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    What is the current prevalence of HIV in Ethiopia and how is it distributed across locations and populations? The epidemic continues to be highly heterogeneous HIV prevalence among the general adult population was 1. However prevalence rates varied markedly by age from 0.

    Between andHIV prevalence remained relatively stable in large cities with a hint of increase from 4. Urban areas that border major roads regardless of region or town size yield HIV prevalence equivalent on average to the largest cities 5.

    Similarly, no comparable information is available for groups such as men who have sex with men MSM and distance drivers, although studies are currently underway.

    What is the change in the HIV epidemic over time, location and population in Ethiopia? While this may be partly explained by expansion of ANC sites to more peri-urban and rural areas where background HIV risk is lower, prevalence ratios of year old versus year old ANC mothers also decreased over the same period.

    General population prevalence among year olds also fell across national surveys conducted in and All are consistent with real declines in HIV incidence. AIDS-related deaths dropped by 50 percent in the two years following the introduction of free ART in according to demographic surveillance data from Addis Ababa.

    HIV prevalence may be stabilizing at national and regional levels Prolonged survival with ART may be masking epidemic declines and even contributing to slight increases in prevalence observed in larger urban areas with better access to treatment. Urban migration and development activity may also pose a challenge to broader declining trends in HIV incidence as more people shift to settings where risk of HIV transmission is higher.

    What behavioral, biomedical, and structural factors have contributed to the levels and trends in HIV prevalence in Ethiopia? Moderate gains observed in this measure between and were limited to rural areas. HIV transmission within marriage represents a substantial if often overlooked source of new HIV infections in Ethiopia.

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    Roughly two- thirds of these have sero-discordant sexual partners. Together, these suggest that the large majority of current PLHIV are more likely to pass HIV to their spouses and children than to outside sexual partners. What are the current responses to the epidemic and are they appropriate to the nature of the epidemic in the country?

    Impressive progress seen in the biomedical response since By the end ofnumber of PLHIV currently on ART reachedwith nearly 50, newly enrolled per year, more than double the modeling estimates for annual HIV incidence. Close to 12 million HIV tests were conducted and million condoms were distributed annually. Commercial sex workers report nearly universal consistent condom use with paying clients, although much lower rates with non-paying male partners.

    Need to adopt more targeted and evidence- based approaches Given the heterogeneous and declining nature of the epidemic, effective responses will need to be increasingly targeted and scaled in proportion to the number of new infections they may prevent. Combination prevention linking behavioral, biomedical and structural approaches are believed to ensure the greatest chance of success.

    What are the key sources of strategic information and are they adequate to monitor and evaluate the epidemic and guide the response? Targeted surveys are occasionally necessary but expensive, time consuming, and quickly outdated. Better routine surveillance data for most at- risk groups are critical for mounting effective prevention response for such groups.

    Prevention investment should not be based on presumption of risk or any single risk condition, but a combination of all three factors. More widely recognized data sources such as EDHS are typically under-analyzed. More studies are needed, but better demand for and use of existing data, even if imperfect, has the potential to substantially improve program response.

    Need to identify sources of new infections Given the changing nature of the Ethiopian epidemic, modes of transmission studies are needed to identify sources of new infections so that prevention programs can be targeted and scaled accordingly.

    As access to treatment continues to expand, population prevalence of HIV will become a less reliable guide on the course of the current epidemic, and the importance of sources able to separate incident from prevalent infections will grow accordingly.
    So I want you all to take a moment and look at this photo, and really reflect on some of the things that come to mind, and what are some of those things, those words.

    Now, I'm going to ask you all to look at me. What words come to mind when you look at me? What separates that man up there from me? The man in that photo is named David Kirby and it was taken in as he was dying from AIDS-related illness, and it was subsequently published in "Life Magazine. So what I want to ask next is this: If we have made such exponential progress in combatting HIV, why haven't our perceptions of those with the virus evolved alongside?

    Why does HIV elicit this reaction from us when it's so easily managed? When did the stigmatization even occur, and why hasn't it subsided?

    And these are not easy questions to answer. They're the congealing of so many different factors and ideas. Powerful images, like this one of Kirby, these were the faces of the AIDS crisis in the '80s and '90s, and at the time the crisis had a very obvious impact on an already stigmatized group of people, and that was gay men. So what the general straight public saw was this very awful thing happening to a group of people who were already on the fringes of society.

    The media at the time began to use the two almost interchangeably — gay and AIDS — and at the Republican National Convention, one of the speakers joked that gay stood for: But as we started to understand the virus more and how it was transmitted, we realized that that risk had increased its territory. The highly profiled case of Ryan White inwho was a year-old hemophiliac who had contracted HIV from a contaminated blood treatment, and this marked the most profound shift in America's perception of HIV.

    No longer was it restricted to these dark corners of society, to queers and drug users, but now it was affecting people that society deemed worthy of their empathy, to children. But that permeating fear and that perception, it still lingers. And I want a show of hands for these next few questions. How many of you in here were aware that with treatment, those with HIV not only fend off AIDS completely, but they live full and normal lives?

    Laughter How many of you are aware that with treatment, those with HIV can reach an undetectable status, and that makes them virtually uninfectious? How many of you were aware of the pre- and postexposure treatments that are available that reduce the risk of transmission by over 90 percent?

    See, these are incredible advancements that we have made in fighting HIV, yet they have not managed to dent the perception that most Americans have of the virus and those living with it. And I don't want you to think I'm downplaying the danger of this virus, and I am not ignorant of the harrowing past of the AIDS epidemic. I am trying to convey that there is hope for those infected and HIV is not the death sentence it was in the '80s. And now you may ask, and I asked this question myself initially: Where are the stories?

    Where are these people living with HIV? Why haven't they been vocal? How can I believe these successes, or these statistics, without seeing the successes? And this is actually a very easy question for me to answer.

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    Fear, stigma and shame: Our sexual histories are as personal to us as our medical histories, and when you overlap the two, you can find yourself in a very sensitive space.

    The fear of how others perceive us when we're honest keeps us from doing many things in life, and this is the case for the HIV-positive population. To face social scrutiny and ridicule is the price that we pay for transparency, and why become a martyr when you can effectively pass as someone without HIV? After all, there are no physical indications you have the virus. There's no sign that you wear.

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    There is safety in assimilation, and there is safety in invisibility. I'm here to throw back that veil and share my story.

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    So in the fall ofI was a sophomore in college and like most college students, I was sexually active, and I generally took precautions to minimize the risk that sex carries. Now, I say generally, because I wasn't always safe. It only takes a single misstep before we're flat on the ground, and my misstep is pretty obvious.

    I had unprotected sex, and I didn't think much of it.

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    Fast-forward about three weeks, and it felt like I'd been trampled by a herd of wildebeest. The aches in my body were like nothing I have felt before or since. I would get these bouts of fever and chill. I would reel with nausea, and it was difficult to walk.

    Being a biology student, I had some prior exposure to disease, and being a fairly informed gay man, I had read a bit on HIV, so to me, it clicked that this was seroconversion, or as it's sometimes called, acute HIV infection. And this is the body's reaction in producing antibodies to the HIV antigen. It's important to note that not everybody goes through this phase of sickness, but I was one of the lucky ones who did. And I was lucky as in, there were these physical symptoms that let me know, hey, something is wrong, and it let me detect the virus pretty early.

    So just to clarify, just to hit the nail on head, I got tested on campus. And they said they would call me the next morning with the results, and they called me, but they asked me to come in and speak to the doctor on staff. And the reaction I received from her wasn't what I was expecting. She reassured me what I already knew, that this wasn't a death sentence, and she even offered to put me in contact with her brother, who had been living with HIV since the early '90s.

    I declined her offer, but I was deeply touched. I was expecting to be reprimanded. I was expecting pity and disappointment, and I was shown compassion and human warmth, and I'm forever grateful for that first exchange. So obviously for a few weeks, I was a physical mess.

    Emotionally, mentally, I was doing OK. I was taking it well. But my body was ravaged, and those close to me, they weren't oblivious. And I remember the look on their faces. They were holding each other on the couch and they were crying, and I consoled them.

    I consoled them about my own bad news, but it was heartwarming to see that they cared. But from that night, I noticed a shift in the way that I was treated at home. My roommates wouldn't touch anything of mine, and they wouldn't eat anything I had cooked. Now, in South Louisiana, we all know that you don't refuse food.

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    Laughter And I'm a damn good cook, so don't think that passed me by. Laughter But from these first silent hints, their aversion got gradually more obvious and more offensive.

    I was asked to move my toothbrush from the bathroom, I was asked to not share towels, and I was even asked to wash my clothes on a hotter setting. This wasn't head lice, y'all. It can be transmitted through blood, sexual fluids like semen or vaginal fluids and breast milk. Since I wasn't sleeping with my roommates, I wasn't breastfeeding them — Laughter and we weren't reenacting "Twilight," I was of no risk to them and I made this aware to them, but still, this discomfort, it continued, until eventually I was asked to move out.

    And I was asked to move out because one of my roommates had shared my status with her parents. She shared my personal medical information to strangers. And now I'm doing that in a roomful of of y'all, but at the time, this was not something I was comfortable with, and they expressed their discomfort with their daughter living with me.

    So being gay, raised in a religious household and living in the South, discrimination wasn't new to me. But this form was, and it was tremendously disappointing because it came from such an unlikely source. Not only were these college-educated people, not only were they other members of the LGBT community, but they were also my friends.

    I moved out at the end of the semester. But it wasn't to appease them. It was out of respect for myself. I wasn't going to subject myself to people who were unwilling to remedy their ignorance, and I wasn't going to let something that was now a part of me ever be used as a tool against me. So I opted for transparency about my status, always being visible. And this is what I like to call being the everyday advocate.

    The point of this transparency, the point of this everyday advocacy, was to dispel ignorance, and ignorance is a very scary word. We don't want to be seen as ignorant, and we definitely don't want to be called it. But ignorance is not synonymous with stupid. It's not the inability to learn.

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    It's the state you're in before you learn. So when I saw someone coming from a place of ignorance, I saw an opportunity for them to learn. And hopefully, if I could spread some education, then I could mitigate situations for others like I had experienced with my roommates and save someone else down the line that humiliation.

    So the reactions I received haven't been all positive. Here in the South, we have a lot stigma due to religious pressures, our lack of a comprehensive sex education and our general conservative outlook on anything sexual. We view this as a gay disease. Globally, most new HIV infections occur between heterosexual partners, and here in the States, women, especially women of color, are at an increased risk.

    This is not a gay disease.

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    It never has been.
    As shocking as the news of Charlie Sheen 's announcement Tuesday that he is HIV-positive has beenit can't compare to the national jolt 30 years earlier when one of Hollywood's most famous leading men revealed that he was suffering from AIDS. A lot has changed after Rock Hudson became the first celebrity to go public with the illness on July 25,at a time when many in the mainstream believed AIDS was only a problem for gay men, drug users and patients who received tainted blood transfusions.

    Advertisement Since the "Pillow Talk" star, who died in October of that year at the age of 59 of complications from the disease, bravely came forward, a succession of other celebrities have also gone public after being diagnosed as HIV-positive the human immunodeficiency virus that can, but doesn't necessarily, develop into AIDS: A r both died from AIDS.

    Getty Images Magic Johnson: The now year-old activist has rebounded nicely as a role model for others in similar condition, still going strong as an NBA analyst and showing that the diagnosis is not a death sentence.

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    As the front man of the arena band, Queen, the British singer cultivated a larger than life persona. But his death on Nov. The legendary tennis star wasthe first black man to win in singles at Wimbledon and the U. The native New Yorker dominated tennis in the mids, before he contracted HIV through a blood transfusion during a heart bypass surgery.

    He became an HIV activist and made efforts to raise awareness before dying in Feb. In his final days, the year-old, whose real name was Eric Wright, wanted to be a cautionary tale. I just feel I've got thousands and thousands of young fans that have to learn about what's real when it comes to AIDS. The Olympic champion dove into uncharted waters with the revelation in his autobiography, "Breaking the Waves," that was coming out both as a gay man and as an HIV-positive survivor.

    Magic Johnson is still going strong since revealing in that he was HIV-positive. Jeff Schear Jim J. The star of "Too Close for Comfort" was first diagnosed as HIV-positive induring the height of the sitcom, but went public 11 years later.

    He's worked steadily since, most recently earlier this year with a guest appearance on the final season of "Glee. As a boxer, "The Duke" endured plenty of punishment in the ring, but that paled in comparison to allegedly being diagnosed as HIV-positive in She added that it was not a result of complicatons of HIV as some media outlets had reported, and is currently suing the Las Vegas Boxing Commission, the doctors and lab disputing the veracity of the original diagnosis.

    One of the most recognizable character actors of his era with a resume that boasts films like "The Green Mile," "The Fisher King," and "Miller's Crossing," Jeter's greatest role proved to be an off-screen activist. Six years before his death in at the age of 50, the actor went public and became a speaker about living with an HIV diagnosis. And just as importantly, he kept working on high profile movies such as "Jurassic Park 3. Though not as famous as Hudson or Magic, "The Real World" star may have done more to combat stereotypes than any other celebrity on this list.

    Hitting a high note for others battling HIV, the Erasure singer came out publicly insix years after his diagnosis. The sci-fi icon contracted HIV from a blood transfusion during heart bypass surgery, though his widow didn't go public with the AIDS-related cause of his death until 10 years after Asimov passed away on April 6, The flamboyant showman went to his grave in attempting to keep secret both his sexuality and his battle with AIDS.

    While is personal doctors attributed his death to a cardiac arrest due to heart failure, a California coroner delivered the bombshell that the singer died of pneumonia-related complications from AIDS.
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    Listen to Audio 56 min. These files can be quite large. Allow some time for them to download. Sarah, let's start from the beginning. Can you tell our readers how you got HIV?

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    When I was born, my mother had a pretty bad C-section [cesarean section]. As a result, she had to get a blood transfusion, and the blood transfusion was tainted.

    So she was unknowingly infected and gave it to me through breast milk. She also unknowingly gave it to my father. They didn't know until a few years later that she was infected.


    Growing up in the s in a small, conservative, religious community, Sarah faced all the burdens of being an HIV-positive kid in an ignorant world. Sarah talks candidly about how HIV took away part of her childhood, forcing her to "face stuff that is hard for grownups to deal with.

    Sarah is currently pursuing a master's degree in counseling. How did they eventually find out that they were HIV positive? And how did you discover that you were positive?

    My father was trying to donate blood at a church blood drive event. He got a paper back saying that he was unable to give blood; this was probably So he got tested, and couldn't figure out what would be wrong because both of my parents hadn't been very promiscuous at all or ever done drugs or anything that was risk-related for HIV.

    He figured out then that he was HIV positive. Then my mother got tested also, and I think they received a letter from the hospital saying that they might have been infected. Although it had been when my mother received the transfusion and they should have been testing the blood, I don't think they were testing every single person quite yet.

    So this was a couple of years after your mom was infected through this blood transfusion? There was a couple of years when your family had no idea that they had been infected. You say that the hospital sent them a letter. When did he receive this letter? Was it years afterward the transfusion took place? Since my dad was tested when he was giving blood two years later, I'm thinking that it was probably two or three, maybe even four years later that they got the letter saying, "We might have had an oopsie.

    Why do you think there was such a long delay? I actually can't talk about the place too much, but I can say that I don't know that they were on top of things. Did your parents decide to test you as well when they tested positive? They actually waited a while. When I was probably eight or nine years old I had some major problems with my tonsils which were, I guess, fairly abnormal. So my mom decided to have me tested then, against the will of my father.

    Do you know why your parents waited so long to have you tested for HIV? I think my mother wanted to have me tested earlier, because she always felt that there might be something wrong with me also, but I think my dad wanted to put it off as long as possible.

    My dad didn't want to deal with it. I wasn't ever terribly sick, so they just waited until then. Do you know why your father wanted to put it off? Do you think he just wanted to believe that you were well? He's very open about [HIV now]. What he's not so open about is how he felt then. It was a very scary kind of epidemic [back] then.

    Even now people aren't that [understanding about HIV], but in the '80s it was a lot worse. People would say you couldn't go in the swimming pool if you had HIV. People had to move and stuff like that. I think my father's decision to put off testing me was more of a protective denial -- he didn't want to deal with it type of thing. So you got tested when you were nine or 10? When you went in and got tested, did you understand what was going on?

    Actually, I thought I was going into the doctor for a checkup and I had to get blood work done. I didn't really know anything about what was going on until a couple of months later.

    My dad didn't want to tell me then either, because he wanted me to have a normal life. I was actually home-schooled for a portion of that year, because when they found out I was HIV positive the private school that I went to didn't have any policy [about HIV-positive students].

    My parents wanted to talk to them and get a policy made before I went back. My dad didn't want to tell anybody, so my mom wasn't supposed to tell me.

    But one day when we were doing our schooling she kind of broke down and decided to tell me. How did you react? Did you understand what she was talking about? You were really young. I was nine or 10, and I knew that there was something wrong with my mom because she had had problems. She was really sick for a couple of years when I was six up until I was eight. She was always pretty sick, so I had an idea that there was something wrong with her. But I had no clue that there could be something wrong with me.

    I kind of freaked out. I was scared that I might die or something. I didn't know a whole lot about the disease.

    But you had heard of HIV? I think I had heard something, maybe here or there on TV, but I hadn't heard a whole lot about it. Did she tell you at that time that your dad also had it?

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    You know, I can't recall. I think she just said, "You and your dad, you're OK, but we have this disease. What happened after that? You know, to be honest, I don't think I processed a whole lot of things for the majority of my life from then on because a lot of traumatic things happened after that. Just to get through [I told myself], "OK, this is happening. I'm just going to get through this. It's like, "Oh, wow.

    I really suppressed a lot of feelings. Stuff is coming up now that I remember. That was traumatic and I didn't even really react to that.

    Do you have a support structure to deal with these topics as they come up now that you're older? I think I'm starting to. My family has helped me as much as possible, and I have friends also that have helped support me. My father hasn't been encouraging at all but my mother was always been supportive of what I wanted to do in life.

    Obviously, my husband is my big support team for me. Other than that, not really. Backing up a bit: When your mother told you that you were HIV positive, how did you tell other people?

    I actually wasn't allowed to tell other people at first. My dad, for whatever reason, didn't want us to tell anybody for a while. But then, after a year or a couple months, I was able to tell my one friend. She had foster sisters and brothers and stuff like that, so she knew what it was. She thought, "Crap, you're my friend. There's something wrong with you," but she was never weird about it.

    She didn't ever hesitate to be near me or with me. She was just a little kid, right? Yes, she was my age. She was just little. Did her family know? After the time when we weren't really allowed to tell people, my dad decided that he would go around and pretty much tell everybody through [public] speaking, despite me wanting to be able to tell people myself.


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