Eritrea’s Progress Combating HIV/AIDS

0.59% PREVALENCE RATE. Government commitment to long-term investments in human capital, strong understanding and down-to-earth assessment of the resources available to foster development are some of the drivers of success in Eritrea.
0.59% PREVALENCE RATE. Government commitment to long-term investments in human capital, strong understanding and down-to-earth assessment of the resources available to foster development are some of the drivers of success in Eritrea.

By Fikrejesus Amahazion,

ACCORDING to UNAIDS, Sub-Saharan Africa (SSA) remains the region most heavily affected by the global HIV/AIDS epidemic. Specifically, of the 35 million people living with HIV, approximately 25 million are living in SSA, and the region accounted for 74% of all the people dying from AIDS-related causes in 2013.

However, amidst these stark figures and though HIV/AIDS remains one of Africa’s most significant public health challenges, significant progress has been made. For example, prior to 2001, HIV/AIDS treatment in Africa was nearly nonexistent; yet, now some 86% of people in SSA living with HIV are receiving antiretroviral therapy (ART), and nearly 76% of them have achieved viral suppression.

While many countries – both in SSA and around the world – have made significant progress in combating HIV/AIDS, Eritrea’s strong record battling HIV/AIDS stands out positively, although receives less attention.

Located in the fractious Horn of Africa, the young, low-income country is on pace to achieve the UN’s Millennium Development Goal related to combating HIV/AIDS, malaria, and other diseases. Further, its HIV-related figures – such as its 0.59% prevalence rate – are distinguished as amongst the best, both within the region and across the continent.

Eritrea’s HIV/AIDS interventions are based upon a multidimensional approach, and involve the participation of various sectors of society. One important component of the nation’s response has been the National Union of Eritrean Youth and Students (NUEYS).

NUEYS has promoted education and awareness of HIV/AIDS across all demographic groups. First beginning its activities in the 1990s, NUEYS has been vigilant and effective in the social marketing of condoms, communicating safe practices, offering awareness and educational programs, and providing youth or peer support and counseling. As a result, “awareness of HIV/AIDS [is] nearly universal [in Eritrea].”[1]

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Additionally, the Ministry of Health has been key in the national response, establishing a national HIV/AIDS policy that, amongst other things, provides guidelines on preventative activities, ensures provisions of treatment and care, and secures the rights and dignity of people living with HIV/AIDS. Part of the latter involves the distribution of ARTs; notably, the estimated total ART coverage in Eritrea has risen to 72%.

*Source: UNAIDS 2014 (Prevalence amongst 15-45 year olds)
*Source: UNAIDS 2014 (Prevalence amongst 15-45 year olds)

ART usage is important since it helps to avert HIV/AIDS related deaths, while being a critical factor in driving down the rate of new infections.

National institutional efforts, such as the establishment of Voluntary Counseling and Testing (VCT) and Prevention of Mother to Child Transmission (PMTCT) centers, have also been vital. VCT centers offer rapid testing and pre-and post-test counseling, while PMTCT centers, which focus on pregnant women, offer testing services and support those found HIV positive in preventing the transmission of HIV to their children. Overall, these initiatives have meant that more people have received greater access to better quality care, training, education, and support.

*Source: UNAIDS 2014 (Percentage Decline in AIDS-related Deaths  2005-2013)
*Source: UNAIDS 2014 (Percentage Decline in AIDS-related Deaths 2005-2013)

Possibly the most significant feature of Eritrea’s HIV/AIDS response has been the targeting of traditional and patriarchal stereotypes and practices. Focusing on these practices is crucial, since many traditional or patriarchal stereotypes and practices can increase HIV/AIDS risk factors. For example, in several countries throughout the region, child or adolescent marriage is still quite common. In addition to representing a significant child rights issue, the practice is thought to increase HIV/AIDS prevalence via several mechanisms.[2] Importantly, Eritrea has made child and adolescent marriage (under 18) illegal, and remained committed to enforcement, especially within rural areas. Consequently, one potential risk factor for HIV/AIDS has been dramatically reduced.

As well, female genital mutilation/cutting (FGM)[3] – a harmful traditional practice found in parts of Africa and the Middle East – has been outlawed. Efforts to eradicate this practice dates back to the country’s pre-independence era.[4] Like child marriage, FGM is a women’s, child, and human rights issue and can place females at a high risk for HIV/AIDS through several causal pathways.[5] Beyond abolishment, Eritrea has also promoted support, awareness, educational, prevention, and recovery programs in both urban and rural areas. Ultimately, FGM prevalence rates have decreased,[6] women’s and children’s rights have been better protected, and potential risk factors for HIV/AIDS have been prevented.

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ALSO READ : Eritrea Presents Experience in Implementation of MDGs
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Last, gender equality has been a central focus in the country, providing the foundation for positive outcomes in battling HIV/AIDS. No less an authority than the WHO has claimed that gender discrimination and violence render females far more vulnerable to infection.[7] Further, the feminization of poverty places women at a tremendous risk for HIV/AIDS since “above all… poverty limits people’s options for protecting themselves and forces them into situations of heightened risk.”[8] Through improving gender equality, a key driver of the HIV/AIDS epidemic may be controlled since women will face fewer barriers in accessing HIV prevention, treatment and care services due to limited decision-making power, lack of control over financial resources, restricted mobility, or unbalanced child-care responsibilities.

Deaths due to AIDS in Sub-Saharan Africa, 2013
Deaths due to AIDS in Sub-Saharan Africa, 2013

Eritrea’s efforts at improving gender equality and decreasing the burden of poverty borne by women include, inter alia: ratifying several relevant international rights instruments, including The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW 1979); making gender equality a fundamental component of the National Education Policy and national poverty reduction strategies; issuing Labour and Land Reform Proclamations to secure the equal status of women in society; and working closely with the National Union of Eritrean Women (NUEW) to coordinate, monitor, and implement gender-equality programs and policies across all sectors of society. Though gender equality is yet to be fully achieved and challenges remain, the efforts represent important steps in the right direction, both for the status of women and in terms of fighting HIV/AIDS.

Overall, Eritrea’s efforts against HIV/AIDS are quite commendable, particularly within the context of the country’s various socioeconomic, development, and regional challenges. Furthermore, its progress illustrates what can be achieved with a self-reliant approach, a capacity to adapt, effective coordination, and cost-effective projects. At the same time, the potentially devastating consequences posed by HIV/AIDS – in terms of severe human toll and national developmental disaster – mean that Eritrea has little room for complacency. Rather, it must continue to augment its existing programs and further promote effective initiatives and interventions in order to control and reduce the harmful impact of HIV/AIDS.

I am extremely proud of the efforts of the many dedicated individuals and groups who have worked tirelessly in the country to combat HIV/AIDS, and I greatly look forward to returning home after graduation to support positive health and developmental efforts.

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[1] Muller, T. 2005. “Responding to HIV/AIDS Epidemic: Lessons from the Case of Eritrea.” Progress in Development Studies. 5: 199-214.

[2] a) Laga, M., B. Schwartlander, E. Pisani, P. Sow, and M. Carael. 2001. “To Stem HIV in Africa, Prevent Transmission to Young Women.” AIDS. 15: 931-934.
b) Bruce, J. 2007. “Child Marriage in the Context of the HIV Epidemic.” Population Council. September (11): 1-4.

[3] Coming to a consensus on how to refer to the practice has been a challenge. At various times, the practice has been referred to as: a) female genital cutting; b) female genital circumcision; c) or female genital mutilation. Here I use female genital mutilation as that is the term utilized by the WHO. At different times, Eritrea has referred to the term as female genital mutilation or cutting.

[4] a) Pre-independence initiatives
b) Recent initiatives

[5] a) Brady, M. 1999. “Female Genital Mutilation: Complications and Risk of HIV Transmission.” AIDS Patient Care and STDs. 13 (12): 709-716.
b) Yount, K. and B. Abraham. 2007. “Female Genital Cutting and HIV/AIDS among Kenyan Women.” Studies in Family Planning. 38(2): 73-88.

[6]According to the Global Partnership for Education, FGM rates have decreased dramatically; for girls under the age of 15, rates have dropped to under 15%.

[7] WHO. 2000. “Violence Against Women and HIV/AIDS: Setting the Research Agenda.” Gender and Women’s Health Meeting Report. 23-25 October 2000. Geneva, Switzerland.

[8] Irwin, A., J. Millen, and D. Fallows. 2001. Global AIDS: Myths and Facts – Tools for Fighting the Global AIDS Epidemic. Cambridge, MA: South End Press.

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Fikrejesus is a PhD Candidate within Emory University’s PhD Sociology program and is completing the Graduate Certificate in Human Rights at Emory University’s Institute of Human Rights. His areas of interest include: Human Rights, Development; Comparative Political Economy; and Globalization. After graduating, Fikrejesus will support developmental progress in the Horn of Africa generally, and Eritrea specifically.