ADDIS ABABA, Ethiopia (April 2002) - Ethiopia is steeped in history, a nation of 12th century churches built into stone and the source of Africa’s oldest written alphabet.

But in this land filled with reminders of the past, communities are fighting for their future - fighting the HIV/AIDS crisis that has brought poverty and suffering to new levels.

"AIDS is like a drought in Ethiopia - it is an emergency," says Dr. Muna Abdullah, who manages CARE's Safe Motherhood Project. "It must be treated that way."

Last year, Ethiopia’s government created a National HIV/AIDS Strategic Framework and AIDS Council, a program that outlines necessary health, education, economic and community measures and also offers legal protection for the growing number of HIV-infected citizens. Ethiopians battling HIV/AIDS call this program a positive step forward. But there is much more to be done.

CARE-trained Nurse Hamelmal in front of the clinic where she does HIV/AIDS voluntary testing and cou

On the Front Lines

"People don’t pay much attention to HIV/AIDS if they’re hungry or homeless," says Fortuna Hassen, project officer for the Urban HIV/AIDS project. "All areas of development are involved in the pandemic."

In the fight against HIV/AIDS, it is not enough to deal only with the health consequences of the virus. More than 80 percent of those infected in Ethiopia are between the ages of 20 and 49 - the country's most economically productive age group. When people lose their jobs because they're sick or infected and can't provide for their families, HIV/AIDS is an economic problem. It's also a gender problem: Often, women are vulnerable to infection because of their subordinate position in society. When women and children cannot afford food, they are more likely to engage in prostitution to earn money. And when children lose their parents and must look after younger siblings, HIV/AIDS is an education problem. Clearly, HIV/AIDS is a significant contributor to Ethiopia’s pervasive poverty.

CARE understands there are many causes and consequences of HIV/AIDS in poor communities. So we're working to solve root problems of HIV/AIDS - including poverty - through multiple and innovative approaches. Our Urban HIV/AIDS project, for example, provides not only care and support, but also peer education and voluntary counseling and testing. Additionally, we plan to distribute food to people who participate in community development projects.

CARE's peer educator and community members who meet regularly to discuss HIV/AIDS

Hope for AIDS Orphans

Besa is the second oldest of five sisters orphaned in 1999 when both their parents died of AIDS. Though their grandmother was able to take in the children, she couldn't provide for all of them.

Besa’s situation is far from unique: Ethiopia has more AIDS orphans than any country in the world. The Ethiopian government estimates that close to 750,000 children have been orphaned by HIV/AIDS. This number is expected to nearly triple by 2014, reaching a staggering 2.1 million.

Besa wants to be a doctor when she grows up, and she knows this means she has to stay in school and stay healthy. Those goals are especially challenging for orphans; with one or both parents unable to provide the necessary economic and emotional support, many children are denied basic health care and education. Many are left destitute. Orphans often are forced to find jobs to survive. And many are exploited, sexually or otherwise.

CARE is working to mobilize community groups that will provide care and support for families impacted by HIV/AIDS. This includes the time-consuming task of going door-to-door, determining who needs help. CARE also works with organizations that offer support to neighbors raising AIDS orphans.

Besa, her sister, her grandmother and her nephew. Besa's parents both died of HIV/AIDS

Breaking the Silence

Despite the fact that her parents died from HIV/AIDS, Besa doesn’t refer to AIDS by name. She's not alone. Complex traditions and social customs among Ethiopia’s more than 70 ethnic groups often result in stigma, fear and denial, creating quite a challenge for CARE staff: How does one inform communities about HIV/AIDS prevention when people are hesitant even to say "HIV/AIDS"?

"People don’t want to talk about it," says CARE volunteer Alemayhu Afinie. "After burials, people know how the person died, but no one says it out loud. But the disease still exists."

One of the goals of CARE's voluntary counseling and testing is to encourage people to talk about HIV/AIDS. It is the first project of its kind in Ethiopia and provides affordable, ($1.20 as opposed to the regular $6-$30) confidential counseling and testing. Every day, CARE-trained Nurse Hamelmal administers approximately 15 HIV tests and counsels people when they receive the results. Approximately 30 percent of her patients test positive. "They may hesitate to mention HIV/AIDS," she says, "but coming to be tested is a sign of behavior change."

With the National HIV/AIDS Strategy Framework now in place, many hope the government will work with community, religious and traditional leaders to help diminish the stigma of HIV/AIDS. They hope that if the government is frank and direct about the crisis, the rest of Ethiopia will follow. "The National Strategy is a definite political commitment," says CARE’s Hassen.

"The National HIV/AIDS Strategic Framework has interventions at the community and individual levels," explains Dr. Solomon Tesfaye, health sector coordinator for CARE in Ethiopia. "Previously, the government didn’t consider HIV/AIDS an issue. Now, there is involvement in all sectors of the government and even from religious groups. This is very positive movement."

"We’ve seen behavioral changes in communities that have lived with their traditions a long time," says Hassen. "This in itself is a great achievement. It’s a struggle, but it’s also the first step for the next generation to have an HIV/AIDS-free world."