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Ethiopia strives to control HIV

The Baltimore Sun

AIDS: A U.S. nonprofit and the Ethiopian army have formed a partnership to promote the use of condoms and safer sexual practices, with encouraging results.

By Mike Tidwell

Originally published Mar 5, 2002

ADDIS ABABA, Ethiopia - Having stopped the bombing and killing of its now-settled border war with Eritrea, the Ethiopian army in recent months has taken on an unlikely new mission: saving as many lives as possible from the deadly scourge of AIDS.

In an unusual relationship that might soon be duplicated across Africa, the Ethiopian military has teamed up with an American nonprofit organization to successfully transform the sexual lives of its quarter-million soldiers.

Years of AIDS-awareness training, coupled with a policy of supplying condoms with every paycheck and frisking soldiers to confirm they're carrying condoms when they leave military bases, are paying off in the form of an HIV infection rate so low it's the envy of the continent.

And now, with the Eritrean war over, the Ethiopian government is demobilizing tens of thousands of HIV-free soldiers with the hope they'll become agents of change and messengers of hope in a nation that contains 10 percent of the world's HIV-infected people.

"Armies in Africa have traditionally been terrible breeding grounds for AIDS," says Emelia Timpo, a representative for the United Nations AIDS Program (UNAIDS) in Ethiopia. "Soldiers turn to prostitutes, then carry the virus to every corner of the country after their service. "But in Ethiopia, the opposite is happening: Soldiers have become safe-sex practitioners and peer educators." On a continent ravaged by HIV infection - up to 25 million deaths are expected by 2010 - success stories have been few, especially among Africa's armies, where infection rates often soar to 30 or 40 percent. But the infection rate in the Ethiopian army is only 5 percent, two percentage points lower than the rate of the country's civilian adult population, rare indeed.

The seeds of this success began in 1997 when the Ethiopian army began buying millions of condoms from DKT International, an American organization that uses a technique called "social marketing" to fight
HIV infection and promote family planning. With funding from international donors, DKT greatly subsidizes the price of condoms in poor countries, then sells the condoms - at prices even the poorest can afford - at commercial outlets throughout the nation, using advertising and other marketing means to stimulate sales. All revenues - which are significant even when condoms are priced at just a penny each - are invested back into the operation, thus allowing classic commercial methods to serve the humanitarian goal of AIDS reduction. In the 1990s, as HIV cases began to explode across Africa, the Ethiopian army approached DKT for more. The two groups worked together to produce a video and tens of thousands of booklets and comic books, all distributed to soldiers, on HIV and other sexually transmitted diseases. Soldiers also received 20 or more condoms with each monthly paycheck and were strictly prohibited from leaving military bases unless carrying condoms.

The result, according to UNAIDS, is a condom user rate of about 85 percent within the Ethiopian army. "We learned from the experience of armies in Uganda and Zimbabwe and other African nations that the time to combat AIDS is before the infection rate gets high," says Capt. Germachew Mamu, head of the Ethiopian army's HIV/AIDS Prevention and Control Team. "There's no question that a key to keeping HIV under control across a nation is to keep it under control in the military." Sandra Gass, an American who is director of DKT operations in Ethiopia, says the good results have exceeded expectations. "When we began working in Ethiopia in 1990, it was nearly impossible to find a condom anywhere in the country," says Gass. "Now we sell 50 million a year, not just to the military, but all across Ethiopia." As for the army program, Gass says, "Our ability to provide a reliable supply of quality condoms at an affordable price, combined with the army's discipline for seeing that those condoms are distributed and used within their ranks, has had an impact that has other African armies paying attention."

The goal now, according to Germachew and others, is for the nation's demobilized soldiers to fan out across the country to their home communities and become models for millions of other Ethiopians, carrying the message and practice of safe sex. Such a strategy can succeed only if affordable condoms are available wherever the soldiers wind up, including rural areas, where 85 percent of Ethiopians live. "And that's the strength of DKT's work," says Vathani Amirthanayagam, a health specialist for the Ethiopia office of the United States Agency for International Development. "Through social marketing, condoms and information on how to use them are available for pennies even in the most remote villages. They're sold in kiosks and small pharmacies and outdoor markets. It's phenomenal."

As international attention and increased funding pour into Africa in light of the still-growing AIDS epidemic there, the success of DKT in reaching rural areas, plus its extraordinary partnership with the Ethiopian army, have convinced many observers that social marketing can and should play a very big role in the future fight against AIDS across the continent. "You can reach a larger number of people in a shorter period of time [with social marketing] than is usually the case with governments trying to directly do the work themselves through clinics and the like," says Timpo. "Socially marketed products just have more reach."

Copyright 2002,

The Baltimore Sun