Making Key Populations a Priority in Ethiopia

By Heather Awsumb, Deputy Director, HIV & TB, PSI

Haimanot’s husband left her 6 years ago.

A mother of two, Haimanot supports her family by selling coffee and tea by the roadside. She also makes money as a sex worker.

Haimanot lives in the rolling hills of Addis Ketema, one of 10 sub-cities of the Ethiopian capital city of Addis Ababa and home of Africa’s largest open-air marketplace. Haimi, as her friends call her, loves to read, taking any chance she can to crack open a book.

In June 2017, Haimi’s friend informed her about a drop-in center (DIC) run by PSI/Ethiopia. Her friend, an HIV peer educator, told her it was a fun place to socialize. So, Haimi started visiting the center every day to wash her family’s laundry and watch TV. The center also offers HIV testing services, funded by the five-year USAID MULU/MARPs HIV Prevention project. Each time Haimi came into the center, a nurse offered her an opportunity to test for HIV. Every time, she refused. After many weeks of coming to the center, Haimi felt comfortable enough to accept the nurse’s offer. When she saw the positive result of the test, she was distraught.

“I cried a lot,” she said. “It was painful, and I was not able to accept the result.”

The drop-in center in Addis Ketema is part of the MULU MELA clinical network, which brings together governmental, non-governmental and private facilities. Through this network, the MULU/MARPS project reached over 590,000 female sex workers and other priority populations. Over 540,000 people received HIV testing and counseling services through the project, of which 17,000 were identified as HIV positive and linked to treatment. As part of this strategic network, DICs function as community-based, central hubs that offer confidential, comprehensive and friendly services to female sex workers.

Initially, when sex workers like Haimi came to the drop-in center and tested positive for HIV, they were referred to a government clinic to receive treatment. With this referral method, only 52% of the women came to the facility, and only 11% started treatment. This was largely due to the stigma they faced at the clinic and the inconvenience of multiple visits. Recognizing the women’s need for comfortable, stigma-free environments, PSI/Ethiopia successfully advocated to the Ethiopian government to allow for provision of antiretroviral (ARV) therapy at drop-in centers. In 2016, PSI/Ethiopia became the first organization in Ethiopia to offer HIV treatment outside of government clinics.

At the drop-in centers, staff are trained to provide HIV testing and treatment services to the women who visit, free of judgement. Since treatment was introduced at the DIC in Addis Ketema, 92% of the women who tested positive have started treatment. A year later, all of these women have continued treatment at the center.

After Haimi learned of her positive HIV status, a case manager from the drop-in center came to visit her. The case manager shared her own HIV status and success with ARV therapy. Hearing this story convinced Haimi that she, too, could successfully take HIV treatment.

“I will live like others,” she asserts.

The MULU/MARPs program currently provides HIV treatment to more than 1,500 sex workers like Haimi at 25 drop-in centers across Ethiopia.

To continue the success of the MULU/MARPs project, USAID has awarded PSI/Ethiopia a five-year follow-on project called “HIV Services for Key and Priority Populations” (HS-KPP). This project will enhance best practices and innovations found during past projects.

Click here to learn more about PSI’s work with HIV.

Banner photo: © Population Services International / Sophia Greenbaum