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TRANSPORT AGAINST HIV/AIDS THE ADDIS-DJIBOUTI CORRIDOR

TRANSPORT AGAINST HIV/AIDS THE ADDIS-DJIBOUTI CORRIDOR. Sameh El-Saharty, MD, MPH Senior Health Policy Specialist The World Bank. World AIDS Day Event Transport and Social Responsibility Thematic Group Washington, DC – November 28, 2007. PRESENTATION OUTLINE . Country & Sector Context

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TRANSPORT AGAINST HIV/AIDS THE ADDIS-DJIBOUTI CORRIDOR

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  1. TRANSPORT AGAINST HIV/AIDSTHE ADDIS-DJIBOUTI CORRIDOR Sameh El-Saharty, MD, MPH Senior Health Policy Specialist The World Bank World AIDS Day Event Transport and Social Responsibility Thematic Group Washington, DC – November 28, 2007

  2. PRESENTATION 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 Dr. Sameh El-Saharty - The World Bank

  3. ADDIS – DJIBOUTITRANSPORT CORRIDOR Dr. Sameh El-Saharty - The World Bank

  4. COUNTRY 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 %. Dr. Sameh El-Saharty - The World Bank

  5. HEALTH 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 Dr. Sameh El-Saharty - The World Bank

  6. DJIBOUTI 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% Dr. Sameh El-Saharty - The World Bank

  7. HIV/AIDS, MALARIA, AND TUBERCULOSIS 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 Dr. Sameh El-Saharty - The World Bank

  8. HIV/AIDS, MALARIA, AND TUBERCULOSIS CONTROL PROJECT • 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. Dr. Sameh El-Saharty - The World Bank

  9. THE 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 Dr. Sameh El-Saharty - The World Bank

  10. ETHIOPIA: BEHAVIOR OF TRANSPORT WORKERS • Many of the drivers and their assistants > 30 y old • Nearly all the respondents had attended school • More than 80 percenthad never been married • More than 93% of all the transport workers lived in cities • Mosthad worked as transport workers > 5 years • More than 96% had circumcision Source: High Risk Corridor Initiative (HRCI) supported by USAID Ethiopia (2004) Dr. Sameh El-Saharty - The World Bank

  11. ETHIOPIA: TRANSPORT SECTOR PROJECT • Objective: to targetvulnerable groupsalong the Djibouti transport corridorthrough 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. Dr. Sameh El-Saharty - The World Bank

  12. ETHIOPIA: TRANSPORT SECTOR PROJECT TOOLS • 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) Dr. Sameh El-Saharty - The World Bank

  13. INFORMATION, EDUCATION, & COMMUNICATION 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) Dr. Sameh El-Saharty - The World Bank

  14. ETHIOPIA: TRANSPORT SECTOR PROJECT RESULTS • 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. Dr. Sameh El-Saharty - The World Bank

  15. DJIBOUTI 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. Dr. Sameh El-Saharty - The World Bank

  16. COMMUNITY RESPONSE NGOs are active in the fight of HIV/AIDS particularly around the port, e.g. PK12. Dr. Sameh El-Saharty - The World Bank

  17. INFORMATION, EDUCATION & COMMUNICATION Built from an old shipping container, the UNICEF-sponsored information centre is helping educate young people about the danger of HIV and AIDS Dr. Sameh El-Saharty - The World Bank

  18. PEER 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. Dr. Sameh El-Saharty - The World Bank

  19. PEER EDUCATION – COMMERCIAL SEX WORKERS CSW from “Soeur à Soeur” NGO that is actively providing peer education and condom use promotion. (Source: The Global Fund website) Dr. Sameh El-Saharty - The World Bank

  20. COMMUNITY RESPONSE - DOCKERS Information, Education, & Communication Peer education ….AND THE RESULTS WERE… Dr. Sameh El-Saharty - The World Bank

  21. DOCKERS: KNOWLEDGE OF PREVENTION MEASURES • Condom use (52%) • Fidelity (77%) • Abstinence (89%) Dr. Sameh El-Saharty - The World Bank

  22. DOCKERS: ATTITUDE TOWARDS INFECTED PERSONS Tolerance of AIDS patients (39.7%) Dr. Sameh El-Saharty - The World Bank

  23. DOCKERS: VOLUNTARY COUNSELING AND TESTING VCT acceptance (22.8%) Dr. Sameh El-Saharty - The World Bank

  24. DOCKERS: 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 Dr. Sameh El-Saharty - The World Bank

  25. Transport 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 - The World Bank

  26. THANK YOU Dr. Sameh El-Saharty selsaharty@worldbank.org Dr. Sameh El-Saharty - The World Bank

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