Utilization of antiretroviral treatment in Ethiopia between February and December 2006: spatial, temporal, and demographic patterns.

BACKGROUND: In 2003, the Ethiopian Ministry of Health (MOH) started to implement a national antiretroviral treatment (ART) program. Using data in the monthly HIV/AIDS Updates issued by the MOH, this paper examines the spatial and temporal distribution of ART on a population basis for Ethiopian towns and administrative zones and regions for the period February to December 2006. RESULTS: The 101 public ART hospitals treated 44,446 patients and the 91 ART health centers treated 1,599 patients in December 2006. The number of patients currently receiving ART doubled between February and December 2006 and the number of female patients aged 15 years and older surpassed male patients, apparently due to increased awareness and provision of free ART. Of 58,405 patients who ever started ART in December 2006, 46,045 (78.8%) were adhering to treatment during that month. Population coverage of ART was highest in the three urban administrative regions of Addis Ababa, Harari and Dire Dawa, in regional centers with referral hospitals, and in several small road side towns that had former mission or other NGO-operated hospitals. Hospitals in Addis Ababa had the largest patient loads (on average 850 patients) and those in SNNPR (Southern Nations and Nationalities Peoples Republic) (212 patients) and Somali (130 patients) regions the fewest patients. In bivariate tests, number of patients receiving treatment was significantly correlated with population size of towns, urban population per zone, number of hospitals per zone, and duration of ART services in 2006 (all p < 0.001). The stronger relationship with urban than total zonal populations (p < 0.001 versus p = 0.014) and the positive correlation between distance from 44 health centers to the nearest ART hospital and patients receiving treatment at these health centers may be due to a combination of differential accessibility of ART sites, patient knowledge and health-seeking behavior. CONCLUSION: The sharp increase in ART uptake in 2006 is largely due to the rapid increase in the provision of free treatment at more sites. The marked variation in ART utilization patterns between urban and rural communities and among zones and regions requires further studies. Recommendations are made for further expansion and sustainability of the ART scale-up.

Causal connections between socio-economic status and health: reciprocal effects and mediating mechanisms.

Using structural equation modeling techniques on data from a nationally representative longitudinal survey, we first explored the reciprocal relationships between socio-economic status (SES) and health status. We then estimated the degree to which health-related lifestyles/behaviors and psychosocial distress are mediating mechanisms of these relationships. As predicted, SES positively affects health, and health positively affects SES. Although the causal path from SES to health is stronger than the reverse, these findings confirmed the hypothesis that both social causation and health selection contribute to social inequalities in health. In terms of the mediating mechanisms through which SES and health affect each other, more than a third of the overall SES-health relationship was accounted for by health-related lifestyles/behaviors and psychosocial distress. A notable part of the effect of SES on health is due to differences in psychological distress, with the effects of health-related lifestyles/behaviors being much smaller. On the other hand, in terms of the effects of health on SES, differences in weight and sleeping behavior are more important than psychological distress.

Patterns and correlates of sexual initiation, sexual risk behaviors, and condom use among secondary school students in Ethiopia.

This study explored the patterns and socio-demographic correlates of sexual initiation, subsequent risk behaviors, and condom use among secondary school youth across Ethiopia. A total of 1,102 students were selected on convenience basis from five urban schools (in Baher Dar, Dessie, Awassa, Jimma, and Dire Dawa) and surveyed about their sexual and preventive behaviors using an extensive questionnaire. Data were analyzed using bivariate and multivariate statistical procedures. One third (33.3%) of the youth reported to have had sexual intercourse prior to the study. Mean age of sexual initiation was 15.3 (SD = 2.5) years. Two-thirds of the sexual initiations were unprotected and some occur with higher risk groups, including much older (15.5%) or casual/commercial sex partners (9.1%). Multi-partnered sex (52.7%) and sex with casual (30.4%) or commercial (25.3%) partners were the most commonly reported lifetime risk behaviors. Although 56.7% of the youth ever used condoms, only less than half of these used them regularly. On the positive note, 83.4% of the youth expressed intentions to use condoms in the future. Socio-demographic characteristics, particularly gender, location, and age, were significantly correlated with sexual and preventive behaviors. Implications of these findings to health education programs for youth are discussed.