kinds of girls have acceptance oy the boys, they attract and invite other female students to go out with the boys. According to the “civilized girls” a girl who has never experienced sex is very much backward. Anybody who wants to be a friend to these people is expected to be “civilized” in their context. All in all, what have been mentioned above can be generalized as lack of assertiveness. Assertiveness is neither being aggressive nor being passive. Rather it is knowing one’s rights and obligations and living by them. Most females lack assertiveness. It may be because of the way they are brought up in the society. But as the saying “every cloud has silver lining”, this assertive behavior can be revived through training and discussion with follow-ups. ■ Some of the university compounds are situated in areas that facilitate the high prevalence of the HIV/AIDS pandemic. Science Faculty, where many prostitutes are settled in its vicinity is a good example. These areas are visited by some boy students for reasons like relief of tension and the like. Boys who have the tendency to go to these places are most likely those who bother female students for sexual intercourse, and the consequence here is obvious. ■ Forcible attacks that females in tertiary level education face have multi directions. Physical attack like rape is not only by male students, but also any one of the male members of the university community. Some evidences that can support this are: ■ a rape report at science faculty in Semester II of the year 1994 E .C by an unknown person; ■ a rape attempt in the same faculty in one of the chemistry laboratory by one of the faculty guards in the year 1996 E.C Unavailability of counseling service in each compound is another problem that somehow enhances the prevalence of the pandemic. The only counseling and guidance service the University provides is located at the main campus and this is not convenient for students, who race against time. In general a lot can be said about problems female students at tertiary level of education face. This paper is only a modest attempt to bring the highlights of the problem to the attention of the participants. The writer hopes a lot more can be dug out of today’s participants.

44 HIV/AIDS AND REPRODUCTIVE HEALTH ISSUES AMONG ETHIOPIAN YOUTH

Tesfanesh Belay1

HIV/AIDS is a large and growing health problem of developing countries. Around the world, 42 million people, 95% of which are in developing countries, are currently infected with the virus. Sub-Saharan Africa with 29.2 million infected people bears the brunt of the epidemics. Each day another 14,000 people including 5,000 women and 2,200 children become infected. Women and young people are vulnerable to HIV AIDS. Young people between ages 15-24 account for half of all new infections. According to UNICEF estimate, nearly 700,000 infants are bom with HIV from infected pregnant mothers. Other sexually transmitted infections besides their role in HIV spread are major problems in their own right. An estimated 20 million of Ethiopia’s 71 million are 15-29 years of age, and therefore, highly vulnerable population. In view of these challenges Ethiopian youth faces today, this presentation attempts to introduce the concept of reproductive health and its contribution to the understanding and prevention of HIV spread. Reproductive health is a relatively new field that has evolved in developing countries partly following the high incidence of HIV infection and untimed / unwanted pregnancies. It has now grown to include sexual initiation, sexual exercise, contraceptive use, family planning, birth experience, fertility, sexually transmitted infections and other associated adolescent problems. Over the last decade, it has increasingly attracted and focused public health researches to adolescents' sexual life and successfully generated a vast knowledge in the area. However, all had their limitations. One of the limitations with the researches and programs so far made is that they tend to homogenize the adolescent population into one genderless mass with little regard to age and social context. It is clear that adolescent boys and girls experience rapid, intense and gender based changes; however the changes and needs experienced by 12 years old girls are considerably different from that of 18 years old boys, not to mention the differing nature of their relationships with their families, cultures and societies. Yet, a few studies acknowledge these differences. Most programs implicitly assume that young people have complete autonomy and control over what happens to them and that socio-cultural realities do not factor in. This has a great implication in design and contenting of programs that are appropriately targeted to young people. So far, programs have centered on small set of intervention model like youth centers, peer education and youth friendly services without due attention to the in-built assumption surrounding these models. For example, peer education is a very popular program model that bases itself on the assumption that all young people

1 Ministry of Health, Addis Ababa, Ethiopia. Sensitized Girls = Healthy Generation Tesfanesh Belay

have peers but studies show that many of the people, especially girls, have no friends which means that they cannot be reached by peer education. Youth centers assume that young people have the time to visit a center that they feel safe enough to travel there and feel comfortable in a mixed sex environment that is often dominated by older boys. In fact all the three conditions are not met for the majority of girls, especially in poor and or traditional setting. It is only a limited number of individuals that could benefit from both types of setups. Many of the popular program models were designed in western setting and based on the lives of young people in those settings. Surprisingly little program development has taken place on indigenous system or on local understanding of adolescents. It is only a few programs that have benefited from a period of formative research, exploration and experimentation. The data generated from the few health researches in the country are presented here to serve as a ground for discussion and show the essence of reproductive health explaining disease incidence and control. Ethiopia is said to have a population of 20 million people between 15-29 years. The mean marriage age, 15.6, lies within this range. In urban centers the average age for first sexual intercourse is 16.1 and 16.8 for males and females, respectively. The situation in rural areas is even worse. The most extreme form of child marriage is practiced. Existing data in Amhara region show that 28% of those married had their marriage before the age of 10, 33% between 13-15 and 12 % after 15 years of age. This means that 51% of girls in adolescence marry below the age of 13 before they see their first menstruation. One study that considered 87% of the married women showed that, 71% were married before their first menses while 16% at the year they started menstruating. The vast majority of these women did not know they were about to be married and did not want to be engaged. Even those that married after the age of 15 did not know about the impending marriage and less than half wanted to marry or consented to it. A study on adolescent life meant to plan the future development programs based on the real life conditions of the young in low income and slum areas of Addis Ababa, demonstrated that young males and females are fairly knowledgeable on many concepts of reproductive health and HIV/AIDS. The vast majority knew that there is no cure for HIV, a healthy looking person can have AIDS and high HIV prevalence is not-confined to the cities and that it is neither confined to economically active migrant youth from rural areas and can be found anywhere conditions are favorable. Their worries were that they have limited access to education, means of earning their livelihoods and safety. Yet, few programs acknowledge these links between social and economic factors and the outcomes of RH, especially for girls. New population in countries like Ethiopia with extremely high HIV prevalence, poverty, traditional norms that encourage practices such as early marriage, rape and abduction, the likelihood to fall in any one of the situations is high. That is a considerable number of girls are likely to be coerced into sex against their will; or forced to marry at a young age, without their sexual initiation which is an act of rape. When one is rendered helpless with no other

46 Proceedings of Workshops on HIV/AIDS and College Girls in Addis Ababa (BSE, 2004/05)

means to support self, one will no doubt be tempted to do anything. Many girls in the poorest areas of Addis Ababa under such conditions are left with no other option other than to sell sex for money. Any form of marriage engagement, promise or betroth, all disrupts the girls' education, primarily because they are done at early ages when students are supposed to be in schools. Fourteen percent are married before they are 10 years, 53% before 15 and 80 % before 18 years of age. The percentage of girls who have not been to schools is much higher in married (83%) compared to unmarried ones (35 %). The main reason for non-attendance of school among the married women is the marriage (59%), followed by parents’ failure to support their education (25%). In contrast, the later accounts for 54% of the unmarried girls. All married girls would have liked to go to school had it not been that they were married. They realize that education gives access for a better life. Studies on adolescent sexual activities, contrary to the above have shown another reality, a finding consistent with other similar studies. Ninety-nine percent of sexually active adolescent girls were married and all but 2% had their first sex with their husband and fiance. Among boys only 22% had sexual experience and only 86% had the first sex within marriage suggesting that even within rural population marriage could drive the timing of first sex. Looking to the preceding information, it is clear that there is a need to give focus to the young people in matters of health and economic support. When young peoples’ right to development are met, they are less likely to have their health undermined by problems such as HIV/AIDS, drug and alcohol abuse and violence. Reproductive health as an approach underscores that the care has to start right from conception and continue up to the later ages. International convention on child rights also document among others the rights of children for information and opportunities to develop life skills, health, and other services and it has been incorporated in the Ethiopian constitution. However, the health of youth and adolescents in general and sexual reproductive health in particular have not been adequately addressed. As a result, there are only 26 freestanding youth friendly services in the country created under the aspects of Family Guidance Association. The few youth centers are hardly usable by girls. There are no youth friendly in public or in private health facilities throughout the country. It is therefore, high time special attention is given to reproductive health needs of the adolescent and pilot programs are initiated all over the country.

47 Sensitization and Mobilization on HIV/AIDS Pictures EDUCATED GIRLS: ARE THEY REALLY SENSITIZED?

Mitiku W/Giorgis1

In many of the countries that experience high HIV/AIDS prevalence, young people between ages 10-24 are the hardest hit. Looking at the world demographic profile, this group accounts for half the world population. About 1.2 million (20%) are between 10-15 years while the rest 80% are between 15-25 years. Most of the people in the age range of 10-25 (87%) live in the developing world. Africa alone harbours 60 millions of them. In Ethiopia the youth below the age of 24 accounts for more than 60% of the population. When categorized by age 51.2 million (32%) are within 10-24 year and 14 millions (20%) within 15-24 years. The university students belong to the latter age group. About 85% of the AAU students are 17-24 years old (KAPS, 1999 and 2002). As studies done in AAU and Bahir Dar universities show, 89.5-97% are single. „ The present HIV/AIDS situation in Ethiopia is alarming. There are a total of 2.2 million people infected with the virus. Children/ infants account for 9.09% (200,000) of the children between 0-14 years while the adults account for 86.4% (1.9 million) o'f those between the ages 15-19 years. The rest 4.5% make other ages. Transmission of HIV in the country in general is in heterosexual community. Although the number of adult males and females (15-49 years) in the population is proportional 800, 000 (42.12%): 1.1 million (57.9%), the number of women/ girls infected with the virus is three times more than that of the boys (UNAIDS, 2002; Camel et al, 200). In children, over 90% of the transmission is from infected mothers to children during or shortly after birth. This mode of transmission is responsible for 5-10% children infection in Africa and 8.8% in Ethiopia. According to the latest figure, the prevalence of HIV/AIDS in Ethiopian youth is 6- 9% among men aged 15-24 and 10-13% among women, These age groups have the highest prevalence of sexually transmitted infections, indicating the practice of high rate of unprotected sex, probably with multiple partners. Although education is claimed often as strongly predictive of better knowledge, safer behavior and" reduced infection, a UNAIDS analysis of studies in seventeen African and four Latin American countries have shown an increase of some land of risk behavior with education in age groups 15-19 years, Reports on reproductive health of the country indicate that the age for the first sexual act among Ethiopian women ranges between 13 to 25 years and a median age of 18.8 years. 10-14% of the unmarried women experience unwanted pregnancies. A study done by the Ethiopian Society of Obstetrics and Gynecology (ESOG)(2002) showed that 58% of the 1075 abortions done in the year 200i were because of unwanted pregnancies. When

1 Pathfinder International, Addis Ababa, Ethiopia. Sensitized Girls = Healthy Generation Mitiku W/Giorgis

analyzed by educational background, 14.6% were high school students; 27.5% had secondary education and 3.6 had university / college education. The epidemiology of HIV/AIDS in many countries of the world is more or less the same. Young people aged 15-24 account for 60% of new infections worldwide. Almost two third of the newly infected young people are girls. A study made in Ethiopia in 2001 showed that of the 11.8 million youth infected with the virus million 7.3 million were young girls/women. The same year the number of people infected with the virus in Ethiopia were 2.2 but the infection rate was more skewed towards the women especially in the age group 15-39 years (Fig. 1). When only those at AIDS stage were considered, the picture was a little different in terms of male to female ratio. Of the 219,000 AIDS patterns, the females were more in the younger ages 15-25 years while the males were significantly higher in ages above 25 years.

Estimated Number of HIV Infected Persons by Age and Sex , 2001 BO. 3 C 2 5 1 0.2 O 1 5 l o . i © 0 5 O i iiii in i • Male t Female

Age gro u p

Fig. 1 AIDS in Ethiopia, 2002

A few studies made on the behaviors and risks of HIV infection among the youth (Hailu et al. 1999, Amsalu Shiferaw. 2003 unpublished) in AAU and Bahir Dar universities respectively, showed that students in both universities have more or less similar risk reception, sexual activity and condom utility behaviors (Tables 1,2). The results however were very much changed in a follow up study made to evaluate the effects of advocacy programs. The risk perception increased from 23.5 to 59.1% and 68.75% for male and females, respectively. The change on the sexual activity was insignificant. It only dropped from 25.35% to 24.29%. The use of condom was markedly improved. It was raised from 16.4% and the non-users dropped from 47.7 to 10.8%.

Table 1 Reproductive Health Baseline Data on Bahir Dar students. M ale (%) Female (%) Total

Risk perception - 12.8 - Sexual activity 52.8 15.8 36.4

Condom utility - - 52.4 Year engaged for 2.5 1.9 52.4 life time partner

50 Proceedings of Workshops on HIV/AIDS and College Girls In Addis Ababa (BSE, 3004/05) \ Table 2 Reproductive Health Baseline Data on AAU students (17-24 years). Male (%) Female (%) Total Risk perception 32.7 14.2 23.5 Sexual activity 23.46 25.4 Condom utility - 16.4 A follow up study made one year after an adyocacy program showed a much- improved situation (Table 3).

Table 3 Behavioral changes before and after advocacy program Before the program After the program Risk perception 23.5% 59.1% Sexual activity ■ 25.35% 24.28% Condom utility 16.4% . 41.4%

51 > Sensitization and Mobilization on HIV/AIDS Pictures GENERAL DISCUSSION - PHASE I

Chairperson: Prof. Afework Bekele; Rapporteur: Teferi Mekonen

COMMENTS It is said that there is no University girls’ club in the main campus. But we have established a girls club and it will be functional by next week. One of our club’s objectives is to play a role in the prevention of HIV/AIDS; at this moment we would like to have collaboration with different organizations/associations or even with the clinic staff members. Please unite your effort with our club. We girl students in the Faculty of Science had learnt about college girls club from our friends in Alemaya University. We have discussed what their club is doing and the role it plays. Then we started talking to girl students by moving from dormitory to dormitory and in doing so we recently established a girls club. The main objective of the club is to help and assist those needy girl students, and to solve their social, economical and related problems. What we mostly do is organizing special gatherings to share experiences and openly discuss our problems. We organize fashion show, dancing and other activities to motivate the participation of girls. Currently we are awaiting an awartl of a legal certificate from the Ministry of Federal Justice and Laws. During the discussion, we have been informed that there were Several students who have been targets for tape attempts (the case of o&mpus guard and Chemistry laboratory technicians can be cited as examples)* The matter calls for the University Officers to reinforce laws to mitigate* such problems. In the cost-sharing strategy, cost for health coverage has been neglected and we believe the University should reconsider it. We need good health care facility in our campus. Such a workshop is very helpful at this moment in raising awareness among girl students. We would like to express my heart-felt appreciation to the BSE. What we used to do after the previous other workshops is that we tore and threw away all the papers and leaflets. Can the BSE make the future workshops more impressive by using other means like Sensitized Girls = Healthy Generation General Discussion

fashion show, dancing and other entertaining which would be more educative?

7. We all are delighted with the efforts of the BSE to organize this workshop. We heard about all those sciences and social findings from different media and workshops. It is good if this type of workshop is organized in a dialogue type b> which everyone of us would converse about our problems. 8. It is also important to invite other girls who can tell us their experiences on how they faced problems or how they solved their daily problems.

9. In the main campus there are elderly women with whom we can talk freely. Counseling should also be designed as a peer group discussion.

10. Girls are not the sole cause of HIV/AIDS epidemics as it is reflected in various meetings. We girls are not responsible for the spread of HTV/AIDS; we better not accept such views rather we should collaborate with our male partners to make our preventive roles more meaningful. 11. There are fund problems for the purchase of equipment for the clinic. There is no STI treatment and evening counseling. Can BSE find sponsors to alleviate these problems? 12. The Faculty of Veterinary Medicine is located in Debre Zeit (45 Km away from AA). We, girl students, are very few in the campus and can’t form a club as what most of you from faculties in Addis Ababa are talking about. We really lack information. Today it is a great achievement for us to be able to participate in such a workshop and the opportunity it provided us with more information about HIV/AIDS. 13. It is nice of BSE to organize this workshop and we are grateful to the society. Though this workshop is the first one in its kind, it is good if male students are considered to be sensitized about HIV/AIDS and other impacts on female counterparts. 14. We don’t need to be restricted with girls club only; it should be holistic to include male students and make them aware of any harsh problems caused by them. Let’s get together and make our male students be considerative and caring for us. 15. This workshop was organized to sensitize female students. But the chairperson is a male and can’t we have a female chairperson for the next workshop? It is also better if more time is allocated for discussion and if possible inviting HIV-infected women to share their experiences.

54 Proceedings of Workshops on HIV/AIDS and College Girls in Addis Ababa (BSE, 2004/05)

It is only through discussion that we can communicate and understand problems easily.

QUESTIONS RAISED AND RESPECTIVE RESPONSES

■ Question: When every issue about girls club is raised, only AAU is being referred to this workshop. How about the efforts made and experiences in other colleges and institutes? ► Response: The AAU girls club was made public mainly in this workshop, only because most of us are based in AAU. However, students from KTEC told us that girls club has been established in their campus and it shows a very promising sign for the betterment of female students. The establishment and organization of more girls clubs should be strengthened. 8 Question: So far I have never seen any effort to treat STI and even the budget allocated for the clinic is very limited. What is the main reason why the university cannot consider an appropriate budget for health coverage of the university students? ► Response: The reason for lack of STI treatment in the clinic is that every college/university student is considered to take care of herself /himself from such infections. If any one is found to be infected by STI, then she/he must get treatment in other clinic on their expenses. Regarding the low budget allocation, those staff members in the clinic have several times claimed for better consideration. What recently happened in the clinic is that certain number of staffs have been transferred to other places. Not only the budget constraint but also there is less number of staff. This issue should be presented to the higher officials of the university. ■ Question: It is good that girls club at the University or college levels has been established, but we have never heard of its activity. When can this initiation be materialized? ► Response: The recently established female students association will be legitimized in the near future. However, those established girls’ clubs have tried to play roles in the problem alleviation and paving a way for the success of female students. ■ Question: Could you tell us about the differences and similarities between the two types of HIV (HIV-I and HIV-II)? Which one is more epidemic? ► Response: The differences between the two types of HIV (HIV-I and HIV-II) are their genetic makeup, transmission rate, area of distribution and virulence. HIV-I is highly transmissible and virulent

55 Sensitized Girls = Healthy Generation General Discussion

one. It is well distributed all over the world and hence more epidemic. HIV-1 has more subtypes / clades, whereas HIV-II has no subtypes. HIV-I is highly mutated and is found to be difficult to m anage. ■ Question: Since we students from AA are not provided with dormitory by the university, we are forced to move every morning and evening from our home to university and vice versa. During early morning and late afternoon journey, we face real harassment. Can’t the university make any strategy to alleviate such problems? ► Response: Two/three years ago those students who were not provided with dormitory facilities were paid ETB 60.00 per month for transportation. But recently such provision has been interrupted and it is better if it is again reconsidered. ■ Question: There are many established girls clubs in different campuses. How can we get information about each girls’ club? Why can’t the university arrange for information exchange in the network form? ► Response: Information exchange will be easy and possible by means of networking only when those girls club and the capacity of the university are strengthened. In the mean time, it is possible to gather in such a workshop and share experiences. ■ Question: It is said that the HIV prevalence in Amhara region is relatively higher than the other regions. What is the main reason for the higher prevalence of the HIV-infection in that region? ► Response: The study was conducted in 1999-2000. Blood samples were collected from army recruits (from rural and urban areas). The sample size was Seventy Two thousand. After analysis the higher prevalence of HIV-infection was found from those who are from Amhara Region. It is a matter of calculating the prevalence and it was higher in Amhara region as compared to Tigray and SPNNR.

56 PREVENTION AND CONTROL OF HIV/AIDS IN COLLEGE CAMPUSES

Mahbuba Awol (S/r)1

The aim of the presentation is to bring about desired behavioral changes in order to control and prevent the spread of the infection by the virus. Let me begin by explaining the meaning of the terms “HIV/AIDS” which are abbreviations of the following terms: ® HIV: - Human Immunodeficiency Virus ❖ AIDS: -Acquired Immunodeficiency Disease Syndrome There are two types of Human Immunodeficiency Viruses: ► HIV-I is a type of virus characterized by 6-8 years of incubation period and its world wide distribution HIV-II virus is characterized as less virulent type. It has an incubation period of more than 20 years. Its distribution is limited to a few foci. Both are transmitted mainly in two ways: 1. From mother to child (new bom) during pregnancy and/or after birth and 2. Through sexual intercourse One of the strategies that need to be done in order to control or prevent HIV/AIDS is creating awareness among the people. This is done primarily by giving the people full access to information about the ‘virus’ so that they understand the ways of preventing the disease. The awareness can be done at different levels using different strategies. One is by organizing sensitization programs like this and addressing the issue to a large group. At clinical level it is done through: ❖ Individual Face to face counseling and ❖ Group discussions/counseling, which are good opportunities for risk assessment. Assessing the risk regarding HIV/AIDS encourages the students to identify the mode of transmission and thereby the ways of prevention. In beautiful occasions like today we have to focus on the methods of prevention and clarifications of misconceptions about HIV/AIDS transmission. The delivery of information in order to bring a change in the individual has to be done in stepwise following the sequences shown below:

1 Awoliya College Hospital, Addis Ababa. Sensitized Girls = Healthy Generation Mahbuba Awol

a. Information: is a level where the most basic ideas and facts are simply addressed. b. Knowledge: at this level we are interested that the students retain the information as knowledge c. Attitudinal changes: at this level students understand the information and tart looking means of prevention d. Behavioral changes: at these level the students attain actual change of behavior and start taking one of the measures to avoid the risk of HIV infection: i. Abstinence before marriage ii. Not having sex outside a single trusted sexual partner At this stage some of the student unfortunately could have already been infected by the virus. We need to take these students one step further and give them detail information on how-they can get the counseling service and how they should lead their lives for better survival after they are infected by the virus. That is by: i. Avoiding further infection with the virus by making sure both partners maintain a faithful relation and use condom correctly in sexual contact ii. Getting regular exercise and avoid smoking and alcohols iii. Getting counseling to help high level of emotional stresses such as persistent anxiety or depression. At each campus we have what is called Voluntary Counseling and Treatment (VCT) centers meant for counseling of patients and create awareness among the university students. These VCT centers aim to: a. Provide learning atmosphere about HIV/AIDS b. Bring about the desired behavioral changes c. Control and prevent the spread of infection d. Increase awareness and motivate students towards the prevention approach e. Avoid commercial sex specially in higher learning institution f. Facilitate easy discussion of the facts about HIV/AIDS g. Care and support of infected persons h. Take prevention measure.

58 PM ra

W lift# (Molla Zeleke)1 n»U*£ P+*H* 70-tl C d flf -

1. PAV 'f'TA* m/.’ ft^A UA'fl? 2. pav ttceft nhM'k? 3. 'l'Cl-9” 4. t f W * P'f’AP PA> '/’ ,PA^A/>7;* hi/MA-')' ^ a * ^ ^ a.s'v-t*^ p^nn- nu^^F 8. n«W'F sw * 'i# p't'0°cit.'t' m a ^ a - * w i t 9. ?(nnH:'} KW')' p m a ^ a - * hry.#??)' m ^ r A a £nnnc p®n/*:f av ^

1. fflV -/-■PA* m,9 » 7rt |M

+ood.*16jP'$ H A i m^ alP K1' M i'A At'It'. 9° %H, A.m+^n* n*A ni994 >».*,.>» ®£ 178 nm- mc?^ n°Mi» fl+httfc®* ‘MT” M»

'}££?A International Conference on Population and Development (ICPD) VfA‘7A«'h X'J^flÂ A ^ ’V* ^.e 'f'£C0.A: UA'fl P*7£' VfC U7f*fl n+ "7A'7* P"7.Â0>- PM.'V'f* Pm/.’ ‘T'l'V/Hf:a>* ""-a,'}'?(»' 'tm'fl# A .T i av\yj. ^{PS°nÂ::

PAV +

AV 'f'P A * ^ c £ n//-^ 0A* A .‘6 P*? 'l'

AV 'f'^A^. flL»-A'7' * jBO^A”

"Reproductive Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity in all matters relating to the reproductive system to its function and process" WHO.

1 Family Guidance Association Ethiopia, Addis Ababa. Sensitized Girls = Healthy Generation Molla Zeleke

A A l f ^ Ul'C.ro”' P ^ V -fA ® '*

♦ ®*Ak ÔhA^'J (\9°'> rPUA VL T JP'> rPUA A # '£'>... P"?.A«M T fisS P 'l' .PAVAA ♦ Ti* ?# * / P ^ V A # ^ n c ? "7**7 * K7A n® A,£- VL .PA ‘^ “VC/ ^ m A ? ♦ K W W m R * /Â flA ? * *74119”!* "7A'fa7 0 P"7„PrtÂ M ’T”'}

♦ PAV A P T T T ? # * .PA A J^/, P 'f ^ * " 11 ?iC*7'M«r A C T H V ® ') -M l^ A - htM i^A n- nv AP

A V l m i b i . f P f A ^ A -fl VL t\al all ;t'ti PMA'VA** +m^°Z PAV 'hVA* m,? A ^ m f l^ 9°% U-’t,.+?>'? AJ&1HA:: O ^ l f h ^ ffcV-F PAV ^* PA^ fc A ^ A -f-'-fH

♦ Safe i f Y i c P ® £ ?” ®A.£-7 ^"/mC P^Afl* °7*7W t7Dri]^''f'(D' >flh:: £ u hlfV <1?= V®* ® 4 * "f -f«7C P ^ A l l ^ A A C T?ff.V ®A.£* ?x')X.U*9° P+<£.ATT rn.'T"? US? °7

P1994 h.K.h. 9AS1” X+«P PrtV UU'fl'T XA"!* " ° c y

♦ «7*>5?®-7u OJA.'fl n ^lT> A 'M A rt* ♦ *c°m* PÂ*? *®m AÂO* ♦ ar}tfab9° n\V? îf*} M£aW®* J^h-cr* At:£a

JiU'> ?»*}£. "7*}?fl»*iP M C .n .lT » *VH.lT> A®*? PA?” :: P^*7^ A4** °n O'7?**? «1j£ 0A« M C f Ph4* If'T .f t ^ / A :: n ^ lP V -r n^A?" h20-40 0 ^ * Pa7.lfV®*'} ®A.£* ®£?” PA h ^ A T h A lfV K W .PA ® * + P+h<7®V (l^lfV* *.PA, M f-W U S 'T* ') t\.h&2 £*C2fi\r-

♦ 0 ^ * 50 aZA,P-'> P°ZU"> SV7A Pa7AcO^»U9®* n A '/vn fl^ O-U' A7Aa7.hy,^ J& I^Â ♦ n < ^ '> 600,000 A'Tf-'f ®A.£* n + ^/H hM.u ‘I i t c ® * a tj^ 99 n^^*? oa* Me5? ♦ n ^ A r 333 ° l W i A P f nÔAHC n7f/> Âh4>A*:: m i.U ^ 9”Yl'}f;t' P"7.hA^ ‘*>W/'> P ^ T ^ T A : : nbCVll*,' W, n^HA MC ( i n ^ P+Ah^« ®o£;F h30-70 n^-f' AA^^^®* /A'MA4wV ♦ 22 "?.A.P-'> P°Zln UH'fl nHIV/AIDS hH.U^° ®*VA 14 Â.P*'> p«7^V®* hAU^. 0A- MC'* P*f*7<. M ^ 9 X’ n/iAAa ^*V,^ ^ ^ A h 'f V®*

60 Proceedings of Workshops on HIV/AIDS and College Girls in Addis Ababa (BSE, 2004/05)

♦ nfiHiv/AiDS oa^A'? actiiv ?ai z c t i - n c h ,* .PA- Ci.V’'} (Vl't\£ TUG” P"7.;>PO>* fltfl'i/'H* hAA 0A- A?,;F V<3)-::

2. PftV 'i'T A .fr H C G ^

M 'P fc.P M>

A»‘f A()-h'> nn^V* <{//')' 'f '^ C ^ T A :: hf/..P7” P*?MA-'} 1A*

PAV UTH1 Pm,V A,A■>'»’ 7'AA^f P//.U h'^/>A VM l^f "7A* J & ^ A " fW’A.& Pm,V 7'A.A.w* (HY,- *AT Aa-/'A'H (M*AjP, P?,V-f*r^' U3V* ^U'JV'M *»m fl‘> h + tb C fr 'lj)T'f-,'i’A:: fN^»AA.£ U-V,^ PAV U7H1 7'A.A.^'>^’ fl.lT> **>£ M "7 Palf S ,9 ”&a>-'} (U.nn PU'lMl HM'S0"?. ^ h h A .PA®*? h V 'H ’ A ^ T H 'fl ?^X a)-9” p?*V'R'V USV'M a\Vrt' A ^ m d * f c ^ ^ A 02015 ?i 7*,.*. nh"7*rf hJZ' AV* P°7. i’TC fl7-8 0)£ 4 ^*VA Pa'f’A'fl y”"/V, MA'VA"^??” h 4 n^'F- 44 A^A**? ^ A ^ A " P'f A.pfc T’A .rt.^^ r x c i * " ricu 7 'flr:T'> +j&a«>- r u it- in Pm,v '-'He A^n^'P ?»'H>A*A, }x?'\-?y/Yi' P'h+nAV^® ? PAV 'KPA* MCCtF (H'70C A"7*::

V/ILU PAV +

1. PfW'A'fl ‘/""fV, £W. tf>A.£* TQa'W.- PUh^’V h ^ A 2. Ptf7?,7* tiT TC ? u h rv 4. PUSV* ?*£-'?* h * * A 5. •>& O iW + 6. PAV 'f’

8. P^^/J'Hl AC^’t'

3. ■^C'M'0

piD a rt-rt a ,a pvn^ n . i f ? r pa^-^v, h (Age Category) cn>u>£^ UUP? llAV U,P, ?»'>^ U8'>V'> P ^ a L ^ n 1®- JKr-Ar,' P-VA"7AV^ P^«K"«^,Pa>- h

,PAirV- g r C & W r ’ h°Aa7^ h'}ZC P'/'A.PP P^^"7, hAA-’-f'J n"70j?» j&m^o^n.'J'A:: ?»Vf/,U? P 'tH fl^^ P^'?; t'T'/j p"7Ji^a^'> tv tv rh^r-i-l' wivdA' f&s.n- p i5 ^^n.7. ^ v ^ V P29 PiD n ftr t (,£<’'!, Yi(\t\ UA'll Ai^CaA::

61 Sensitized Girls = Healthy Generation Molla Zeleke

♦ f 15 ‘H*®* P^V 't’TA#*- rh*7 ♦ p m ^ * ? * 7 ° u c * w - i ’t.p i .h, ♦ Piiw i+rt hfchA ^SÂ 0°ffH-'} ♦ til5 *,£*A A A 'l^ T hft,U h A A £ ?” (? >»Ah 29 <*<7D* HA©* nîrv- ♦ h i5 £ > (? Âfl>*7 ID"}* tlaT}7?at'9° PA°7* A

P29 6^ f&tKD-!

♦ n M * ^ ? /ao>*'> p*?£- rv£iD+ 1/ ^ 7 ? ♦ ©n,.^ n'f'A/'P Him ^hv** mmc p-ftpi hn+xrr run* a^’F a»h* ^?;^ h- ‘? Adolescents : 10-19 Years Youth 15-24 Years Young People : 10-24 Years

♦ aini+ rt nA#V*K flMNjV* ^hhA ?6£mt hAA o>*At .pa- ftooyf^CD* a£^F?° *££A •?”* A?‘fe?D *££A?” ♦ n«.U hAA h<»W? PlfV PfchA* PAV APT? P0? ' ^ ? A a ^ * p®zhE*.n*K *'*!£'} puj&tfj^ h^ vh^ i p"z+CR-n^ xn, v®* ♦ £ u >»£•"■£? p°7.-inA*^ nucj& p^J^•^;^<^ P n o v * u - v , ^ ^ p^ a™ * ♦ (Dn/.f.^ p*A * A^-f A?°£-T A©**** ^A^V* A^fih?" PaW £ n * ♦ (Dnrf.? (Adolescents) n*TC 1/5? Pt>A9w'> Wf-fl AA^^hA* 6.15 H A P ’? h W V ® P^Ai^ UlM 1.2 PAf-*} (Dnit'f ♦ 85 0A« M C T n^V t-fa*- ♦ h A U * n.'>;F 0A- ?h<£6h h ic t 1/4Va* Adolescent n«®lf?f»*

62 Proceedings of Workshops on HIV/AIDS and College Girls in Addis Ababa (BSE, 2004/05)

4. f'f-AP PM ^ A ^ A9°'i c A P ^ A ?

4.1 (I"? * 1? A £ 0A« iD n i'W '} hA>A®* PtMU'Kl'fl hÂ flÂP* Âm * P+£®°£®* hue'll UL (0%.V V®:: ®rttfh t lf H ? ftÂ U'H^+An* P®Z«**Ah^^ *A* A,*7’ V®:: (D n t fjr X\?’(VX' (\M A# M^*®A£* ,emnÂ:: 4.2 ho-'i hu-') nu'fl^+An- M£’ fw "vvntT. a®t pV7^?° W 'f - 'w h M 'Z M F 'l'} w,> fl®"/^ aj& 'I 'h tl' M z . f A c i - h K C t t V A:: ♦ n;l'yvuc;i' a l' ® at ^Tr?” ’iiu "'/aa£*p AhhA ^nm'> au£:th ♦ e tn -‘r ' f â4^-M 'Miâ- a®*®*t aa av ^ a ^ pmaâ-* h W fW 'tt '1'%c a^-ac* p'V’fi^ /"/j °nV/* 7^^Mov. ?AC.p A 4.3 ntlSW -5? * P £ £ L ^ ?«v (1HIV/AIDS n+ A j& PA,'}* H -P v ^ ?tP'fvn‘/i crap>art 4.4 n v ' i l + r t t)£ a'L P"ZhA* JiC'V'H? A\¥^T? US?* h V ^ n ^ if v -T a ^ a # hi8 9®®* n.'>T h+h.P'7* P ^X /P -M >*?C (l£ -n ,* A ^ + P C P " W ^ n * f l^ lA * 'fll/-®*? I I U t \ h A ? ASÂA, * AhA* A .^ * PhQAHC ClTJ.^f 7b'?'.*£ n.. *,£*A ®A.'fl (OH*... 4.6 W W V L f< £ t\al aX f\'\' nÂ'J- 'J.H, TlH'fl AAA,«vr® ASÂA, P^/a* 1W * A*?#*? ^mn(l£*"7, flA.£ hirv* ©?*?• P°M1£ A^ £

5. r’z.^A^'f5®- fMA'jft-l- A/av** f^ruc^-v PS»”hC ^A-7A -^

5.1 ®"/'f’'f n/»*lA A©*T‘ P®?«- PA,* av

63 Sensitized Girls = Healthy Generation Molla £eleke

PPAV +:: j&tf.? A*))?. PAV +‘PAi^ HCC^T

♦ PAV f P A ^ *7°UC*K ?9")iC M A 7 A -* ♦ PA®-V* /Pm ** P0'}/ ♦ h*}Ac ♦ PMAMC n7f;> 9 ° C ^ ° ^ VYl9°^ ♦ n^^V'Y* Pi^hCV P£?” (VCT) ♦ PACW ? altr6^? tt&Pl'') MA*7A-* h^A a7^'^‘? ♦ ll®*c5? ? C r iff* 't'Vnc?)'} er7tl‘?a)} (Post Abortion Care) ♦ £ \)£ ®A.£* MS.U-90 P ^ T A * - h l£ \7 fr'h ♦ PUSV* *£-7* h**A . ♦ P f c ^ K l hCt}'t'

6. nMA-7A-b *•>£,* JB3=AA?

♦ m,9 n ^ m t i r I p^?*?/"^ P*7A a * ! 0) /* > f A lfW ♦ n -^ u c* n,* r> A')? hA.v.h^f?

♦ a®*a® I'd ava/’PT mn.p P;m 04^ * 1* n^+Aj^Tf ^h/r MA*7A-^ ^Am *

7. f <’Z1A7A*n:?:®*? MA*7A-* «®A«i?,:f A.?^® * P°Z7n«

P^AIA^®**} PMA^A*** ^»A«4 O^P-f- ^nm^9v fcj&fi*?1’:: AlUV9° P ^ A / P ? ° )7 'W 'F J&A'Wk*::

7.1 h<™^.P ^C P 't'ffh ' ^*7C * *'>*'>£* M C * P^ZA'!!/?®'? MA*?A»*?• n*£-"V^ l*V,^ £A.PA:: fllLU 6 1 £ PAV -t'

♦ PM AÂ-* Â*** A«Wj ♦ P ^ 'M T ’C * ♦ p m a ^ - * *p ^ ®*£- "*>m 7.3 n+. ^ ^ 5 ? f/ \a7a? l 't ♦ AAÂ^®* A®*TV an&La\ AA°Z'IO®- * A *7®* ♦ Amif'TV P/tHAHC P°Z.PAh*A- U*V,^^T'> *A°7®* ♦ flM AÂ-* Â«i* ®*At AA"ZAm- PAlAÂ-^ ^J&V'IT«;f P'f^-1 M ^ C ♦ >»7A‘?A«»f-^ P^’ A?^°ZAm- /.A°7®4> 7.4 ^ '? A ‘7A»'/.*? n " Z ® A ^ n * XH, iltbO^l Vi> ®nMs-:f ® A hA,V.h ^7A7A XJM.AM’:? AÛ P^Z/tCd-^^T ♦ P°ZAm- AilAÂ'f-^ PAVA* AA^J&Â^® * ♦ n^lA'VA-^ A ^ ^ - f ^J& ^-1^®- fcÂ hh* /A^-'fl 0^*700- Â°7A+ 9 1 ^ /

64 Proceedings of Workshops on HIV/AIDS and College Girls in Addis Ababa (BSE, 2004/05)

♦ h ^ A t?A»rfc PC P'WH- P^Ah^A*? Pm,? ^°?C

♦ "ZA 'IY ^? 4£m n* jR-fAA P°ZA flpfr ♦ a.'f’AP?^') ♦ P ^ A O 'T ^ (Doj^f ib’k^o^'} M4*6 XrCl.fr h^C 'i arDttimd i 8. cd'*?#^ ? °tf^ IW"}* S M * W

croaatffpTf.q Oinj^ 't 'T A * 't'0 \? aZ J M i r v - ^ 'M ./ T O a - ifv®* w W ^ r 3 tfo + m ^ © * ? al-::

£i> ?»a>^} JW4.IT1 h M A ^ A -* A t E i^ -f PaZm(14i O t M ^ T

A®"/** MA^A** A.Am« P°?.^A« 0A a7

8.1 P(ontf#'} ^°?C ^«?C n ^ m C a jn tff'} C ? ° Z ^ ° i A'JfrA.Â, fi(Dn1'b ?alftma>''} MA7A-* 0®")** <5W* < w t.fr fZAl Vn> A"7A'> P°Z,PA7'A ‘PV5?® '}? 'f l? 5?©* <”,r>7£- Va>*:: J&U7 W Z t . 0) M S ^ A O A ^ ^ P^ZlOtf©* P**)A X * t K i'lHC <*>t»Cfr n AP°Zin PUh7°9 Acs.** t-sp-^®*? nîA^n* v t, n*MA- ^ °? n n * fcÔ A - P ^ C ^ tf’ fcUA»* . P h ^ A : : 8.2 A®'l/'f^ M^-U©-) hhiUTfr ^*C 8.3 O'VA P*DA'f’ ? 8.4 n*t XH, ^ A m * f*?CFfw'} °lfiovT 8.5 &&9° P rh C M W fa * ACR*0?-? <*>^+9°

9 . Pm.«r £Cg-f-?F hM tiK *

9.1 P'J VmA XH, ^ A m * ? 9.2 9°% A9* /h-ih^UC* ®J&r hA^ ‘f’?* rfi* l e i ^9°/ 9.3 woo?? tc+fri puTi'fl rfr^’Hircfr ma-va*** p^nna®* £ i m * hA;>* Pifv/ ° i L m ^ 9.5 P*°$.P ifV M A ^A -* ^ A ^ to$A* f W O^VmA fj'cmtf croifjj 9.6 IH, ? ° l.ftfr i ?aZfX9°nbfr (D&r £ A ^ ?°Z(\"tfa*’} V IC "70»psffr

10. t n

10.1 n l c i ^ *£*9 J7**A IH, (Dntf?’} ‘"t w w f t 'i c * ') <^AP* >,*"/«* <77APPTfT UAP*f7 ^A?A/ 10.2 ^ ° A h r <7DA^'>‘7^» ° 7 ^ ‘7 /+mC,’>9 P:f'} f(i^h ,+ A/ 10.3 ajnf.f.^.'} Aj&n/flrt* h')fl/)’t’iil%' al£ 6 ai /Avoiding Overcrowding

65 Sensitized Girls = Healthy Generation Mol la Zeieke

10.4 P J ilA ^ A -* h

1 1 . rh+ r-kf (I't'trn 0*9°6f ^ n c ? a*"?**? m h * o m n * t x k f ftia * rt,

11.1 0 ° 7 ( l f

n.^A'fl "7'vnc n*c

»l£ hXH, ®£ TJL P M A ^ A -* /iJÂ-*} n ^ A ^ * ? *h-^'*j'>5^ A®"***? AA.f-'F (lÂm* 'l.fc J&IÂ:: n^lfV*?0 (1®"/+^ iw ; P°zh+A«*7 *'fl£* h 'H ’A.^,A>$p'F n*7hi££- 4J& V®*::

11.2 frtV +«PA* m.9 £*?£• ?°? *?*A.*A, h r i ' A d l v®-?

U. n*?°UC* ft* ®-At Prt.+A'fl 9 '“ ' i W PAV fk^ :t'9°VC:t' ^"Am *

♦ nAc*j+ *?°uc* ®*at pa+A'fl r * n w pav u p c

♦ P'fC'Eh* £ ^ 2 ® " |* * PhUA»* AAmV M W V h ‘IK C l

AS^AA, n**A >»nn £ v,4*a urn** nAn^ n*'flc «£* tow? u-A-f? fr/a** P7*fl CO^ AAm9 +AT*A::

♦ pa*A'fl

A. PhAV,h MA*7A«* n*?”uc* a* ®-at^ irv h*/a* ®*«i, .pa- w "!*? < r ° t $ s *?°uc* P^/'l'V-n* P^ hAY.h* S’?®*:: J&U**> \7?t ®«/'f:F rWAlA-O* hA.V,h ^je.Ft-5^*:: P M A ^ A -* ^ A ^ ^ ^ 9 ° ftlfV- P®'»/**'}

V,^ /iA+^^y°:: A?”AA, PJiAÂ-* AflQ.^ JÂhh* PMAÂ-^ P/ilAÂ-* Â^ A*}* £m+AA*:: n ^lfV * ^ p®n/^ °7<>hA /Multipurpose youth center/ (1H.U ®rtJrfc*> aoC*i’ti / i M M 6 L ^ VrtC::

66 • Proceedings of Workshops on HIV/AIDS and College Girls in Addis Ababa (BSE, 2004/05)

rh. /Services in multipurpose youth center/

♦ p9 °h c /MAh* nhA/

«, T P ^ A + ^ . P ♦ Pfl^V hfl,* 0>'&i aiTr>'?y'f' ♦ Mini Media ♦ Film show, soccer (DSTV) ♦ Drama clubs P^A^®*? hUA«* A^A**? i^ W fA ♦ ^Pft'N V fl ^ " JV J P*»0AHC 0 7 ^ h * * A ♦ A£ P 'f'^ A d 'f’ P£?° P ^ h c M A ^ A -* A/CT/ ♦ ®A.£* Ylfr*A ♦ AAm9 /FLE, Assertiveness, life skill) skill required for communication, negotiation etc...

073. (Itonj^ (D*ti t ffc MA'VA-*

♦ O') h ? ^9°\)C1 M A ^A -* (XC^PW ♦ &TC /VCA-f * ha^AAC^* 'fch't'ff.P'K’^/

12. warf* Ir^flÂ^ ®£ *®-A£* M+ffn ?ol(Wn1ay'} U'fU+A'fl P^VOV AÂ*? W oi'ijtf-*? P^Â (1P?i£ -7* £^5?®- .PA®*? P'fcb‘TA-2. fl«MA* +A°ZT A ^ ^ C S A0? ® ^ £"/"> rPA®*f>' h ^ A V®*::

®"M j h^-A h'f^mÂ* P+A+hhA? Pm^ <^"7 ^ ^ jb71 h+£d7 J»70 AÂ**? ‘T ^ id-JP AÂÂ, A#*? P^ + n^7C nÂ^f®* A ^ ^ fr MC 770, fc'Jfc'W'} J&^VA:: nM ^??0 £m 7*>a ^ jb a n°?nn- h ^ ^ tj ^h<£ rvuV'fe*} ^ HA^^m^®* A 't'A ffi P + P A m if*? jB 7 Â ::

P^P-fr^ a+A-fl 0°9”6 f "V'VnC A00^ ^ h*0?0?/"*? hA.A*^ ^A A "Y'Vn^ (M fc^V* n^'PmC .P4AAA J^CS^C fc^U-JP PA.A-’f? i '^ h C A M C n°Z® «An* *»?7£* p®«/^^7 ?*7c £7£- ®7. Pifv a ^ a ^ a, n 47?^ ^ 1? ajb £ 7 ^ :: fl^lfV-?0 fl07'Wte-iF,» ®*At P ® « l'f^ '} PAV rf, m ,V A ^ m H * P+mV- T9tf^? ®£ ^HC n^TPCV M A ^ A - “Youth Friendly” n a7 £ Y 7 £ 7 £ - AV7®* * 7 C * ® * A £ 't$ c % 6 PlTV U«A* O'VA?0 IfV H 'h 'm A ,e® ^

67 Sensitized Girls » Healthy Generation Molla Zeleke yfl /References/

1. Adolescent Reproductive Health Let’s Save the Future Generation, Nov., 2001.

2. MC fOKijf* T'A.iX a16+

a n ? ? P7°hhc rt-flrto T 6 T & l i n 1995::

3. Improving Reproductive Health in Developing Countries, October 1995.

4. Implementing Reproductive Health Services in an Era of Health Sector Reform,

March 2000, Karen Hardee, Janet Smith.

5. Making Reproductive Health Services: Youth Friendly, February 1999.

6. P® "H j 'f r V C t t P^*^ Vrhrt. 1994* M10::

68 VIEWS OF COLLEGE GIRLS

HIV/AIDS AND CAMPUS GIRLS

Melat Aberra1

The introductory part about HIV/AIDS has already been addressed. Hence, I will go straight to the “Girls on campus” issue. ■ Girls on campus, especially in Unity University College, tend to be conservative, but as a matter of fact they need therapists, counselors, psychologists and sexologists if there could be one available around. ■ The other issue on campus girls is the government’s concern on HIV/AIDS. The government seems be very lax because when it comes to some works like announcements, they do it, but not carefully. For example 10th grade students when they come to the university are reluctant to have sex with anybody they want because they are very young and are scared of being exposed to different diseases including viral ones. ■ When it comes to other universities or colleges, there are some promising activities on line. But HIV/AIDS prevalence in high schools seems to be higher. The reason for this can be our cultural taboo that youngsters are shy as no one talks about sex, when and at what age to do it, how to take care of themselves, etc. Especially girls are supposed to go to school and when they return back they will sleep. That is all. This makes it difficult to decrease HIV/AIDS prevalence in colleges, campuses or schools. The other point that seems encouraging is when teachers come to class; they encourage the use of condoms to prevent ourselves from HIV/AIDS and other STDs. But, can condoms secure these problems? Rather if could have been better to teach them how to make friends and what relationship should be there with boys. Then after they know each other well, they may decide whether to have sex or not. But on the roadside, any body can pick up condoms for Birr 0.20 (twenty cents). This simply means telling the young just “go and have sex”. Right?

1 Student at Unity University College, P.O. Box 5716, Addis Ababa, Ethiopia. Sensitized Girls- Healthy Generation Views of College Girls

rtlfVflh U'A* a7Vfl)': n + ( o ') * * a)j&h a,**? ■MlMl 1

h i \ t \ 9 * 'Art* a n * * rtA a fcjs-rt W i* * * A,**? - t m ? * rz cp frr. hO'19x> U'fr'}?0 h&6\9° -flrt* A,-fr* AHU **7C a n * * 11**7 * t\0»\r'r r*'} *v\*ih toA â- fm f* J&^c £ i n ? hrt hA,A *77 PAa>* *£? a>«AT ? t \ l r £ V A9a)^l J&Â? m s W W ) h T C * £ £ 0)£ aW lT a)* <Â*?::

h i *7*1? r i htM V' HD'i 'fm ^n-fi aw°c ho? n^a)^* aj& .pao)*'} VA,fi j&nAT cii't\'t' hitr^hy.'. y r ^ a * k j - w ft? a?#?* h 't K& ft *?&>* ao(\\\ <*n hov^T|fl).? fljj&rt h?+? *£A >i«V? £U ?? n ^ A ^ A hm.Va> k * hj& ft? ?a1 '? W M£o©’ +AA *?& m hK W A r.-. ?(\ (1AH.P *7? *°731ah? A?*!* fW «P? k * *£ ft? a 7 f ? 4 * ' t M -fl? -Art? h+VA? .PAHtfah? A ^ l>A* aV‘T4''h a t t ^ A h?*1?^ A..ptf»^? £ * A A :: j&u?? A?A h£ ft n fc ^ a )- a>AT ^ ‘T O h.Pa)* h?** h^>TC Z C l p f a b P^fc+mfr nch^ 7AAP* h W f c Mh<:? Prsah* j&^AAtfA::

£U? MU A9?* A(D* 4-A. VA-fl A<*>AA 77^* .PAfl* k* h£ ft 0>&A f?i«? A^*? *7A* >b* *£ ft? A"7T** h < r o l1 a a + n* ^Tj&Â’ *?£,* <7°^ flA? M in *90** j&if? ? &u?? ®7A-n hA?A? ? axi ' V W ( D ' H& n*#F? Vfl)* -nfc m hao:: AAitu a)?*?* m i a* *ca MCA â ^fr? *+? A* fAp L p f f t n n^*7»1* a>''} o vR L l AWrt?:: £UT> ‘y7^<'‘7 hÂ? Jl0?^ K£ ft ^ 0o°j(\+ rim y* no* U'fr r)M?* n?i/,::

AAfl)* JHrth. *»?£ A?A ft rt)j&A N? ^Va)’? f°^,fA^ T4-* ^rt, frtffi’ A3f ru^X-r AJ& >»J& ft ^Vrta)’ Â<^ T** frrt©? hÂO:: rtJÂA n^h+A’* f+hA+fD’? +<7oAh+Al:-

h T ? * Aj&mVhC nahV't Aj&4«^ ^ca 'f'A+hhA* A-fl t\?(T\i 79 n^AV* nA^>* 6 ^ ° % hAP +;>£•** AJ^Vah? A?°Va)-? ^Ai; V© nftm. f+ ^ V ^ I? nA^r ?7<.i ^.a-r n r h-HA-T cd ^h ^ ^«*c

1 Queens College, Addis Ababa.

70 Proceedings of Workshops on HIV/AIDS and College Girls in Addis Ababa (BSE, 2004/05)

n ^ P+nrtO)' 6"! £ ^ 7 ? 'KD* f'M ^A fi w i n m +h n

M&fta)' fl?' T ? * h'f'+Ma)* ?i«X 0v'lt\£'} AUl) hfCDfO)' h6°7£ / ”C eroab&th) fl(P*rti h i* /H?^u

7 h ? (D 'tr AMdCD- hA^^A*?" fT*>* rh.V'} JSW i*

OT^nu'J A**£C S1#? ^(D’ÂU JS^?10 na)'(i£ 7i^7 h'ti'*) °T)nch PUAVU') *A*R A W T ) no AW} LKT ^ J& 7 C ^ 5 ro T*>*r ttiu ° if\r h£HA?° h 'M ' ° n £ A ’ pa'J a>n* A;W * nÂ.9 n£ ft**7ih hfira AW ttT A*«£<£T CD?£ v* A<Âu f*?hA £*<£*} H i^ -flU 7A

71 Sensitized Girls » Healthy Generation Views of College Girls

7 * * 9 1 h? ;: n/h&fl)* o * t a x > 6 ? UAOh A.#i#C «Pm^7 PtoD^* fcitffrD' MA+? VnC:: T*fc* P ‘TU’©'** A®WM*K *7(D* A^AT** A..PAah* dtD'** ?i,P£7* tfo'H*:: H<£. PfciATn-M Pd©^* 9 ° ' W fl)W +* A M ‘P‘fc*D* A.A-* M V t f 0 ? >i7*0,fa>9 V?*'} *77V* h U l rt^fl)£f* U - l p a h Q££*^A7?° ?i7£7m£* f t ) 7££9A:: ? I,P W ^ *7C H£ .PAfl* Pd£7* PHO •*.£* flhm,* >©•::

P?£* *>P-fr.P nnu ©AT h M H£ £A*0* A*£CA A^V-* **77° ^ J ^ A ^ O M rh,*7 ( D & r ll^ A A )x 74P9*© A£ *CA»£.rL7 n ^ A h * pma*7 / " & * ? > ’* n M ’flc** ^ p ^ ^ o o f r ' i p y - t m+*»7 ©j&a t-> 5'>? < * © + * 9 *ruc* £*?** -h? iuf7 nAh* vnc=: *77 - H ^ u c * ^ «7£9©* y z c p b r - h i P<Â,7 AP© A*7C £‘7Ah?° 00& .PA5* AinTlJP vnch*:: h*9 ^071 A?*7 If 771 hAOA?0:: *97+ **»*lf9*l/-*9 A.A-* *7£l/>* lf? A lH : A ^ C 'fltt'*D;S7 >iffl*0 *7©* fa h V t f 9 ° h747£» A©* ,PAn*7 OT*^ i i ? "7P* T<* V© &0AA:: ?iW° IMT-V* PH*7 °>t\9° ' t ' A T C M "77V* A£ ,?AlMl*7 M W m ^m C £*£A fA£7+?A:: 77 nA,M** AAC* P7-^ W t h l g . **7C M * WT .P^TAtfA:: £*7V* *T<^*79 ÂhfPV*7 Âi°7i^7 ÂJP ^TGV*? n7i^7 n*7Aam71 ^7ft;A O :: ^7>?7£,JP H?»? 0£A 7/JP (1A? Â?"7 Pfl)+n? j& ^ flA ^ A :: A?|V, *)£>*! ^TCV* A^.7^ +7 hin *ruC'fe Vflh:: *77 071^9 If4? A.^'H A>«7£* ‘#’7 A£lf7 AA,h7£:JP >iAÂ7fl>r:: >.^, 0AÂ7flhJP P^J&fl)* 7-H lfV9 h Â H 9 ° C M h k t . h & . f l S A.A* * 9 ° ^^^97^ *77 POA^7 M IfÂ::

^ A 79 A^*? P5P*Tiflh7 M^*77 h + P K n h i t T<< A?° hl.5- 2 "T.A.P”? h?lj&^ ^<177 PU^?° T*7C m V + r h , hÂ*7 J&A* "700A7 <^Cm9A:: n^J&iA' P^^Ti PÂafflJ-Ty0 h * ? M C f a P-f^rhn*? +*7nc ^»£C77 A7£°79(D^ INV ?«VCA'7 n^'VAA l>iâ)«7 A90-flAA7:: infO^T?" AA+Afl)mr n^7A* ?»7a)*A‘PA7:: (D4>A A.»AA?°:: *77 U'A, fl)^7S ^ >»7t>7 HJ& v5*:: A ^ l/ ’V’ >»*? ?»CA* AJ&"7C A A + ^ i? AHU UTZ-O J^7 /i£*C77AÂ? A9££Ct7A*A ?i7*f,AA7? ?iHU A£ n+*7nc A l ^ X ^ f a h PflT.7077 T*fe* IÂA^ Afl) J&j&* ?i7«SVA ^ + ^ .A 1 :-

> >»? P+°7CVa)' ?i9+^^779 . P A * ^ rt,7-*7 n^A+O flC h?Tj&^ hT PLP77 A.f-^f +A4. n ^ iT A.+? M^V*7 ?.7£ ^^/7^ <^lb h"7P* ?i7*Pfll'fl:: ^A77 ^ ^ 7 h"7A* ?»7^mC^

1 Student at Central Health College, Addis Ababa.

72 Proceedings of Workshops on HIV/AIDS and College Girls in Addis Ababa (BSE, 2004/05)

A.A-* h i m ^ r :: h+A4^ “l i r * A * p ^^cao * m r * pa?°9 ?iû w * ? +°?nc n^6'^ Â-n PA7tMl?a:: > A,* A£? A,* ?i9** A,* CD'Tl'K A£* 7°AA,9 h C h f A,* A£ <^0/> ^rrvflÂ* JH^CO P?TJ;*'h'flC9 P^'WrWl* A,* Aa>’ hfi£^ *A"1A*:: rta?'>r MA4< h'T'AW ’:: ®7*> fcW'Y.lf4?* A"7CD^ ?r^f\(V'l V'hl ^ C ^ A * : : UK^M.n h.K(^ in hA,A°T 'K iH W i* :: > dO)’ A»A°* AA££7' ?iW° A'Th^fl)* h ^ A * £A<> oo%ao&p *7?*? hP7(D* fD'AT 'flpP tfDCm? tfo+^nc J&7H9A::

.PUA hAh' XAvda'} »1£ .PA ^-M *7A ‘1A* 0A*X* ‘7'T'a7, T ? * ? ^ Am9*::

hP* 0»iF;hch>ab?

n i h & c r h m ? h A h£C1” T C A 7 hPT1^ * A * A ^ A ’ j& g/P 'nA A,h A h A A,^a)> £7^,A ■7*} twl-Z-b 0A C'D^fl^^ ^ A hTir £"l u r cro^

/S')*A* hJ&^AT0 P*tA * A 7 0 u r J ^ h A fiTD^* 't'OO^d)' 7^ 7A 7^ f l > Aj&nA’ 1\ flfi* M\UU' + ‘?nn<'a)* flA,h*}** PHA^AT” 7f^ 4iA * A + 'TH14’> h7^ ?%h *7ChU "14*^ n A + u

73 Sensitized Girls = Healthy Generation Views of College Girls

A T c r h & irir kflu h ^ M rn-fiTu? hOA Q,rn h & k iA u r ^ i hh+UA.) ft')W r in i> A T M A PTn^i PTft-P1 fD'fiTu? h°5irn

*7f hJ&AUJP hl& ht]\h hlfi~ flM'fll) oviPfy^ hU'lt) Tit*! hi+i 4& (\.in A,A H AV hh ? 7 1 n ? z c ? 6 \ ' t ^ ^ A A * OA*‘/° 'M A^ cd££Vfl)* bifi^o') n£>n 'n

«fcA#A vu m m * A * A 'f'A « 'F-A” 'fl+ A ^ C f ) 9°T T ? ^ h V*£U7£ Mi h,P* 0°<£;hrthCD' CD '- h'fliCD’

74 Proceedings of Workshops on HIV/AIDS and College Girls in Addis Ababa (BSE, 2004/05)

it.

n7ic A°"n 1

(ln .e ^ A h al'fyV r> MAcd- ci)£ A a)- P ^ + A A * ? h & 'tf llT i^ ' 7ci>s j&u *.h£.ri *7T?-7** A.A-* P'fvn+^nffl)* ^Câ= ?DA^....fl)H+ £*7^ ^ n itf ^ h/H9* cd£ A £ ((17);>cd- ,PA11* 7<£ArivC ?i9* llfDA.fr 'UU h+CDA* ll^.A n ^ T O * fl)H+) ■*■ n h $ 9 hw.U'913 (i^cc hhnii *aa* hAn* n7i+? p c nÂAT0 ? =5- u^D?°'f'?CD- PA7l*JCD-'} £7° fin* (l^DCD-Afr CDll'f' 9'Tci)’:: nh^.h&.fl kfrA H7W'? PÂ^fcD’ ?°Ah^* ?*9 f^rt^cD* îA':: hVlLU?° ^h h A:- 1. *h^£9 P^tfCT AA • 2. PlPCD-7* <^*7 A 3. w n f - u Â^CD* *frA* 4. + ^ flr? T <* * c i)'h * 5. ? h ¥ r

^frA nhov- x h , n°/A?° A.e, n+Aj&y° m c ** CIM’*9 “m il, rPA7^' tfDlf9'Tci> 70M: ll'/liU hlTM T'K IlM 'P'A’^ IW’AA* h^m** ûnÂP* ^hhA n7 ^ * ? h . b S°^ ^ iK ^ -P A -ltA 'P7? ?°h?.P* lf5;A:: MLU A£ ^V«V> .PAn* T .P * Prt.'f-T- + A * G ^ E 4? a77A9 n>b*.*£.fc fi.e,£A <7°A4^h* A.e, jr*? h £ 7 * h'JfrTV' .fc^'PA? PÂCD* 7cD:: j&U? T.P* A^JÂA CD^l* A,* n?l.e,Â- A?cn^ ?1?*AA'>? f^.AcD’ T^* ôÂA Â0* ,& ^ A A ^ A ::

a ,* - v ^ ^ v nûc* Âr ?Â7 nr? nk*.h£.n n'n^ ?i?mÂ'>? Allu Â A A.lf7’ ^DhhA nî5? (1M*A;- 1. nA.e, A'illJ^ £A^ P^ Âm*: 2. 7?llfl hAfcD- Â"7A* 'l\l? < E P7?H-nS' fT‘>a7T‘>‘/° Atf7^,A* h*^c n^* n+A^P {VPY f"7.m*A' ^T'CD*::

,e,u?u cd-a° hfrc* fh .V .h & .m n.e,Â îlh^ h^ruc^T? Â+^*>A ,(V o rn A :: ,e,u A.M A* P ^ ^ A cd* A . ^ A ^ * 1169*9 n c ir 7 ^ * ? ^cu A.e,ir?T nÂA9 n+A^p ^nnA a^ aa^/.it? “n ^ ' i - u r * a n*A ?iPAA9 ?aP*7A AAlfV CD-m,* ÂH .e,lT9A::

1 Awoliya College, Addis Ababa.

75 Sensitized Girls » Healthy Generation Views of College Girls m iu t * * a n ** o)£nu p®i74.*n* p'tvw n<**>HCP* V©:: "7A*?0:- 1. fmu* (Dixr*1!* f+^n n^rAA* 2. a*n*7i7 A ^ m .? p£?° AA.A-* <7B'H9?*p:F 7?H-n IW im * * 4. na)'Il‘M * 7.H.T1 tf*>6EU.CT ^d'OA** ^ m ^ ^ A n A * ? "77/? n^*>7C ©6R r u n t f ^ 5. ©* +A.PP h ' } * ' } & 9 ° hh^*? abcn. *Pa>A£ (WVTf?4?** 6. AAÛC^fi +4^*4 ntfÂA fc'M'HftVti Oj&AhAfi *'>£‘T.(PA+'FC7i n^>97C n ^ i1?:: J&U P*?*?*: © 7** :: nnu Him IHTTC /"C h^fi i u a f \ h * P C ZH. hA£ Pm^+Akfahr? A»A-:f nw.0?" A-flfi? fl^ÂA *7rfw A:: 7. P^CAa* >»£7? k'ttlW *'>£*+£a>- h')SLa% ov'n^7\ A A ^ l^ fl)^m ? * n^^m C A'>£**C‘t/,fa)' j&^hCÂ:: 8. n>.«i h s t y w poa&v-k p^M m c a*** ^j&tja * 9. °7*ni A^ *77*** A,£d7° AÂ*? Hfr ZH AA^<£ WfrV** AAdCTH9* AAMAHC n f i ^ ^ K AA*,£A P*"/*'/* n W im * 10. ^ A Tft P ^# ^lm C 9 Pa7* £ Al.P ffl> ’'} n*Aj&^ PfflA.'fl T^4r7 *7°fl P ^ A * PmVhi if*? h7*f A ^ h T 0 h A h A ?»?£**mcR itfffi fc'}£,*a>A>l 0 ^ 7 4 ^ * ^ sr.A h2>>C7i AÔflA 't\')£*z?aiaii ntroîi 1 1 . P'V'fli t \ P *7TfV* AJ’+C'fl ffl'n* A,**? P^m5P£ 7-A*7A M -flA- ( D & 9 ° MS*?* P^-fli t \ P *7TfV* AW.07° ^hn^flh A^£ AAAaM fl)A.*n A-hCd^T. P"7^©»feah flh'fl JiA?° A'tt?";*'# ^ ‘VC A'tt^.fchA* **7C flh A * JP h7-^7i >,7£*7.ir} nÂX* PfflA.-fl T.P*©*'} N'>£,* ‘#,flj& 0 ^ 7 4 ^ * ‘ t t f a b : :

W l-M . ftp •?Tfr»* T”? j&hft^A?

1. n+h^^j& hfc ^C P^-fli A^ WfrV* K lX + L P l ££C Â :: 2. *A n+A P ^ ^ C ^ A T I? A'î'flhn,1? P'T.ATTi'} Tf^C^]A:: 3. hA/i A,* ^ C £K5P * P*7-fWl *7 ^V* A^mêjp AÂ*7 'fl^ £lf9A:: P+Kîflh 7 1 ^ * ?»££C H ^ A A * J& î^lA::

5^7 £ir

1. £A+ Â7 AC^TfV h+hA+5^ hfr i7i»0VA7i7 J&h£9 J&Afl)C*fl7iA:: AAH U ^ nn.*An^7i^.U W * h+A£P A,f-^ ^C P^-fli °7^V* P^^-i*? A?°£ AAAfab A^HAHC AÂ P^ÂT A^-Affl)- Vfl)’:: 3. A^^.h^.n k£A h^^Ânh riiV W 5P n+AA’ A ^ o p A ^ ? ‘PV?a>- 9 * W ) f * Vah:: j&uJP W 0 ! * ' } ' } MJtWC*? h^lfV n*

76 Proceedings of Workshops on HIV/AIDS and College Girls in Addis Ababa (BSE, 2004/05)

Mart*'} ?t\ .fft+^A :: ?>»?£■ U'lC <)£*7* ?°

rtVliU *■?(?¥ ao^fb, n fllTJ J & ^ A ?

1. n n n ^ T a}h7'Y> z r c h$'n**ia)''} rrfv* t.p* m ^ ^ ha ■ 2. h?4' ons- f^n^Ar* ftrn^T- m f * r i s u n h'}£aV f'A (\0O{.** ovTUCJ 3. QAln r h l? ') ' f^C'flAT* mil'll flf";* M ^ ’fl A • 4. h A h A 5. f V f l A ^ A ^ V7C, ’f 'M i’i * M < 7 D fim * T 6. OlA tfoAh- ^7/99*: 7. n ^ u c ^ ? a .6 'fl?; ?©£<£,* uj&a)^^?? t\ci£ { . ai ^o^nc- 8. h ^'fl^ fl<£»* h^'fli /" ;? C7'>TV* fl)’ ?,*£• AW i* nd9* W>?u 10. hl>*

?i*/iiu9 mj& fH iH c tifa)’? M&trtxp'hrh, n*v(DM' s ^ ' r } u h z t\ m-M n V l t r 'm r nM i?^ A9A£;?'K ?i??D A?#1? JiWlrt?::

n?i*z,9 nj»axt,p M.K 'h iv i ^ r n ^ m ^ .e , OhfDA^ ^UniA-fl A?° Sensitization and Mobilization on HIV/AIDS Pictures GENERAL DISCUSSION - PHASE II

Chairperson: S/r Semira Afendi; Rapporteur: Teferi Mekonen

The Chairperson summarized the aims of BSE in organizing such workshops, the role of sensitization and mobilization of girl students on the fight against HIV/AIDS, the advantages of establishing girls club in each University/College, free and fair access for information in the campus, and establishing network among girls clubs. Having said so, the chairperson opened the floor for comments and questions.

COMMENTS

> A heartfelt appreciation was expressed to BSE for organizing this workshop, taking the lead to initiate sensitization and mobilization of girl students to fight against HIV/AIDS, and bringing girl students from different campuses together and inviting them to discuss on their burning issues and share their experiences. It has also been mentioned that BSE has contributed to realize the goal of strengthening/establishing girls club in the campuses. > It has been mentioned in the presentations that condom has a great advantage to prevent the transmission of HIV. However, its promotion on ETV is usually shot after beer advertisements. This trend tends to reflect a message of encouraging condom use for arrogant sexual activity and breaking abstinence and faithfulness. Therefore, it is good if BSE can make effort to revert the modes of condom promotion. > The advertisements of condom on ETV have very special and attractive artistic presentation. It can be captured easily and can be remembered as a good and only solution to prevent STD transmission. This by essence will rise sexual desire and encourage the people for sexual intercourses. The promotion should be made in a way that the use of condom is just to minimize the transmission risk but that cannot protect one from being infected. The risks must be made clear in each advertisement. > Sexual desire is clearly a natural feeling, but the most severe way of HIV transmission can be caused by exposed sexual activities. If we fail to respect the first two options (i.e. abstinence and be-faithful), then the use of condom is recommended only as a third option. From different publications and media announcement, the use of condom is clearly indicated as a strategy for the prevention of STD and HIV, it has also advantage in the prevention of unwanted pregnancy. However, failure in condom use has been observed in male partners. This workshop or any means of training must be conducted to teach males on the proper use of condoms. Sensitized Girls = Healthy Generation General Discussion

> In both the Muslim and Christian religions, it is clearly emphasized to be married and remain faithful to the spouse. Sexual activity before marriage is strictly forbidden and all should respect it as a daily life directive. Rather than talking about condom and investing in condom, it is wise and safe to follow the Holy Books (Holy Bible and Koran) to refrain from sex before marriage and remain faithful to the loved ones after being married. Therefore, there is a strong objection of condom introduction and promotion for use. It is also not a good idea to tell us about condom use as an option for prevention. The idea of condom use should be rejected completely! > Here in Ethiopia, like other developing countries, there is poor economic condition and unemployment in the population. These factors are the leading social and economic causes for the higher HIV transmission. Most of us here in this auditorium are students and must focus on how we can be employed and contribute for the development of our country after graduation. To achieve our best goal and help ourselves, please unite your effort and concentrate on your study, and disregard sexual activities before marriage. > All the ABC strategy needs genuine consensus to be implemented. We need to accept the very fact of condom use rather than bringing irrelevant and endless issues for discussion. What we need at this' point should be to understand the message addressed on each poster and TV advertisement. How many of us can understand the message of each poster? It has been seen also that ladies have encouraged male partners for sex by wearing seductive clothes and showing unnecessary exposures. Ladies go out simply for sex as a means of getting money and other kind of gift from male. First, let us fight this epidemic rather than blaming male partners and ridiculing condom use! We do not need to give it time. > It has been said so many times that females are the one who encourage males for sexual desire. However, to be clear that we females have a right to dress any type of clothes. For that matter, males also dressed in a manner-less fashion too. It is rather good to teach them to behave themselves rather than blaming females. > In these days, the transmission of HIV in our setting is rampant. The basic reasons are due to neglecting or underestimating certain social and economic aspects. The following eight points are the major ones and if they can be corrected, the transmission rate will definitely be reduced. 1. Underestimating Marriage, 2. Healthy environment and society are not given value, 3. Artistic presentation of films and dramas that arose sexual desire, 4. Alcohol and drug use are not strictly forbidden, 5. Acceptance of commercial sex work as a means of income for living,

80 Proceedings of Workshops on HIV/AIDS and College Girls in Addis Ababa (BSE, 2004/05)

6. Manner-less and seducing appearance and clothing of females, 7. Gathering of females and males in one confined area (bus and school room), and 8. Very poor education on condom use.

QUESTIONS RAISED AND THEIR RESPONSES

> The prevalence rate of HIV in Ethiopia looks relatively high. In the presentation, it has been indicated that the prevalence rate is higher in Amhara Region as compared to the Southern Nations Nationalities and Peoples Region (SNNPR). What can be the reason for this significant variation in prevalence rate? How about the prevalence in urban and rural parts of the country? What was the basis for comparison of HIV prevalence in the two regions (Amhara and SNNPR)? Are other parameters like population size, culture, economic status, and population movements considered correctly? > Different findings indicate that HIV prevalence can vary from place to place. Available evidence on the prevalence of HIV in urban parts of Ethiopia suggests that of the major 5 regions, Amhara Region was the most affected region, followed by Addis Ababa, Oromia, Tigray, and SNNPR. Homogeneity in the spread of HIV in the rural areas has been observed. The same study on male army recruits showed the prevalence rate in SNNPR as 4.3% and 10.5% higher in Amhara Region. Actually the most specific reasons are not articulated in the work, nor have the population size, culture, economic status of the regions have been considered. However, as it is indicated in different works of other places, the most likely factors for the uneven spread of HIV among regions might be socio-economic, cultural, demographic factors, sexual behavior patterns and the prevalence of STIs. ® Proper use of Condom is recommended as an option for the prevention of HIV. What is the efficiency of condom in the prevention of HIV? Is the rumor about the transmission of HIV by the condom itself true? > Nowadays all condoms are made from latex and the quality is electronically tested before marketing. Here in Ethiopia, all imported condoms are tested by Drug Administration and Control Authority. So far there is no scientific evidence presented on the probability of transmission of HIV by the condom itself. Other than such rumors, there is no side- effect or complaint. ® It has been observed that condoms are shelved in kiosks, shops, bars and hotels at different places and within poor quality containers; consequently, exposure to sun, heat, wind and other conditions. Does this have any effect on the efficiency of condom? > It is recommended to keep condoms in safer places, otherwise its quality will be in question mark. Care should be given when condoms are purchased, i.e.

81 Sensitized Giris = Healthy Generation General Discussion

the package MUST be intact, there should not be any physical damage on it, and it should not to be used beyond the expiry date. • The percentage of HIV transmission is different between males and females. However, it has been reported that there is discordant infection. What is the main reason for the discordance and how often does it happen? > The number of HIV infected students in Queens’ College has increased from year to year, and more of the victims are female students. Based on this information, is it possible to sa> that students from private colleges are highly infected (because it has been once mentioned in one new paper)? > Biologically, females are more vulnerable lor HIV infection as compared to the male partner. In most discordam cases, the couples might not have been tested for HIV before they start sexual intercourse and could not assure how one of them became infected. At any rate, for the transmission of HIV to take place there are certain factors like higher viral load, advanced disease stage and STI. There are cases where one naturally gets deletion of the viral receptive part of the immune cells, in which case they are mostly not infected. One good example for such kind of non-infection is the prostitutes in Kenya who have been on commercial sex work but remain uninfected for long period of time. > Regarding the increment of HIV infection in private Colleges, there is no scientific justification; it is entirely based on personal observation. This area needs to be addressed in the future! • Why did you (BSE) not invite the government officials who can take our comments, raised questions and other information to be addressed with special emphasis? > BSE has consecutively invited different governmental official to participate in these sensitization workshops, but most of them declined to be involved, other than EHNRI and Family Planning. Addis Ababa HAPCO is a good example that cannot show up for participation. However, our effort will continue to bring such officials to the workshops. At this point, we have to appreciate the concern and support given by UNFPA. • There are people whose status becomes worse and their symptoms aggravated even if they have started treatments with ART. How is this happening to them and can we say that the drug is not effective for these people? > There are various reasons for such cases - the development of TB, cancer, drug resistance and poor adherence - where the drug has no effect to minimize the viral load and rebuild the immune system. In a very poor country like Ethiopia, drug resistance and sensitivity tests cannot be done and in most cases the administered drug could not have the appropriate effect on the virus strains. Treatment with monotherapy has a higher probability of developing drug resistance. On the other hand, higher doses of drug to overcome resistance level lead to increased risk of side effects. Nutrition, treatment for other infections and prophylaxes for OIs along with HART (combination therapy) is

82 Proceedings of Workshops on HIV/AIDS and College Girls in Addis Ababa (BSE, 2004/05)

the most reliable and effective means of treating HIV/AIDS patients and prolonging their life. ® BSE has organized such workshops for girl students in the universities, and colleges, what is the plan/effort to organize workshops for high school students? > BSE has planned to launch these workshops in phases - the first phase is for university/college students, and the second one will be for high schools. Since the number of high schools is tremendously high in the capital, it is not possible for logistic purpose to make it at the same time. Other than high schools, there is a plan to undertake such workshops in the other universities/colleges outside Addis Ababa, but the experience we got so far will help us to implement it in a very coordinated way. One main advantage of such workshop is to get girl students together and discuss on their basic needs. Such valuable information will help for the more successful implementation of the next steps. • Why doesn’t BSE arrange for educating girl students on how to prevent pregnancy and family planning in general? FP is pleased to be invited to participate in such workshops, and provide valuable information to the targeted audience -like girl students in this case. FP believes that every human has a right to get information and equal service. Family planning clinics are established in different parts of the country based on this fact and are giving services to all freely and equally. There are different posters and written materials (in local languages) distributed among the population to provide information to have a planed family structure, prevent unwanted family crises and produce healthier generation. Family planning based study in Gondar University has indicated that there is a high rate of abortion and a study in Jimma University shows a high prevalence of HIV infection among the students. At this point, there is a need to prevent the transmission of HIV and avoid unwanted pregnancy by coordinating FP with VCT. FP highly promotes condom for prevention of infections and unwanted pregnancies. Whether someone rejects or accepts the promotion of condom; since scientific evidences are supporting the use of condom as a third option for safe sex, FP will advocate for that, and distribute condoms. There is a plan for extending FP services in the universities/colleges. • What strategies did Uganda used to fight the HIV/AIDS epidemic in the country? What lessons can we learn from their strategy to fight HIV/AIDS? > After observing the catastrophic death of most residents in one area, the government officials started to work very hard. Governmental officials have internalized the problems and mobilized the public to fight the pandemic. The good example is that the President visited all the affected people, undertook voluntary test publicly, and made a speech that was aired on the national radio

83 Sensitized Girls - Healthy Generation General Discussion

on a daily basis. They have estabhshed VCT at a district level and all services are given freely. Campaign to avoid stigma and discrimination, provision of intensive free care and treatment of HIV/AIDS patients at home, clinic and hospital-based service also played a great role. The main success in the reduction of HIV transmission is achieved by serious implementation of ABC strategies, public education on the mode of HIV transmission and its prevention.

CLOSING REMARKS BY THE V/PRESIDENT OF AWOLIYA COLLEGE

Dr. Abdela Kedir

• The best of protection is attack and intensive fight against the cause of a problem, • Religion plays a great role in the fight/control, • Practice the lessons learnt from Uganda and other nations on the fight against HIV/AIDS, • Cleaning ourselves and our surroundings for the well-being of the population, • Educating the next generation for more protection and more peaceful world, and • Finally, appreciated the efforts of BSE, organizers, presenters, and all the audience.

84 ETHIOPIAN JOURNAL OF BIOLOGICAL SCIENCES

Publish Your Manuscripts in the

Ethiopian Journal of Biological Sciences (EJBS)

For further enquiries, please contact the EJBS Secretariat at:

PO Box 31819 Addis Ababa, Ethiopia. Tel.: 251-11-1573422 E-mail: [email protected]

Coming soon: EJBS Vol. 4 No. 1 and Vol.4 No.2 THE BIOLOGICAL SOCIETY OF ETHIOPIA

Ob je c t iv e s Create awareness on environment O rganization and development issues in the formal The Society is governed by an officially and informal education sectors and registered constitution and is managed by an Executive Committee elected for a period of two amongst the general public; years by the General Assembly. The Executive Promote biological research and Committee consists of President, Vice president, encourage biologists to strive for Secretary, Treasurer, Editor-in-Chief, Public professional excellence; Relations Officer and three ordinary members. In Contribute to the growth and addition, it has a Programme Coordinator to run development of biological education the Society’s activities. and give technical support and encouragement particularly to M e m b e r s h ip biology teachers; There are four types of membership: Regular - those who have a diploma or higher Enable biologists to interact with qualifications in biology or those who have their local as well as international studied biology for at least two years at university counterparts through seminars, level; , 1 workshops, symposia, publications, Associate - Biology teachers or persons engaged etc.; in biological research who do not fulfill the Popularize biological science requirement for regular membership; through publications and the mass Institutional - institutions wishing to support and media; benefit from some of the activities of the Society; Provide consultancy services and and Student - those registered in higher education conduct collaborative investigations institutions and who are majoring in biology. on issues that require biological

expertise; C u r r e n t o f f ic e HOLDERS OF THE BSE Publish scientific journals and President: Dr Yalemtsehay Mekonnen other documents as media for V/President: Dr Mekuria Lakew communication among its members Secretary: W/t Eden Ephraim and the general public. Treasurer: Dr Gurja Belay Editor: Dr Seyoum Mengistou PR Officer: Ato Mulu Bitew A c t iv it ie s bl Organize conferences, workshops, Members: Dr Tilahun T/Haimanot W/o Tsehaynesh Lema seminars, panel discussions and film Ato Befekadu Refera shows; Auditors: W/t Adey Feleke Support the existing environmental education school clubs and encourage the Prog. Coord.: Ato Abebe Ameha Ato Delelegn Woyessa establishment of others; Assist. Prog. C.: W/t Menaleshewa Tadesse Publish background reading materials Office Assistant: on biological topics in English and the main local languages to improve the All inquiries about the BSE understanding of biological issues for can be addressed to: students, teachers, and the general public; The Secretariat bl Create networks with sister societies The Biological Society of Ethiopia and organizations at national and ISl 31819 international levels on matters of Addis Ababa, Ethiopia common interest; 9 011-157 3422 or 01 1-123 9477 Ext. 234 Seek for funds to support the society's Fax 011-155 2350 activities. E-mail: [email protected] THE BIOLOGICAL SOCIETY OF ETHIOPIA

A Few Messages about the Sensitization Workshops

SENSITIZED GIRLS = HEALTHY GENERATION (From the Biological Society of Ethiopia)

Ethiopia is currently facing a major health problem, that of HIV/AEDS, which is severely affecting the life, economy and social interaction of the victims, their families and the society at large. Recent efforts to create awareness and reduce the spread of the disease do not seem to have given satisfactory results. News and data that are released every other day demonstrate this fact. As with many other social and economic issues, women in general and girls in particular are easily vulnerable to the pandemic.

Females have a higher chance of being infected with HIV during unprotected sexual intercourse. Women and girls usually take the responsibility of caring for AIDS patients in the family, and may suffer economically when the husband dies of AIDS. For these and other cultural reasons, usually girls are the ones who are deprived of the opportunity to go to school. Those girls who have joined higher education institutions are the ones that got the chance to break through these barriers. However, these groups also face the risk of being infected with HIV. That is because they belong to the age group of females (15-24) that have a higher prevalence for HIV/AIDS than their male counterparts. The worst part is that the status of college girls with respect to prevalence and impact of HIV/AIDS is not evidenced to date.

Girls at higher learning institutions need be a point of focus in the fight against AIDS; they are the models and educated mothers of future Ethiopia. The Biological Society of Ethiopia (BSE), therefore, organized successive sensitizing workshops for these target groups under the main theme "Sensitized Girls = Healthy Generation". This is believed to be a contribution to the World AIDS Campaign 2004 that has a thematic focus on Women, Girls, HIV and AIDS. The outputs of the Workshops could be of benefit to college girls, their families and the society as a whole.

CAMPUS GIRLS CONFRONT AIDS: REAL VOICES FROM THE REAL WORLD

Twenty years after the first clinical evidence of AIDS, mankind is still dealing with the disease. This scourge has killed infants, children and adults in large numbers. The statistics of mortality and infection are incredible, and they continue to mount by the day. AIDS is one of the No. 1 killers in Africa today. Available statistics SENSITIZED GIRLS - HEALTHY GENERATION also show that across the continent, there are 3.4 million infections every year and 28 million people living with HIV/AIDS. Life expectancy is gradually declining to 30 years. Despite some good examples in reducing HIV prevalence cases given by some countries like Uganda, Cambodia and Thailand, HIV continues largely to spread uncontrolled. The factors enabling HIV spread are similar worldwide and include poverty, lack of education, economic insecurity, lack of female empowerment, social exclusion, sexual exploitation, and lack of information and/or commodities for self-protection. The case of Ethiopia is not far from this fact. Everyone should understand that it is a necessity to educate on how to make responsible decisions since HIV/AIDS is something one can get and must be aware of.

It's a huge problem, but as a girl, a college girl, we can really make a difference. As has been said by a college student: “How we deal with AIDS and its effects will be the heritage that our generation leaves”. We are in the age of having a golden opportunity to do so many meaningful things. We must.... we must be sensitive to do something relevant to the current state o f the epidemic. Let us make an impact with the superior quality we have on ourselves, by making quality decisions in our life and strengthening our attitude towards fighting HIV/AIDS.

Finally we must ask each other: “I care, do you?”

HIV INFECTION AND ITS PREVENTION (Contributed by Teferi Mekonen)

Course of HIV Infection: typically follows > Primary acute infection with a characteristic clinical picture, > Prolonged period without visible symptoms, > Severe immunodeficiency resulting in secondary opportunistic infections and tumors

Modes of HIV Transmission: > Sexual intercourse (anal or vaginal) The risk of transmission of HIV through sex is higher if the sex involves anal sex or rough sex (rape) that causes lesions, if sexually transmitted infections are present, if the vagina is immature, if the women is menstruating, if the man is uncircumcised, and/or if the HIV-positive person is newly infected or in the late stages of infection. THE BIOLOGICAL SOCIETY OF ETHIOPIA

> Contamination with blood Transfusion of HIV-infected blood and blood products, use of contaminated cutting/piercing, syringes or surgical equipment, and sharing of contaminated needles in drug injection are the ways for HIV infection. > Mother-to-Child Transmission HIV can be transmitted to an infant during pregnancy, labour and delivery or breastfeeding. Factors that influence the risk of infection are higher viral load of the mother at birth, low CD4 count, Vitamin-A deficiency, presence of STI, sexual activity during pregnancy, and mode of delivery.

Vulnerability to HIV Infection: > Drunk people - alcohol affects an individual’s ability to make decisions and negotiate or demand safe sex, thereby increasing their risk of acquiring and transmitting the virus. > Circumstances - that cause vulnerability include poverty, low social status, inequality, discrimination, marginalization, and criminalization. > HIV infected people - they have less means to live positively with AIDS, because they cannot afford treatment, cannot access care, may lose their jobs and resources (more impoverished), may face increased stigma and discrimination.

Strategy for Prevention and Care: > Apply the ABC-rules (A- abstinence, B- be faithful, C- use condom) > Use of antiretroviral drugs > Safe delivery practices, and breast milk substitutes > Disinfection and sterilization of instruments (needles, cutting and piercing materials, surgery and dentistry equipments) > Transfusion of screened blood > Protect health care workers > Mobilizing and building human capacity to respond to, cope with, and overcome the effects of HIV/AIDS (e.g. education) > Make available (accessible) voluntary counselling and testing services > Investment in future technologies (e.g. Vaccines and microbicides) > Intensifying poverty reduction and improvement of social services as well as behaviour change o Family planning o Good nutrition o Social, spiritual, psychological and peer support o Respect for human rights o Reduction of the stigma associated with HIV/AIDS

For more information on HIV diagnostics, visit: http://www.who.int/bct/ SENSITIZED GIRLS = HEALTHY GENERATION The Biological Society of Bthiopia Available Booklets

The Biological Society of Ethiopia publishes the Ethiopian Journal of Biological Sciences (EJBS) and proceedings of the Society's conferences. The following booklets are available for subscription or can be collected for free at the Secretariat Office.

Type of Year of No. of Title Publication Publication Pages

Ethiopian Journal of Biological Sciences 3(2) Journal Sep. 2004 123 Ethiopian Journal of Biological Sciences 3(1) Journal Mar. 2004 111 Ethiopian Journal of Biological Sciences 2(2) Journal Sep. 2003 130 Ethiopian Journal of Biological Sciences 2(1) Journal Mar. 2003 92 Ethiopian Journal of Biological Sciences 1(1) . Journal Sep. 2002 128 Sensitization and Mobilization on HrV/AIDS Proceedings 2005 84 Wetlands and Aquatic Resources of Ethiopia: Proceedings 2003 101 Status, challenges and prospects The Wildlife Conservation Areas of Ethiopia: Proceedings 2002 114 Current status and future prospects Imperative Problems Associated with Forestry in Proceedings Feb. 2001 154 Ethiopia Update on HIV/AIDS Intervention and Research Proceedings Jan. 2001 104 Issues Book of Ethiopia; A biodiversity challenge 2000 154 Abstracts Biological Society of Ethiopia Activity Report Report 2000 65 (1996-2000) Have We Valued Our Biodiversity? Proceedings Feb. 1999 137 Investment Yale Akababi Tifat (Amharic) Proceedings S e p .1999 63 Aklilu Lemma International Memorial 91 Proceedings 1997 Symposium Practical Approaches in the Teaching of Biology in Ethiopian High Schools (1992); and Proceedings 1995 79 Strategic Plan for Environmental Education (1994) Panel on Population-Resource Balance Proceedings Jun. 1994 41 Inaugural Conference of the Biological Society Proceedings 1989 47 of Ethiopia

O u r address: The Secretarial, The Biological Society'of Ethiopia. PO Box 31819, Addis Ababa, Ethiopia. Fax: (251) 1 I 155 2350, Phone: (251)11 157 3422 OR (2 5 1) 11 123 9477 Ext. 234. E-mail: [email protected]

Berhanena Selam Printing Enterprise