AIDS (08.15.03) Vol. 17; No. 12: P.1835-1840 - Tuesday,
Data on national HIV prevalence in Ethiopia are sparse,
especially in rural areas where more than 85 percent of the
population lives. To support health policy planning,
Ethiopia's Ministry of Defense decided to estimate HIV
prevalence in army recruits. The current study described HIV
prevalence in relation to socio-demographic characteristics
among nearly 72,000 men recruited in 1999 and 2000. It is the
first study, according to the authors, to report extensively
on rural areas.
Of 71,626 recruits enrolled in the study 9,713, (14 percent)
were from urban areas and enrolled in 1999, and 61,913 (86
percent) were from rural areas and enrolled in 2000. Compared
to the 1994 population census, the sample of nearly 62,002
rural recruits was fairly representative of the general
population's marital status and geographical origin, but over-
representative of Orthodox Christians and under-representative
of people without education.
The researchers found an unexpectedly low HIV prevalence in
the army recruits, contrasting with previous HIV estimates
based on sentinel surveillances among pregnant mothers in
Addis Ababa and the Amhara region and recent models suggesting
that urban HIV prevalence peaked at 19 percent in 1995 and
declined to roughly 15 percent in 2000, while non-urban HIV
prevalence would plateau at under 10 percent in 2000.
This study found that HIV prevalence in rural recruits was 3.8
percent. Prevalence was lowest in recruits ages 18-19 and
highest in the 25-29 age group. Farmers and students had the
lowest overall HIV prevalence.
In urban recruits, overall HIV prevalence was 7.2 percent.
Prevalence was lowest in the 18-19 age group, increased to 9.4
percent for the 20-24 age group, and rose to 15.3 percent
among the 25-29 age group.
In rural recruits, risk factors for HIV included higher
education levels. "The impact of education on HIV prevalence
in rural areas suggests a role for primary and secondary
schools in (rural) Ethiopian HIV programs," the authors noted.
Also, rural Orthodox Christians were more likely than Muslim
recruits to have HIV. Circumcision was not a factor, as both
religions practice it. "Orthodox church officials should be
involved in exploring their potential role in HIV prevention
efforts," the researchers stated.
Age and urban residence in the Amhara region were risk factors
for urban recruits, while education and ethnicity were not
significantly associated with infection.
The authors pointed out that in Africa, HIV prevalence can
vary widely among geographical areas. This study found pockets
of high and low HIV prevalence, and the investigators
suggested that proximity to road or trading centers and
perhaps cultural factors may account for the regional
differences. The Amhara region appeared to be most affected by
the epidemic, with higher HIV estimates among both rural and
"The impact of religion, education, and region on HIV
prevalence suggests avenues for targeting HIV prevention
efforts in Ethiopia," the authors concluded. "Thus our study
may be instrumental in targeting HIV control efforts in
Ethiopia. It also, for the first time, provides a geographical
picture of the country's HIV epidemic, which can aid in the
design and interpretation of future HIV studies in Ethiopia."