HIV/AIDS Prevention Among Transport Workers: Lessons Learned from a Peer Education Program in Ethiopia Mengistu Asnake, MD, MPH and Metiku W/Giorgis, BSc, MSc PATHFINDER INTERNATIONAL 131st Annual Meeting and Exposition of the American Public Health Association San Francisco, CA November 17, 2003

131st APHA Annual Meeting and Exposition Background: Ethiopia Total Pop. = 70 million Adult HIV prevalence = 6.6% Urban HIV prevalence = 13.7% Rural HIV prevalence = 3.7% PLWHA = 2.2. Million Highest prevalence = Age In 2000, Pathfinder/Ethiopia, with funding from USAID, began a project with transport workers, through ISAPSO, a local partner.

131st APHA Annual Meeting and Exposition Program Justification  The job requires mobility, resulting in frequent temptation for casual sexual.  Existing community-based programs may not reach transport workers.  Multiple purpose in reaching transport workers, passengers and surrounding community.  Transfer of HIV/AIDS message along transport routes.

131st APHA Annual Meeting and Exposition Booth-Based Services (Information and referral at transport terminals) From January 2001 to June 2003, 78,336 sessions of booth-based services reached:  80,530 drivers & 80,794 assistants  18,964 cashiers & 54,622 office workers  468,326 passengers  152,682 community members living in the booth area

131st APHA Annual Meeting and Exposition  1,252 Posters,14,093 fliers/leaflets and 19,859 brochures  2,369 booklets  700 paper caps and 659 T- shirts  735 car stickers and 1,656 radio cassettes Educational/Promotional materials distributed

131st APHA Annual Meeting and Exposition Condom Distribution

131st APHA Annual Meeting and Exposition Program Collaborators  Road Transport Authority  Ten transport owners associations  Peer educators  Management of Middle Distance Bus Terminals  Pathfinder International, with USAID funding  Integrated Service for AIDS Prevention and Support Organization (ISAPSO) - implementing Partner

131st APHA Annual Meeting and Exposition Success Stories

131st APHA Annual Meeting and Exposition Success Stories (Cont’d)  Establishment of national transport HIV/AIDS activities coordinating committee at Federal Road Transport Authority (RTA).  Inclusion of STI/HIV/AIDS education in the training curriculum for drivers and mechanics.  Growth of peer educators committees to legally recognized local NGOs.  Replication of middle distance bus driver (MDB) experience to truck and train route.  Assignment of material and human resources for the program from transport owners association and RTA.  Breaking the silence as a sign for change in behavior (open discussions, increased condom use, and avoiding environments conducive for casual sex).

131st APHA Annual Meeting and Exposition Perception of Beneficiaries  Decrease in fear/stigma to discuss HIV/AIDS openly.  Increased availability and use of condoms.  Many transport workers are getting married through the choice of faithful partnership.  Replication of MDB experience to truck and train route.  Avoidance of environments conducive to casual sex.  With a decreased clientele from transport workers, most community sex workers are changing their professions to petty trading.

131st APHA Annual Meeting and Exposition The Way Forward  Replicate similar activities on a wider scale.  Involve peer educators beyond the transport sector in psychosocial support.  Create linkages with hotel settings along transport routes.  Create more legal associations from peer educator committees.  Maintain HIV/AIDS activities within the labor union agreements.

131st APHA Annual Meeting and Exposition Conclusion The program has achieved its purpose by:  Reaching mobile and vulnerable groups.  Promoting behavioral change in the target populations.  Mobilizing the road transport authority and transport companies.  Creating an environment conducive for partnership in sustaining project activities.  Establishing a model for accessing hard-to-reach populations and creating a mechanism for replication.

For more information, please contact: Pathfinder International Headquarters Nine Galen Street, Suite 217 Watertown, MA USA Phone: (617) Fax: (617) Web: or Pathfinder International/Ethiopia Bole Road, Near Lalibela Hotel Phone: Fax: Thank You!!