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TRANSPORT AGAINST HIV/AIDS THE ADDIS-DJIBOUTI CORRIDOR Sameh El-Saharty, MD, MPH Senior Health Policy Specialist The World Bank World AIDS Day Event Transport.

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Presentation on theme: "TRANSPORT AGAINST HIV/AIDS THE ADDIS-DJIBOUTI CORRIDOR Sameh El-Saharty, MD, MPH Senior Health Policy Specialist The World Bank World AIDS Day Event Transport."— Presentation transcript:

1 TRANSPORT AGAINST HIV/AIDS THE ADDIS-DJIBOUTI CORRIDOR Sameh El-Saharty, MD, MPH Senior Health Policy Specialist The World Bank World AIDS Day Event Transport and Social Responsibility Thematic Group Washington, DC – November 28, 2007

2 November 2007Dr. Sameh El-Saharty - The World Bank2 PRESENTATION OUTLINE Country & Sector Context Djibouti HIV/AIDS Project Design Ethiopia HIV/AIDS interventions for truckers Djibouti HIV/AIDS interventions for transport sector workers Results Transport Sector Challenges

3 November 2007Dr. Sameh El-Saharty - The World Bank3 ADDIS – DJIBOUTI TRANSPORT CORRIDOR

4 November 2007Dr. Sameh El-Saharty - The World Bank4 COUNTRY CONTEXT 23 000 sq km Population: 795 000 75% living in poverty 75% urban population Religion: 99% Muslim Per capita income: $780 Economy: 90% of food imported (Ethiopia, Yemen, Europe) relies on service & trade sectors from its port Primary school enrollment: 39 %.

5 November 2007Dr. Sameh El-Saharty - The World Bank5 HEALTH SECTOR CONTEXT One of the poorest health indicators in the world & below regional averages Infant mortality: 67 per 1000 live births Child mortality: 94 per 1000 live births Maternal mortality: 540/100,000 live births Incidence of infectious diseases is high & rising (HIV/AIDS, malaria, & TB) Health expenditures = 7 percent of GDP

6 November 2007Dr. Sameh El-Saharty - The World Bank6 DJIBOUTI AND HIV/AIDS The analysis of the AIDS cases reported in 1999 indicated that: Transmission mostly heterosexual Persons aged 15-29 represent 47.4 percent of registered AIDS cases Women are infected at a younger age than men HIV/AIDS Seroprevalence rate (2001): General population: 3% Prevalence among 20 – 35y: 5%

7 November 2007Dr. Sameh El-Saharty - The World Bank7 HIV/AIDS, MALARIA, AND TUBERCULOSIS CONTROL PROJECT US$12.0 million Grant to Djibouti Project Objectives: To prevent HIV infection To provide care, support, and treatment to people with HIV in Djibouti To treat and control the spread of malaria and TB

8 November 2007Dr. Sameh El-Saharty - The World Bank8 Project components: Capacity building and policy development Health sector response to HIV/AIDS, TB, & malaria including prevention, treatment, and integrated care Multisector response to HIV/AIDS prevention and care Community-based initiatives for the three diseases. HIV/AIDS, MALARIA, AND TUBERCULOSIS CONTROL PROJECT

9 November 2007Dr. Sameh El-Saharty - The World Bank9 THE CORRIDOR TO TRADE & AIDS Addis-Djibouti Trade Corridor: 850 Km two-way stretch that has more than 27 towns/stops. About 4000 truckers and assistants traverse daily Truckers stop for meals, overnight stay, meet with sex workers in hotels and bars, and engage in unprotected sex. The majority of the truckers along the corridor are Ethiopian Ethiopia has a national prevalence rate of 6.6 percent in the adult population and an estimated 13.7 percent in the urban population. Djibouti is therefore highly susceptible to the cross-border HIV transmission through the transport sector. The risk is not only of becoming infected with HIV but also of spreading it beyond the two countries through other corridors HIV/AIDS will likely continue to seriously damage and diminish the health, economy and development of the country

10 November 2007Dr. Sameh El-Saharty - The World Bank10 ETHIOPIA: BEHAVIOR OF TRANSPORT WORKERS Many of the drivers and their assistants > 30 y old Nearly all the respondents had attended school More than 80 percent had never been married More than 93% of all the transport workers lived in cities Most had worked as transport workers > 5 years More than 96% had circumcision Source: High Risk Corridor Initiative (HRCI) supported by USAID Ethiopia (2004)

11 November 2007Dr. Sameh El-Saharty - The World Bank11 ETHIOPIA: TRANSPORT SECTOR PROJECT Objective: to target vulnerable groups along the Djibouti transport corridor through prevention, information, basic treatment, support and care services for underserved, vulnerable groups. Targets of the project: 50 percent of persons in high-risk groups will have used a condom during their last non-union sexual encounter (baseline was 20 percent) 85 percent of the vulnerable groups population will have been reached through Information, Education, and Communication (IEC) / Communication for Behavior Change (CBC) programs on HIV/AIDS.

12 November 2007Dr. Sameh El-Saharty - The World Bank12 Interventions to increase demand for HIV/AIDS related services along Ethiopia- Djibouti corridor Training of Field communicators Distribution of flyers, stickers, booklets, T-shirts, pocket diaries, and song cassettes Interventions to prevent the spread of the disease (condom distribution) Interventions to detect HIV/AIDS (Voluntary Counseling and Testing Centers) ETHIOPIA: TRANSPORT SECTOR PROJECT TOOLS

13 November 2007Dr. Sameh El-Saharty - The World Bank13 INFORMATION, EDUCATION, & COMMUNICATION This information center is one the 21 HIV/AIDS sites set up by Save the Children along the Djibouti Corridor (Photo by Marina Walker Guevara)

14 November 2007Dr. Sameh El-Saharty - The World Bank14 2050 truckers & assistants were trained on prevention methods 20 trained Field Communicators 19 Voluntary Counseling and Testing Centers 25 Information Centers established 50 % of the high risks groups have used a condom in their last non- marital sexual relation. ETHIOPIA: TRANSPORT SECTOR PROJECT RESULTS

15 November 2007Dr. Sameh El-Saharty - The World Bank15 DJIBOUTI PORT The Port of Djibouti is located at the crossroads of one of the busiest shipping routes in the world, linking Europe, the Far East, Africa and the Persian Gulf.

16 November 2007Dr. Sameh El-Saharty - The World Bank16 COMMUNITY RESPONSE NGOs are active in the fight of HIV/AIDS particularly around the port, e.g. PK12.

17 November 2007Dr. Sameh El-Saharty - The World Bank17 Built from an old shipping container, the UNICEF- sponsored information centre is helping educate young people about the danger of HIV and AIDS INFORMATION, EDUCATION & COMMUNICATION

18 November 2007Dr. Sameh El-Saharty - The World Bank18 PEER EDUCATION - TAXI DRIVERS Taxi drivers are a risk group in Djibouti as some sleep with their clients when they are unable to pay the taxi fee. The Union of Taxi Drivers of Djibouti meets to discuss ways of encouraging the use of condoms among their drivers. Every Monday and Friday, peer educators go to various taxi stands to inform drivers about HIV/AIDS and to distribute condoms.

19 November 2007Dr. Sameh El-Saharty - The World Bank19 PEER EDUCATION – COMMERCIAL SEX WORKERS CSW from Soeur à Soeur NGO that is actively providing peer education and condom use promotion. (Source: The Global Fund website)

20 November 2007Dr. Sameh El-Saharty - The World Bank20 COMMUNITY RESPONSE - DOCKERS Information, Education, & Communication Peer education ….AND THE RESULTS WERE…

21 November 2007Dr. Sameh El-Saharty - The World Bank21 DOCKERS: KNOWLEDGE OF PREVENTION MEASURES Condom use (52%) Fidelity (77%) Abstinence (89%)

22 November 2007Dr. Sameh El-Saharty - The World Bank22 DOCKERS: ATTITUDE TOWARDS INFECTED PERSONS Tolerance of AIDS patients (39.7%)

23 November 2007Dr. Sameh El-Saharty - The World Bank23 DOCKERS: VOLUNTARY COUNSELING AND TESTING VCT acceptance (22.8%)

24 November 2007Dr. Sameh El-Saharty - The World Bank24 DOCKERS: SEXUAL ACTIVITY 84% had non- union sexual intercourse But only 13.2% used condoms Good news: 94% of CSW used condoms…. …Still a long way ahead

25 November 2007Dr. Sameh El-Saharty - The World Bank25 Transport Sector Challenges Showing the relevance and role of the transport sector in both the transmission of, and fight against, HIV/AIDS. Assessing the extent of the problem of HIV/AIDS among transport sector workers. Developing partnerships with local organizations and associations that can understand the issues of the transport sector workers (recruiting peer educators). Developing common approaches and interventions that foster collaboration between the transport sector and the other sectors/ministries involved in HIV/AIDS control. Strengthening transport sector capacity to fight HIV/AIDS at the borders (border delays, over-night stops, etc..).

26 November 2007Dr. Sameh El-Saharty - The World Bank26 Dr. Sameh El-Saharty selsaharty@worldbank.org


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