Timing of the introduction into Ethiopia of subcluster C' of HIV type 1 subtype C.

Viruses circulating in Ethiopia during the 1990s cluster with main subtype C, but a significant subcluster, C', was noted in multiple analyses. This subcluster of subtype C(C') was in a fifty-fifty equilibrium with the main subtype C (Abebe et al., AIDS Res Hum Retroviruses 2000;16:1909-1914). To analyze genetic diversification within the subcluster of HIV-1 subtype C designated C' in the course of the epidemic in Ethiopia, we analyzed 165 env gp120 V3 sequences obtained between 1988 and 1999. We observed a highly significant positive correlation between sampling years of individual sequences and their synonymous distances to the reconstructed common ancestor of the HIV-1 subtype C' subcluster. The extrapolation of the regression line of synonymous distances back to the date when no synonymous heterogeneity was present among the Ethiopian HIV-1 C' population allowed us to estimate 1982 (95% CI, 1980-1983) as the year of the onset of HIV-1 C' genetic diversification and expansion in Ethiopia. These results are in agreement with retrospective epidemiological and serological data, which demonstrated the absence of an HIV-1 epidemic in the Ethiopian population before the 1980s.

Identification of a genetic subcluster of HIV type 1 subtype C (C') widespread in Ethiopia.

Others and we have previously shown that subtype C is the predominant HIV-1 subtype and the major cause of AIDS in Ethiopia. The present study shows that subtype C in Ethiopia has a genetic subcluster, designated C', has not increased in frequency, or spread geographically, over the period 1988 (%C' = 23/53) to 1996-1997 (%C' = 26/50). There is no association of the HIV-1 subtype C or subcluster C' with geographic location, time of sample collection, or risk group in Ethiopia. Of 105 randomly collected samples representing 7 different towns in Ethiopia, all but 2 (1 subtype A from Addis Ababa, 1997 and 1 subtype D from Dessie, 1996) belong to subtype C.

Baseline for the evaluation of an AIDS programme using prevention indicators: a case study in Ethiopia.

Strategies for preventing transmission of human immunodeficiency virus (HIV) include ensuring that individuals have adequate knowledge of how HIV infection can be prevented and encouraging behaviours that decrease risk of HIV infection. In addition, there is evidence that early and appropriate management of other sexually transmitted disease is effective in reducing HIV transmission. Programmes and projects promoting prevention of HIV transmission should be evaluated periodically for their effectiveness. Between March and September 1995, ten prevention indicators developed by the WHO Global Programme on AIDS were used to establish a baseline measure for evaluating the effectiveness of the Ethiopian AIDS control programme. The indicators were measured using a structured population survey, through record review and key informants, structured observation and interview in health care facilities, and through a serosurvey among antenatal clinic attenders. The following results were found: promoting knowledge of preventive practices was successful; a relatively high proportion of young male adults had sexual risk behaviour; poor condom availability outside Addis Ababa, the capital; and very weak STD case management. The prevalence of syphilis and HIV were 8.8% and 13.6%, respectively, among pregnant women aged 15-49 years. These results should serve as a baseline for repeat surveys to assess the effectiveness of HIV prevention programmes in Ethiopia.

Sociodemographic profile of children affected by AIDS in Addis Abeba.

A survey was conducted in Addis Abeba between October 2, 1993 and December 10, 1993 to assess orphanhood due to AIDS deaths. It was possible to trace only 1,047 AIDS cases among residents of Addis Abeba. During the survey, 59% of the cases and 16% of their spouses were already dead. The total number of children born to the index cases were 2186, among which, 883 (40.4%) were below 15 years of age. Two hundred eighty (30.4%) of these children had lost either one or both parents. Other social problems include ill health in 10.5% among which 3.9% had AIDS; 14.1% were school dropouts. There were also children who faced abandonment, displacement and who lacked medical care at the time of their illness. The existing coping mechanism seems to be relying on the extended family, which is an important social support system. However, there is a need to raise community awareness and strengthen the system to enhance the effort in protecting and supporting children affected by AIDS.

PIP: A survey was conducted in Addis Abeba between October 2 and December 10, 1993, to assess the extent of orphanhood due to AIDS mortality. Only 1047 AIDS cases could be traced among residents. During the survey 59% of cases and 16% of their spouses were already dead. There were 2186 children born to the index cases, 883 who were below age 15 years. 280 of these 883 children had lost either one or both parents. 3.9% of the 10.5% who were in poor health had AIDS. 14.1% had dropped out of school. Children were also identified who faced abandonment, displacement, and a lack of medical care at the time of their illness. Reliance upon the extended family is an important coping mechanism in this setting. The authors point to the need to raise the level of community awareness and strengthen the system to enhance efforts to protect and support children affected by AIDS.