transport against hiv/aids the addis-djibouti corridor sameh el-saharty, md, mph senior health...
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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
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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
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ADDIS – DJIBOUTIADDIS – DJIBOUTITRANSPORT CORRIDORTRANSPORT CORRIDOR
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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 %.
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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
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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%
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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
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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
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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
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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)
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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.
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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
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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)
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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
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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.
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COMMUNITY RESPONSECOMMUNITY RESPONSE
NGOs are active in the fight of HIV/AIDS particularly around the port, e.g. PK12.
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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
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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.
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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)
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COMMUNITY RESPONSE - COMMUNITY RESPONSE - DOCKERSDOCKERS
Information, Education, & Communication
Peer education
….AND THE RESULTS WERE…
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DOCKERS: KNOWLEDGE OF DOCKERS: KNOWLEDGE OF PREVENTION MEASURESPREVENTION MEASURES
Condom use (52%)
Fidelity (77%)
Abstinence (89%)
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DOCKERS: ATTITUDE DOCKERS: ATTITUDE TOWARDS INFECTED PERSONSTOWARDS INFECTED PERSONS
Tolerance of AIDS patients (39.7%)
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DOCKERS: VOLUNTARY DOCKERS: VOLUNTARY COUNSELING AND TESTINGCOUNSELING AND TESTING
VCT acceptance (22.8%)
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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
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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..).