Interview with Negatu Mereke, head of the National AIDS Secretariat

Negatu Mereke is the head of the National AIDS Secretariat – the Ethiopian government's task force coordinating the fight against AIDS. Ahead of World Aids Day, Negatu - who took over the helm of the secretariat in February 2002 - tells PlusNews how it is overcoming criticism of incompetence from the World Bank and how it will go about trying to win the war against the virus. QUESTION: How serious is the HIV/AIDS pandemic in Ethiopia? ANSWER: Our country is among other countries in being at the forefront of the HIV/AIDS pandemic. Since the first cases, the pandemic has been spreading rapidly, and now here it involves both towns and urban areas and affects every age and ethnic group in the country. The prevalence was 3.2 percent in 1993, and it is now 7.3 percent. About 2.6 million are living with HIV/AIDS, and about 250,000 are children below the age of five years. There are also about 900,000 AIDS orphans. Q: Is it the most serious problem the country is facing today? A: Yes, because it has a major social impact. It is killing the most productive age groups. It has also left so many orphans. It also affects teachers, and if it affects teachers it affects the educational programme. It affects the health budget. So many of the beds are occupied by these AIDS patients, so those who are sick with other diseases cannot be easily hospitalised. It affects the social development programme, and it even affects security. If it affects those military people it affects the security of the country. Q: Has the government got the HIV/AIDS pandemic under control? A: The Ethiopian government responded early to this pandemic with a national task force. During this time, advances were made in the areas of condom promotion, surveillance and patient care and expansion of HIV/AIDS screening. As time went on and with the worsening pandemic, the government issued a comprehensive five-year strategic framework until 2005. This plan no longer recognises HIV/AIDS as just a health problem, but that it is a health, developmental, political, economic and social problem. This plan identifies ten strategies: condom promotion, behavioural change, sexually transmitted diseases prevention, HIV testing and counselling, [and] safe blood supply among others. Q: Why was the World Bank so scathing of the HIV/AIDS secretariat? A: We did not adequately establish the institutional arrangements that enabled effective absorption of funds of that size when the loan of US $59.7 million was secured two years back. Institutionally, we did not have that capacity to deal with the funds that came to the country. The absorption of funds of this size was strange for us. Even if the government and other stakeholders were very cognisant of the magnitude of the problem, and committed to fight the spread of the pandemic and mitigate its impact, they lacked experience and capacity to handle it in terms of funds of this size for HIV/AIDS. Q: Have things now changed? A: In the last year, we have seen unprecedented levels of political and institutional interest in reversing the cause of the HIV/AIDS pandemic. In fact, in the last few months or so we were highly engaged in addressing basic policies and organisational issues. We believe this will accelerate the implementation of HIV/AIDS prevention and control. With our legal status proclamation, political leadership has improved significantly, providing a more enabling environment for the fight against the pandemic and its effects on development. Effective institutional arrangements have been put in place from federal level to the smallest community. We have cleared the organisational confusion that impaired the speedy implementation of the three-year World Bank loan. Absorption of funds has accelerated. From the first year of the loan, less than US $1.5 million was disbursed. The following year, the amount rose to US $12 million. Some 292 organisations and 25 government bodies have secured funds out of 350 applications. Q: Do you think the HIV/AIDS pandemic is going to get more serious in Ethiopia? A: It is very difficult to say. It can be observed from our current situation that the government’s political leadership is providing a more enabling environment, so that from every direction people are trying to control infection. If the government is trying to provide a more enabling environment it is a multi-sectoral programme, so it should not be left just to the government. We are doing our best. The government is trying its best to try to control and prevent the pandemic. The government is trying to expand its programme up to the grass-roots level. That means there is a lot of political commitment. We are hoping that it [the pandemic] will decrease. For the last few months we have been engaged in addressing policy issues that are essential for a next move. We believe that this will accelerate the implementation of HIV/AIDS prevention and control. When we say accelerate it means we are on the verge of controlling this programme and prevention. We are on the verge of preventing this expanding. Q: Does that mean the situation is under control? A: Is there a place in the world that has already controlled this pandemic? On the prevention programme, we are trying our best. We are mobilising. This programme is very complex. We are trying to make the environment enabling so people involved can become involved in the prevention and control programme. It should not be left [just] to the government. For this pandemic, I have not heard of any country who has already controlled it. Q: What are the main obstacles stopping important strides being made in tackling the virus? A: As far as our knowledge is concerned, the government is taking different measures, but it doesn’t mean we don’t have any challenges as far as the programme is concerned. Policy measures and organisations have been set up and much has been accomplished, but there is still more [to be done]. Involvement of the public at community level seems to be minimal at this time, and [also] coordination and integration of other sectors. Stigma and discrimination have been reduced. There are also other problems, like limited manpower, technical material and financial and managerial capacities. The government is trying to fill the gaps. There is a high awareness, however, that behavioural change is lagging behind. Q: How do you change their behaviour? A: This takes time. We should give them training as to how to prevent this. When I say there is no behavioural change it doesn’t mean there is nothing being done. We have to teach the community, by giving people information. Q: How are you working with religious organisations to promote the use of condoms in Ethiopia? A: The issue of condoms is quite sensitive in Ethiopia. We are not forcing anyone - particularly those religious organisations. It is up to the religious organisations. We just tell them about the use of condoms. We leave them to tell their followers to use condoms. We have to be careful in using the faith-based organisations. The secular approach is working on condoms; the religious organisations are working against HIV/AIDS in their own way. We want them to complement [our efforts]. It is difficult for a religious organisation to advocate condoms, because one of the Ten Commandments says ‘Do not commit adultery.’ If they advocate condoms they are directly violating that commandment. So they should do it their own way.