Ethiopia’s evolving battle against HIV enters a new phase

In June 1981, a cryptic alarm began to echo from hospitals in Los Angeles and New York: young men, previously healthy, were succumbing to rare, aggressive illnesses that confounded doctors and devastated families. This marked the official emergence of AIDS—a health crisis that would spiral into a global epidemic.

In those early years, fear outpaced understanding. Treatment was non-existent, and stigma shadowed patients as much as the disease itself. The United States alone recorded more than 100,000 AIDS-related deaths between 1981 and 1990—a grim measure of a pandemic just beginning to unfold.

But Africa’s story with HIV/AIDS began even earlier.

A blood sample collected in 1959 from a man in Kinshasa, in what is now the Democratic Republic of Congo, remains the oldest confirmed case of HIV. By the mid-1980s, the epidemic had quietly but firmly taken root across the continent. In Uganda and Tanzania, a wasting illness locals dubbed “Slim” signalled a silent catastrophe spreading through communities.

Ethiopia was not spared. The country officially recognized HIV/AIDS in the mid-1980s, as clinical reports and public awareness began to catch up with the rapid spread of the virus. Like many African nations, Ethiopia bore the epidemic’s harsh toll with limited medical infrastructure and scarce public resources.

By 2005, the country reached the peak of AIDS-related mortality, according to the Ethiopian Public Health Institute (EPHI)—a reflection of the devastating years before widespread access to antiretroviral treatment.

Today, Ethiopia’s battle with HIV has transformed, though far from over. Projections for 2024 estimate that nearly 600,000 people are living with HIV nationwide, according to the EPHI. Encouragingly, HIV prevalence among adults aged 15 to 49 has dropped to 0.7 percent, based on 2023 data from the Centers for Disease Control and Prevention (CDC).

But the numbers, while improving, mask a more uneven reality.

“National prevalence and new infections are indeed declining,” says Fikadu Yadata, Lead Executive Officer at the HIV Prevention and Control Office under Ethiopia’s Ministry of Health. “But when you disaggregate the data by age, geography, or gender, alarming disparities appear.”

Speaking to The Reporter, Fikadu detailed these regional differences: Addis Ababa leads with an HIV prevalence of 3.3 percent, followed closely by Gambella at 3.2 percent. Combined rates in Harari and Dire Dawa reach 5.1 percent, placing them among the hardest-hit areas. Other urban centers such as Adama, Bahir Dar, and Mekelle also register higher-than-average rates.

“Urban areas show prevalence rates nearly seven times higher than rural communities,” Fikadu said. “We also see a troubling trend among adolescents and young women, with infection rates around 1.7 percent”—a figure that should concern anyone thinking about the next generation’s future.

He also pointed to the persistent risk factors: reduced international funding, high infection rates in key populations, and continued stigma and misinformation surrounding the disease. In Ethiopia’s rapidly urbanizing regions—particularly in the south, west, and east—young people face unique vulnerabilities. Limited access to education, employment, and reproductive health services only amplifies the risk.

“The rate of decline is slower than we anticipated,” he said. “While we’re not seeing an increase in new cases, the reduction is not matching our expectations.”

Ethiopia has made significant gains in expanding HIV testing, treatment access, and viral suppression. Experts say the country must now pivot from a generalized response to more targeted interventions.

According to Fekadu, the Ministry’s strategic approach emphasizes risk behaviors and sustainability, with a targeted focus on geographical regions, age demographics, sex, and marginalized populations.

Even as Ethiopia strives to close the HIV treatment gap, new research is reframing the global conversation around care—this time, focusing on a population long overlooked: older adults living with HIV.

While international attention often centers on youth and reproductive-age adults, three groundbreaking studies conducted by the University of Nairobi’s Center for Epidemiological Modeling and Analysis (CEMA) are challenging that lens.

The B/F/TAF, Sungura, and Twiga studies—unveiled at the International AIDS Society Conference on HIV Science in Kigali, Rwanda—offer new hope and critical insights for Africa’s aging HIV-positive population.

These studies revealed a stark gap in HIV treatment design: older individuals, especially those over 60, are frequently excluded from both research and programming. Yet they face a heightened risk of coexisting conditions such as kidney disease, hypertension, diabetes, osteoporosis, and depression—complications that interact dangerously with certain antiretroviral therapies (ART).

“Older people with HIV are a neglected population,” said Loice Ombajo (PhD), an infectious disease specialist and Co-Director at CEMA. “The B/F/TAF study helps us understand how aging, HIV, and chronic illnesses intersect in African settings.”

The B/F/TAF study, which included over 1,000 HIV-positive participants aged 60 and older, reported promising results.

According to study data, some widely used HIV treatments—particularly standard TLD (tenofovir/lamivudine/dolutegravir) regimens—may compromise bone and kidney health in older patients. The findings also highlighted that inadequate coverage of hepatitis B (HBV) vaccines limits eligibility for simplified dual therapies, raising new questions about treatment inclusivity and safety.

“We plan to follow this cohort for five years,” Ombajo said. “By comparing HIV-positive and negative individuals, we can better understand the true impact of HIV on aging.”

Back in Ethiopia, these findings resonate with ongoing shifts in the national HIV strategy.

While new infections continue—especially among adolescent girls, young women, and key populations—Fikadu said the country has adopted a strategic sustainability plan aimed at improving efficiency amid declining donor support and waning stakeholder engagement.

“We are working to revitalize partnerships, integrate HIV services into the national health system, and mobilize domestic resources,” he told The Reporter. “Our approach is rooted in targeting high-risk behaviors, with a strong emphasis on underserved and marginalized areas.”

More than just managing HIV with ART, the Ministry is prioritizing holistic, one-stop service models, where patients can access care for the full spectrum of health needs.

“Many people living with HIV also suffer from noncommunicable diseases—diabetes, hypertension, cancer, and mental health issues,” Fikadu said. “We’re developing integrated clinics that support physical, mental, cultural, and social well-being while ensuring viral suppression.”

Achieving viral load suppression—as fewer than 1,000 copies of the virus per milliliter of blood—remains a core goal. “If we can suppress viral loads, people living with HIV can lead long, healthy, and socially productive lives,” he said.

Despite expanded testing and treatment coverage, recent data show an uptick in new HIV infections among adolescents, who Fikadu says often lack adequate knowledge about the virus or access to sexual health services.

“Based on the latest figures, adolescents are not practicing safe sex consistently, and that’s making it harder to fully contain the epidemic,” he said. “As a result, we’ve refocused our efforts on high-risk groups—including female sex workers, long-distance truck drivers, and people who use drugs.”

Schools and universities, he added, remain high-risk zones. In response, the Ministry has launched a digital outreach campaign using Telegram, Android apps, peer education, and mentorship programs in partnership with academic institutions.

Globally, the broader picture offers cautious optimism.

As of 2024, 40.8 million people are living with HIV worldwide, according to data from the Joint United Nations Programme on HIV/AIDS (UNAIDS). New infections stand at 1.3 million annually, and while the virus continues to pose a grave health challenge—particularly in sub-Saharan Africa—progress is undeniable.

AIDS-related deaths have plummeted by 70 percent from their 2004 peak, falling to an estimated 630,000 in 2024. More than 31.6 million people now have access to life-saving ART, thanks to sustained global commitments to eliminate HIV/AIDS by 2030.

For Ethiopia, the path forward is clearer than ever: sustained investment, targeted interventions, inclusive research, and the unwavering resolve to treat not just the virus, but the people living with it.