TRANSPORT AGAINST HIV/AIDS THE ADDIS-DJIBOUTI CORRIDOR Sameh El-Saharty, MD, MPH Senior Health...

TRANSPORT TRANSPORT AGAINST HIV/AIDSAGAINST HIV/AIDS

THE ADDIS-DJIBOUTI CORRIDORTHE ADDIS-DJIBOUTI CORRIDOR

Sameh El-Saharty, MD, MPH

Senior Health Policy SpecialistThe World Bank

World AIDS Day EventWorld AIDS Day Event

Transport and Social Responsibility Thematic GroupTransport and Social Responsibility Thematic Group

Washington, DC – November 28, 2007Washington, DC – November 28, 2007

November 2007 Dr. Sameh El-Saharty - The World Bank 2

PRESENTATION OUTLINEPRESENTATION OUTLINE

Country & Sector Context Djibouti HIV/AIDS Project Design Ethiopia HIV/AIDS interventions for

truckers Djibouti HIV/AIDS interventions for

transport sector workers Results Transport Sector Challenges


ADDIS – DJIBOUTIADDIS – DJIBOUTITRANSPORT CORRIDORTRANSPORT CORRIDOR


COUNTRY CONTEXTCOUNTRY CONTEXT

23 000 sq km Population: 795 000

75% living in poverty 75% urban population

Religion: 99% Muslim Per capita income: $780 Economy:

90% of food imported (Ethiopia, Yemen, Europe)

relies on service & trade sectors from its port

Primary school enrollment: 39 %.


HEALTH SECTOR CONTEXTHEALTH SECTOR CONTEXT

One of the poorest health indicators in the world & below regional averages Infant mortality: 67 per 1000 live births Child mortality: 94 per 1000 live births Maternal mortality: 540/100,000 live births

Incidence of infectious diseases is high & rising (HIV/AIDS, malaria, & TB)

Health expenditures = 7 percent of GDP


DJIBOUTI AND HIV/AIDSDJIBOUTI AND HIV/AIDS

The analysis of the AIDS cases reported in 1999 indicated that:

Transmission mostly heterosexual Persons aged 15-29 represent 47.4 percent

of registered AIDS cases Women are infected at a younger age than

men

HIV/AIDS Seroprevalence rate (2001): General population: 3% Prevalence among 20 – 35y: 5%


HIV/AIDS, MALARIA, AND HIV/AIDS, MALARIA, AND TUBERCULOSIS CONTROL PROJECTTUBERCULOSIS CONTROL PROJECT

US$12.0 million Grant to Djibouti

Project Objectives: To prevent HIV infection To provide care, support,

and treatment to people with HIV in Djibouti

To treat and control the spread of malaria and TB


Project components: Capacity building and policy development Health sector response to HIV/AIDS, TB, &

malaria including prevention, treatment, and integrated care

Multisector response to HIV/AIDS prevention and care

Community-based initiatives for the three diseases.

HIV/AIDS, MALARIA, AND HIV/AIDS, MALARIA, AND TUBERCULOSIS CONTROL PROJECTTUBERCULOSIS CONTROL PROJECT


THE CORRIDOR TO TRADE & AIDSTHE CORRIDOR TO TRADE & AIDS Addis-Djibouti Trade Corridor: 850 Km two-way stretch that has

more than 27 towns/stops. About 4000 truckers and assistants traverse daily Truckers stop for meals, overnight stay, meet with sex workers

in hotels and bars, and engage in unprotected sex. The majority of the truckers along the corridor are Ethiopian Ethiopia has a national prevalence rate of 6.6 percent in the

adult population and an estimated 13.7 percent in the urban population.

Djibouti is therefore highly susceptible to the cross-border HIV transmission through the transport sector.

The risk is not only of becoming infected with HIV but also of spreading it beyond the two countries through other corridors

HIV/AIDS will likely continue to seriously damage and diminish the health, economy and development of the country


ETHIOPIA: BEHAVIOR OF ETHIOPIA: BEHAVIOR OF TRANSPORT WORKERSTRANSPORT WORKERS

Many of the drivers and their assistants > 30 y old

Nearly all the respondents had attended school

More than 80 percent had never been married More than 93% of all the transport workers

lived in cities Most had worked as transport workers > 5

years More than 96% had circumcision

Source: High Risk Corridor Initiative (HRCI) supported by USAID Ethiopia (2004)Source: High Risk Corridor Initiative (HRCI) supported by USAID Ethiopia (2004)


ETHIOPIA: TRANSPORT ETHIOPIA: TRANSPORT SECTOR PROJECTSECTOR PROJECT

Objective: to target vulnerable groups along the Djibouti transport corridor through prevention, information, basic treatment, support and care services for underserved, vulnerable groups.

Targets of the project: 50 percent of persons in high-risk groups will have used a

condom during their last non-union sexual encounter (baseline was 20 percent)

85 percent of the vulnerable groups population will have been reached through Information, Education, and Communication (IEC) / Communication for Behavior Change (CBC) programs on HIV/AIDS.


Interventions to increase demand for HIV/AIDS related services along Ethiopia-Djibouti corridor Training of Field communicators Distribution of flyers, stickers, booklets, T-shirts,

pocket diaries, and song cassettes

Interventions to prevent the spread of the disease (condom distribution)

Interventions to detect HIV/AIDS (Voluntary Counseling and Testing Centers)

ETHIOPIA: TRANSPORT ETHIOPIA: TRANSPORT SECTOR PROJECT TOOLSSECTOR PROJECT TOOLS


INFORMATION, EDUCATION, & INFORMATION, EDUCATION, & COMMUNICATIONCOMMUNICATION

This information center is one the 21 HIV/AIDS sites set up by Save the Children along the Djibouti Corridor

(Photo by Marina Walker Guevara)


2050 truckers & assistants were trained on prevention methods

20 trained Field Communicators

19 Voluntary Counseling and Testing Centers

25 Information Centers established

50 % of the high risks groups have used a condom in their last non-marital sexual relation.

ETHIOPIA: TRANSPORT ETHIOPIA: TRANSPORT SECTOR PROJECT RESULTSSECTOR PROJECT RESULTS


DJIBOUTI PORTDJIBOUTI PORT

The Port of Djibouti is located at the crossroads of one of the busiest shipping routes in the world, linking Europe, the Far East, Africa and the Persian Gulf.


COMMUNITY RESPONSECOMMUNITY RESPONSE

NGOs are active in the fight of HIV/AIDS particularly around the port, e.g. PK12.


Built from an old shipping container, the UNICEF-sponsored information centre is helping educate young people about the danger of HIV and AIDS

INFORMATION, EDUCATION & INFORMATION, EDUCATION & COMMUNICATIONCOMMUNICATION


PEER EDUCATION - TAXI DRIVERSPEER EDUCATION - TAXI DRIVERS

Taxi drivers are a risk group in Djibouti as some sleep with their clients when they are unable to pay the taxi fee.

The Union of Taxi Drivers of Djibouti meets to discuss ways of encouraging the use of condoms among their drivers. Every Monday and Friday, peer educators go to various taxi stands to inform drivers about HIV/AIDS and to distribute condoms.


PEER EDUCATION – PEER EDUCATION – COMMERCIAL SEX WORKERSCOMMERCIAL SEX WORKERS

CSW from “Soeur à Soeur” NGO that is actively providing peer education and condom use promotion.

(Source: The Global Fund website)


COMMUNITY RESPONSE - COMMUNITY RESPONSE - DOCKERSDOCKERS

Information, Education, & Communication

Peer education

….AND THE RESULTS WERE…


DOCKERS: KNOWLEDGE OF DOCKERS: KNOWLEDGE OF PREVENTION MEASURESPREVENTION MEASURES

Condom use (52%)

Fidelity (77%)

Abstinence (89%)


DOCKERS: ATTITUDE DOCKERS: ATTITUDE TOWARDS INFECTED PERSONSTOWARDS INFECTED PERSONS

Tolerance of AIDS patients (39.7%)


DOCKERS: VOLUNTARY DOCKERS: VOLUNTARY COUNSELING AND TESTINGCOUNSELING AND TESTING

VCT acceptance (22.8%)


DOCKERS: SEXUAL ACTIVITYDOCKERS: SEXUAL ACTIVITY

84% had non-union sexual intercourse

But only 13.2% used condoms

Good news: 94% of CSW used condoms….

…Still a long way ahead


Transport Sector ChallengesTransport Sector Challenges

Showing the relevance and role of the transport sector in both the transmission of, and fight against, HIV/AIDS.

Assessing the extent of the problem of HIV/AIDS among transport sector workers.

Developing partnerships with local organizations and associations that can understand the issues of the transport sector workers (recruiting peer educators).

Developing common approaches and interventions that foster collaboration between the transport sector and the other sectors/ministries involved in HIV/AIDS control.

Strengthening transport sector capacity to fight HIV/AIDS at the borders (border delays, over-night stops, etc..).


Dr. Sameh El-Saharty

[email protected]

TRANSPORT AGAINST HIV/AIDS THE ADDIS-DJIBOUTI CORRIDOR Sameh El-Saharty, MD, MPH Senior Health...

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