Creating a Cross-Continental Exchange of Knowledge to Support Young Women in Ethiopia

By Birhan Mengistu December 5, 2013


Every hour, an estimated 50 young women are newly infected with HIV. In many areas of the world, gender inequalities make it especially difficult for women to access HIV prevention, treatment, and care services.  Even basic information about HIV is unattainable; UNAIDS estimates that only 38% of young women have accurate, comprehensive knowledge of HIV/AIDS.

This critical issue has not gone unnoticed in Ethiopia, where approximately 380,000 women over the age of 15 are living with HIV (the total population of Ethiopia is over 90 million). In 2009, we at NASTAD Ethiopia began working with the Federal HIV/AIDS Prevention and Control Office (HAPCO) to identify ways to support this at-risk population. Knowing that our membership of U.S. state AIDS directors had significant experience in delivery to scale of proven effective behavioral interventions targeting high risk populations through the CDC Diffused Evidence Based Interventions (DEBIs), we leveraged their skills and training expertise to modify and adapt selected DEBIs for implementation in Ethiopia.

One particularly successful DEBI was introduced in the Dire Dawa region in northeastern Ethiopia, where HIV prevention among women is a priority. To support the response to this need we helped to establish relationships between the Dire Dawa Regional Health Bureau (RHB) and the County of San Diego Health & Human Services Agency, as well as the Maryland Department of Health and Mental Hygiene. The RHB and HAPCO representatives worked with staff from both health departments to identify the best DEBI to address the issue of HIV/AIDS transmission among young women in the Dire Dawa region. The regional delegates identified Sister to Sister (S2S) as the most appropriate intervention and requested technical assistance from their U.S. based counterparts for adaptation and implementation in Dire Dawa.

Sister to Sister had been implemented successfully in various areas of the United States, and was designed for adaptation and implementation in other areas of the world. The intervention aims to reduce risk behaviors that increase the transmission of HIV and sexually transmitted diseases (STDs) among sexually active women ages 18-45.

In Dire Dawa, NASTAD worked with local behavioral health experts to tailor S2S to target high risk women, in particular those with mobile lifestyles and who might be unable to attend multiple successive information sessions. NASTAD and its local partners identified and trained S2S facilitators, all local women with similar demographics as the target population. The facilitators were trained to engage with the participants in a way that both communicated important information about HIV transmission and provided emotional support and empowerment for the young, female participants.

During the two hour sessions, the facilitators provided epidemiologic and statistical information about the incidence and prevalence of HIV/AIDS in Dire Dawa. The facilitators then worked with the participants to discuss HIV/AIDS and its transmission, correct condom use, negotiation skills around condom use, and how to make condom use fun and pleasurable. These lessons were all discussion based, and participants were encouraged to share their personal attitudes, concerns, and experiences relating to these and other issues.

S2S was found to be highly successful in Dire Dawa and in the other Ethiopian regions where it was implemented. The intervention led to a better understanding of condom use, an increase in correct and consistent use of condoms, and an increase in the number of people testing for HIV after having participated in the training.

In collaborating with both our local Ethiopian partners and our membership of U.S. state AIDS directors, NASTAD helped to provide Ethiopian women with the information they need to maintain healthy and empowered lifestyles.  NASTAD Ethiopia will continue to facilitate the exchange of information and knowledge among our international partners in order to address the needs of at-risk populations.

To learn more about the implementation of Sister to Sister and other DEBIs for HIV prevention in Ethiopia, please review this informational brochure, or email Randy May. Visit to learn more about the NASTAD Global Program.

Anna Carroll, Associate, Global Program, also contributed to the development.