HIVAIDS AND GENDER IN ETHIOPIA

					 HIV/AIDS AND GENDER IN ETHIOPIA:
The Case of 10 Weredas in Oromia and SNNPR




            Sponsored by UNDP
  Undertaken by Miz-Hasab Research Centre




                                    December 2004
Gender and HIV/AIDS In Ethiopia


                                  Table of Contents
                                                                     Page

Preface                                                              6

Executive Summary                                                    8

1. Gende r and HIV/AIDS: An Overvie w                                12
     1.1 Introduction                                                12
     1.2 The Gender Context in Ethiopia                              14

2. Research Methodology                                              17
     2.1 Objectives                                                  15
     2.2 Target Areas and Population                                 18
     2.3 Methods of Data Collection                                  20
          2.3.1 The Survey                                           20
               2.3.1.1 Identification of Respondents                 20
               2.3.1.2 Research Questions                            21
               2.3.1.3 Quality Checks                                21
          2.3.2 Focus Group Discussions                              22
         2.3.3 In-depth Interviews                                   23

3. Background Characteristics, Knowledge of HIV/AIDS, and
    Routes to HIV Infection                                          24
     3.1 Demographic and Socio-economic characteristics of
          Respondents                                                24
     3.2 HIV/AIDS Perceptions in Studied Communities                 28
           3.2.1 HIV/AIDS Occurrences                                28
           3.2.2 Knowledge about HIV/AIDS                            29
           3.2.3 Source of Information on HIV/AIDS                   33
           3.2.4 Voluntary Counselling and Testing                   33
     3.3 Routes to HIV Infection and their Underlying Causes         35
           3.3.1 Cultural Norms, Values and Practices that Enhance
        HIV Infection                                                35
         3.3.2 Socialisation of Women and Men                        38
         3.3.3 Marriages and Related Practices                       39
           3.3.4 Virginity                                           40
     3.4 Sex and Sexuality                                           41
           3.4.1 Sexual Needs and Desire                             41
            3.4.2 Decisions about Having Sex                         44
           3.4.3 Perceptions of Vulnerability                        44
     3.5 Women‟s Rights to Property Ownership, Work and Access
          to Services                                                45
           3.5.1 Economic Rights                                     46
           3.5.2 Legal Rights                                        47
           3.5.3 Access to Information and Social Services           47

4. Social Capital                                                    49
     4.1 Community Structures and Networks                           49
          4.1.1 Community Leaders                                    49


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Gender and HIV/AIDS In Ethiopia


          4.1.2 Community Associations                             50
          4.1.3 Religious Organisations                            51
     4.2 NGOs and Other Civil Societies                            51
     4.3 Government                                                54
          4.3.1 Policy Provisions                                  54
          4.3.2 Constitutional and Legal Rights                    55
          4.3.3 Trends in the Implementation of Policy and Legal   56
                 Rights of Women                                   57
               4.3.3.1 Courts and Police                           57
               4.3.3.2 Education                                   58
               4.3.3.3 Health                                      58

5. Discussion and Way Forward                                      60
     5.1 Discussion                                                60
          5.1.1 Traditional Moral Codes                            60
          5.1.2 Socialisation Patterns                             61
          5.1.3 Partial Implementation of Laws                     62
          5.1.4 Skewed Intervention Programmes                     63
          5.1.5 Neglected Groups                                   63
          5.1.6 Possible Points of Entry                           63
          5.1.7 Windows of Opportunity                             64
     5.2 The Way Forward                                           65


References                                                         71
Appendix 1: Table of Results                                       73
Appendix 2: Wilber’s Integral Frame work                           87
Appendix 3: Maps                                                   88
Annex of Wereda Profiles                                           90




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Gender and HIV/AIDS In Ethiopia




List of Tables
Table 1: List of Communities and Weredas where the Study was Conducted
Table 2: Background Characteristics of Key Informants by Sex and Occupation
Table 3: Major NGOs operating in the studied communities and their activities
Table 4: Process and Product indicators
Table 5: Percentage Distribution of Demographic Characteristics of Respondents by
         Wereda
Table 6: Percentage Distribution of Socio-economic Characteristics of Respondents
         by Wereda
Table 7: Percentage Distribution of Knowledge on Modes of HIV Infection by
         Wereda
Table 8: Percentage Distribution of Knowledge on Preve ntive Strategies by Wereda
Table 9: Percentage Distribution of Level and Source of Information on HIV/AIDS by
         Wereda
Table 10: Percentage Distributions of Perceptions and Attitudes Towards Voluntary
         Counselling and Testing by Wereda
Table 11: Percentage Distribution of Knowledge on Harmful Practices that Enhance
         the Spread of HIV/AIDS by Wereda
Table 12: Percentage Distribution of Attitudes Towards Virginity by Wereda
Table 13: Percentage Distribution of Gender Sexuality and HIV/AIDS by Wereda
Table 14: Percentage Distribution of Attitude Towards Gender and Sexuality by
         Wereda
Table 15: Percentage Distribution of Perception of Risk and Attitude Towards HIV
         Infection by Wereda
Table 16: Percentage Distribution of Woman‟s Right by Wereda

List of Figures
Figure I: Educational Level by Gender in Study Areas
Figure II: Literacy by Gender in Study Areas
Figure III: Ownership of Land by Gender in Study Areas
Figure IV: Knowledge of Two Most Common Modes of Transmission by Wereda
Figure V: Attitude Towards PLHA by Wereda
Figure VI: The Most Common Prevention Method by Wereda




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Gender and HIV/AIDS In Ethiopia


List of Acronyms

BCC                 Behavioural Change Communication
BSS                 Behavioural Surveillance Study
CCF                 Christian Children‟s Fund
CSA                 Central Statistics Authority
CSO                 Civil Society Organisations
CSW                 Commercial Sex Workers
DHS                 Demography Health Survey
FDRE                Federal Democratic Republic of Ethiopia
FGAE                Family Guidance Association of Ethiopia
FGD                 Focus Group Discussions
FGM                 Female Genital Mutilation
GTZ                 German Technical Cooperation
HIV/AIDS            Human Immune Virus/ Acquired Immune Deficiency Syndrome
HTP                 Harmful Traditional Practice
IEC                 Information Education Communication
IIRR                International Institute of Rural Reconstruction
KMG                 Kembata Menti Gezmi (Kembata Women‟s Self- Help Association)
MTCT                Mother to Child Transmission
MOH                 Ministry of Health
NCTPE               National Committee on Traditional Practices of Ethiopia
NGO                 Non Governmental Organisation
OSHO                Oromo Self Help Organisation
OSSA                Organisation for Social Services for AIDS in Ethiopia
PA                  Peasant Association
PLHA                People Living with HIV and AIDS
PMTCT               Prevention of Mothers to Child Transmission
SNNPR               Southern Nations Nationalities and Peoples‟ Region
STI                 Sexually Transmitted Infection
UNDP                United Nations Development Program
VCT                 Voluntary Counselling and Testing




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Gender and HIV/AIDS In Ethiopia


Preface

UNDP, as one of eight co-sponsors of UNAIDS, has a well-defined contribution to
make to the overall response of the United Nations system in assisting countries to
take action against HIV/AIDS epidemic. UNDP‟s Leadership for Results programme
(L4R) focuses on action aimed at creating an enabling policy and resource
environment to achieve Millennium Development Goals (MDG) and the UN General
Assembly Special Session on HIV/AIDS (UNGASS) goals.

L4 R is a synergistic package of approaches with multiple entry points. The key
interventions include
        -        Community Conversations - empowering communities to identify
                 their challenges and find their own solutions
        -        Leadership Development Programmes – generating a new kind of
                 leadership, based on the values of human rights, gender equality and
                 non-discrimination
        -        Arts and Media for Social Transformation – creating an enabling
                 environment by creating new icons and changing the discourse on
                 HIV/AIDS.

The HIV/AIDS and Gender Study in Ethiopia constitutes an integral part of L4R,
which was initiated with an aim to lay the grounds and feed into further strategic
planning processes and implementation of L4R. It explores the underlying causes of
peoples‟ behaviours with special focus on power relation between wo men and men,
which are shaped by norms, values, beliefs and traditions. After eight months of the
study it confirmed strong interlinkage between gender disparities and HIV
transmission and revealed the perceived concepts of femininity and masculinity are a
major contributor to the spread of HIV/AIDS.

The report presents different cultural practices related to sex and sexuality, which
have been exercised for generations in two regions of Ethiopia, namely Oromia and
Southern Nations and Nationalities People‟s Region (SNNPR) and uncover
underlying reasons and beliefs that support these practices, linking them with the
spread of the epidemic. At the same time, however, the report points out the window
of opportunities, which exist right in the communities, to overcome the challenge
posed by the epidemic.

The field survey was conducted from October to December 2003 in six woredas in
SNNPR and four woredas in Oromia region, namely Guraghe, Alaba, Welayita,
Dawro Gedio and South Omo in SNNPR and Borena, North Shewa, East Shewa and
East Hararge in Oromia. The selection of the woredas was largely based on cultural
diversity, HIV/AIDS prevalence and proximity to the “AIDS corridor”. Further,
before the finalization of the report, two regional workshops and o ne national
workshop were organized to verify the findings and to enrich the recommendations of
the draft report. In the study more than 2,000 people from ten communities were
interviewed. In the three workshops, approximately 200 representatives from
communities, federal, regional and woreda governments, international and national
NGOs and donors participated. The concern and commitment shown by everybody
participated in the study should be noted. I would like to express my sincere gratitude



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Gender and HIV/AIDS In Ethiopia


to all the respondents and participants since they are the ones who made this report
reach to this stage.

A special thanks to the members of the Technical Committee for the Research,
composed of representatives from different institutes working for HIV/AIDS and
gender issues in the country, who voluntarily attended a number of meetings to
contribute their technical knowledge and expertise to the completion of the study and
the finalization of the report.

The Miz- Hasab Research Center (Dr. Hailom Banteyerga, Dr. Marvellous Mhloyi,
Dr. Aklilu Kidanu, Dr. Dehab Belay and Dr. Ayalew Gabre) requires particular
recognition of their hard work and dedication ensured the success of this Study.
UNDP Ethiopia HIV/AIDS team lead by Ms. Nileema Noble, Deputy Resident
Representative and Ms. Kelemework Tekle, Assistant Resident Representative, is
commended for their dedication and commitment to the successful completion of the
report. We would also like to thank the Japan Women in Development Fund for
funding the project.

This report is comprised of five chapters. Chapter 1 gives you the overall overview
on issues related to HIV/AIDS and gender. Chapter 2 explains the research
methodology used in the study. Chapter 3 and 4 present the findings of the field
survey. The last chapter, Chapter 5, summarizes the discussion points and forwards
the recommendations aimed at turning the tide of the epidemic.

As indicated above, the findings and recommendations of the report will assist L4R to
shape its projects more responsive to gender issues, and, consequently more effective
to curb the spread of HIV/AIDS. Further, we hope that all our partners, including
communities, federal, regional and woreda governments and NGOs, will find this
report useful in helping them understand and incorporate responses to the pandemic
from a gender perspective. We believe that the attainment of gender equality will
give us a great tool in the fight against HIV/AIDS.




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Gender and HIV/AIDS In Ethiopia


Executive Summary

One of the most puzzling issues regarding HIV/AIDS is that despite the information
people have on HIV transmission and prevention, self- risk assessment remains low at
the individual and community levels. Similarly, sexual behaviour remains virtually
unchanged. In countries like Ethiopia, HIV is mainly transmitted through sexual
relations. This has made it necessary to explore the assumptions, beliefs, norms and
values people have about sex and sexuality, as well as the ways men and women are
socialised and the existing customary practices that enhance the spread of HIV
infection. It is generally believed that prevailing masculinity and femininity
ideologies underpin the sexual behaviour of men and women. Thus an in-depth study
that explores these issues is essential to suggest policy and programme interventions
in the fight against the spread of HIV/AIDS.

United Nations Development Programme (UNDP) Ethiopia commissioned this
HIV/AIDS and gender study as part of its HIV/AIDS and Gender and Development
Programme. The study was funded by the Japan Women in Development Fund and
was conducted from September 2003 to May 2004.

The study was undertaken in 4 weredas in Oromia and 6 weredas in SNNPR. The
sites were selected in consultation with the UNDP Ethiopia office and the Technical
Committee for Research composed of representatives from different agencies working
on issues of HIV/AIDS and gender. HIV prevalence rates and the diversity of cultural
and occupational categories in the areas were among the criteria of selection. A
triangulation of methods including survey questionnaires, focus group discussions and
key informant interviews were used to collect primary data at the community level.
Most of the data collected were qualitative, supplemented with quantitative data.

Objectives
The three main objectives of the study were:

           To document and understand the basic cultural norms, values,
            assumptions, beliefs, perceptions, attitudes and practices that render
            women, and the community at large, vulnerable to HIV infection.

           To identify existing social capital (windows of opportunity) that are
            accepted and practiced by the community at large, and to explore the
            potential that such capital has in being used to change norms and values
            that expose the community to HIV infection.

           To suggest policy and program interventions, utilising existing social
            capital identified in the communities, to bring about fundamental changes
            in individual and societal thinking towards gender, particularly the
            masculinity and femininity perceptions that are believed to be the major
            macro variables that guide behavioural practices of women and men.

 Findings
    For the most part, Ethiopian communities remain rural and traditional. They
       have values, norms and beliefs about sex and sexuality that result in exposing
       community members, particularly women, to HIV infection. Prominent


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Gender and HIV/AIDS In Ethiopia


        among such values are extra marital relationships, marriage by abduction, wife
        sharing, widow inheritance and female genital mutilation.

       While multiple sexual relationships within and/or outside the marriage are
        widely exercised, the self-risk perception to HIV infection is very low. Both
        extra marital relationships as well as polygamous marriage appear to have
        inherent elements of trust between partners, since these behaviours are socially
        condoned and sanctioned.

       The socialisation process of men and women puts men in a position of
        absolute authority over women, and women are expected to be obedient and
        submissive to men economically, socially and sexually. This process puts
        women in a situation where they cannot use their abilities and know-how to
        deal with impending problems.

       Men are socialised to be sexually and physically dominant over women and
        expected to be knowledgeable and experienced about sex. To be engaged in
        multiple sexual relationships is also condoned as natural for men. This
        apparently increases not only the vulnerability of their sexual partners but also
        their own vulnerability to HIV infection.

       The government legal structures have not yet penetrated the communities.
        Instead, the customary law prevails to deal with disputes and problems of the
        communities, including husband and wife disputes and sexual abuse and
        harassment, which tend to be in favour of men.

       Generic HIV/AIDS programmes have been focusing on the behavioural
        aspects of individuals and targeting mainly “high risk groups”.

       In spite of the high desire among the people to know their sero-status, there
        are communities where VCT services are still not available.

       Pastoral communities are more vulnerable to the HIV/AIDS infections. Due
        to their mobility, their access to social services and information is very
        limited. Furthermore, in pastoral communities multiple sexual relationships
        are more institutionalised, compared with sedentary communities.

       Although there are serious constraints, culturally determined and exacerbated
        by the lack of effective interventions on the side of the government and civil
        societies, communities do offer opportunities for change. Each community has
        a set of social capital that can be used to stop harmful customary practices.
        The study showed that it is possible to effect social change and the ingredients
        for such a process are readily available in the communities.

       There is a growing sensitivity on the side of the political leadership and the
        civil societies working on HIV/AIDS that the fight against HIV/AIDS requires
        deeper understanding of the gender relations and their underpinning values in
        the target communities.




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Gender and HIV/AIDS In Ethiopia


Recommendations

       IEC/BCC messages must be redesigned in order to draw the links between
        local traditions and HIV as well as to target the „invisible‟ to address
        underlying factors.
       “Risk groups‟ must be redefined both at policy level and program intervention
        level since prevailing cultural practices put a whole community at risk.
       Gender issues and HIV/AIDS are inseparably interrelated. Thus, any HIV
        related interventions need to implicitly and explicitly address gender concerns,
        looking at women‟s vulnerability vis-à-vis men‟s. The empowerment of
        women (and change in status quo) is prerequisite if communities are to reduce
        not only women‟s but also men‟s vulnerabilities to HIV.
       Government legal structure at the community level must be informed and
        trained on such laws and policies which aim to protect and promote right of
        women as well as cultures and traditions of communities where they are
        assigned. Also, there is the need to inform community representative of these
        laws and policies through community-centred dialogues.
       Government policies should be designed, taking into consideration the social
        values of people as well as past experiences as a country.
       Political priority should be given for the provision of basic social services and
        infrastructures in pastoral communities. Further, given their mobility and
        cultural values and norms, any intervention programme should be delivered
        through culturally sensitive approaches to be accepted by communities.
       Social capitals such as traditional values and community leaders should be
        used in any community-based interventions targeting social change. Also, any
        positive examples that have actually influenced change should be documented
        and disseminated in wider forum.
       The Government and NGOs should strengthen their capacity for service
        delivery, recognizing gaps between needs and availabilities of these services
        in most communities.


Although HIV/AID poses a serious threat to the country, it has also opened doors of
opportunities for cultural change – through questioning of values, norms and attitudes
that condone risky practices for HIV and practices that reinforce gender inequality. It


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Gender and HIV/AIDS In Ethiopia


has created opportunity for dialogue on cultural issues that perhaps would never have
been challenged. Like a silver lining on a dark cloud, HIV/AIDS has provided the
opportunity for stakeholders to revisit and accelerate development interventions. In
order to effectively combat against HIV/AIDS, the need for accelerating literacy
goals, the need for strengthening health coverage etc. have become absolute priorities.




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Gender and HIV/AIDS In Ethiopia


1. An Overview of Gender and HIV/AIDS


1.1 Introduction
Although HIV/AIDS is spreading at an alarming rate in Ethiopia, changes in
behavioural practices remain low. This is in spite of the fact that people are informed
about HIV/AIDS (BSS, 2000). Prevailing HIV/AIDS campaigns have not made a
significant impact on attitudes and practices of the target population. One of the main
reasons may be that the campaigns on HIV/AIDS focus on the direct observable
behaviours without due consideration to the cultural beliefs, ways of thinking, norms
and values that guide practices which expose the community to HIV/AIDS infection.
This study attempts to link the invisible social norms, values, and beliefs with the
visible behaviours that expose people to HIV infection. It aims to address the root
causes for the rapid spread of HIV/AIDS.


The United Nations Development Programme (UNDP) Ethiopia commissioned this
study as part of its HIV/AIDS and Gender and Development Programme. The study
was conducted from September 2003 to May 2004, and was funded by the Japan
Women in Development Fund.


Interventions have largely been based on models and programmes, which derive from
western paradigms that are inevitably context insensitive. Specifically, community
perceptions of gender, the issue of masculinity, femininity, gender power r elations,
and how such relations expose the community to HIV/AIDS, remain obscure. Thus
they tend to render existing programmes minimally sensitive and responsive to the
needs of women and men as different groups. This oversight has disadvantaged
women, who are largely powerless to make decisions about protecting themselves,
their partners and their children. As heterosexual transmission is the basic mode of
HIV transmission in Ethiopia and the rest of Africa, an understanding of gender
constructs can enhance the effectiveness of HIV interventions.


Gender describes feminine and masculine characteristics that are socially and
culturally determined, as opposed to those that are biologically determined. It refers
to the social and cultural meaning assigned to being female and male. People are born
female or male, but learn the appropriate behaviour and attitude, roles and


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Gender and HIV/AIDS In Ethiopia


responsibilities. This learned behaviour is what makes up gender identity. Gender
shapes the opportunities one is offered in life (IIRR, 1996).


Generally, social norms and values ascribed to gender identity make women
dependent on men economically, socially and culturally. This dependency tends to
cause women to suffer disproportionately from a violation of their rights and different
forms of violence based on established patterns of discriminatory “traditional” gender
roles and expectations.


Women are also more vulnerable to HIV/STIs infections. Biologically, women have
large mucosal surfaces and micro- lesions. In addition, the viral load in sperm is more
than that of vaginal secretions. Furthermore, the prevailing gender norms adversely
affect women more about their risks and societal vulnerability to HIV/AIDS. Women
are less likely to be treated for STIs, which have a synergistic relationship with HIV
infection. Women have less access to such key resources as information, education,
employment, income, land, property and credit. These realities compound individual
risk by significantly limiting their choices and options for risk reduction.


Moreover, in cultures where HIV is seen as a sign of promiscuity, gender norms shape
the way men and women infected with HIV are perceived. Generally, HIV-positive
women face greater stigmatisation and rejection than men.


However, gender roles and obligations are not static. They are dynamic and vary over
time and across class, caste, religion, ethnicity and age groupings (UNAIDS, 1999).
This variation ensures the survival of a particular people at a given point in time.
Therefore, influencing changes in gender roles and obligations could minimise a
community‟s exposure to HIV/AIDS.




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Gender and HIV/AIDS In Ethiopia


1.2 The Gender Context in Ethiopia
Ethiopia is a country with over a hundred ethnic groups, and exhibiting linguistic,
cultural and social diversity. The gender context in Ethiopia is characterised by
disparities in the economic, social, cultural and political positions and conditions of
women. Ethiopian women constitute 50% of the population (CSA, 1999), but they
disproportionately bear the burden of poverty resulting from the stereotyped gender
divisions of labour and restricted access and control over household and national
resources. Underlying these disparities are cultural norms and values that determine
activities and opportunities of men and women. Women constitute 30% of formal
employment and 98% of the informal sector. About 90% of those employed are
concentrated in low paying jobs. In the informal sector, the pattern shows that women
are either self-employed or work in family owned businesses. Indeed, a natio nally
representative survey revealed that nearly half of the working women in the survey
were self-employed; 43% worked for a family member, while 9% worked for non-
family owned businesses, and 41% did not receive any form of payment (DHS, 2000).
A significant number of women are forced to live on sex work as a source of income.


The participation of women in politics is very low. In the 2000 election, women took
42 (7.7%) of the total 547 seats. At regional level there are only 244 (12.9%), female
representatives out of 1891 council members. At Wereda Councils, 4,648 (6.6%) are
women out of the 70,430 council members. At the kebele level women constitute
129,032 (13.9%) of the 928,288 elected officials (Ethiopian Women's Association,
2004). Only 1 (5.5%) of the 18 ministers is a female. At a level lower, there are five
women who hold the rank of vice minister. Presently, among the 28 ambassadors that
Ethiopia has appointed to different missions abroad, only 4 (14.3%) are women.
There is no female representative of Ethiopia in international organisations.


Although attempts are being made to raise women's participation in education, it
remains low. Only 19% of women and 40% of men are literate, while 6% of women
and 13 % of men are partially literate (DHS 2000). There is a much lower literacy
level among rural women and men. Literacy levels also vary widely among regions,
from a high of 68% among women in Addis Ababa to a low of 9% of women in the
Somali Region. Literacy among men ranges from a high of 87% in Addis Ababa to a
low of 16% in the Somali Region. 3.5 million boys and 2.16 million girls were


                                          14
Gender and HIV/AIDS In Ethiopia


enrolled in all primary schools in the 1998/99 school year. The male general
enrolment rate in primary school is 56% compared to 35% for females, (MOE, 1999).


Harmful traditional practices, shared by most ethnic groups in the country, can
enhance HIV infection. For instance, "Women, from infancy to adulthood, and
children of both sexes suffer most from the effects of harmful traditional practices,
ranging from the allocation of family food resources, nutritional taboos to other
harmful practices such as female genital mutilation (FGM), early marriage or
marriage by abduction, uvulectomy, milk tooth extraction, keeping a baby out of the
sun and force- feeding fresh butter to new-born children" (NCPTE, 2003 pp. 3-4).


These are not rare occurrence. For example, marriage by abduction is widely
practiced with an occurrence rate of 69%t at a national level, (NCTPE, 1998). It
occurs in almost all regions of Ethiopia. It is very high in SNNPR, followed by
Oromia, Benishangul, Afar, Harari, Gambella, Tigray, Somali, Amhara and Addis
Ababa.


Ethiopian women are also exposed to different forms of sexual violence such as rape,
wife battering and marital rape. Rape is a common occurrence in both urban and rural
areas. It is traditionally tolerated to the extent that most women who have been
violated do not report the incident. In a study conducted among adolescents from six
peri urban centres in Ethiopia, 9% of sexually ac tive women reported having been
raped, while 74% reported sexual harassment, (OSSA and German Foundation for
World Population, 1999). Traditional beliefs and religion also belittle women,
(NCTPE, 2003).


One of the major expectations from a woman is being able to produce as many
children as possible. Fertility is a guaranteeing factor for a woman to stay with her
husband. An Ethiopian woman gives birth on the average to 5.9 children; fertility is
higher in the rural areas at 6.4 (DHS, 2000). Consequently, maternal mortality rate is
one of the highest in the world and accounts for 25% of all deaths among women aged
15-49. Estimates for maternal mortality range from 871 to around 1100 deaths per
100,000 (DHS 2000).



                                         15
Gender and HIV/AIDS In Ethiopia


Many women get married at a very young age.              The 1990 National Family and
Fertility Survey revealed that 34% of women were married before age 15. Almost all
women end up being mothers by the time they reach the age of twenty (CSA, 1990).
The mean age at marriage for women at national level is 16 years. However for
Amhara, Agaw, Argobat, Kemant and Tigray communities' commitment to marriage
could start when a girl is 4-5 years old. Girls could get married at an early age of
about 9-10 and stay for a while in the family before sexual intercourse sta rts.
However, it has been noted that the groom often forces the bride to have sex before
she is mature; it is common sight to see a pregnant 11-year old girl, who often have
complications during delivery, such as obstetric fistulae that results in lifelong misery
due to total and permanent incontinence.


The HIV/AIDS prevalence rate in Ethiopia is estimated at 6.6 %, 13.7 % in urban
areas and 3% in rural areas. The peak age range for AIDS cases is 20 – 29 for women
and 25 – 34 for men, indicating that the peak age range for new HIV infection is 15 –
24 for women and 20 – 29 for men. This is due to the fact that women start their
sexual activities at a younger age and with older partners than men. Given that girls
are socialised not to discuss issues on sexuality, most of them are ignorant of sex and
hardly able to negotiate safe sex with their partners.


Nevertheless, Ethiopia offers some opportunities to address gender disparities. The
Ethiopian Constitution of the Federal Democratic Republic of Ethiopia, (FDRE, 1995)
article 35 makes explicit provisions that recognize the rights of women to access
resources, services and respect their human rights. In addition different policies have
been adopted with an aim to enhance the involvement of women in the de velopment
process of the country and to narrow the existing gender disparities.




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Gender and HIV/AIDS In Ethiopia


2. Research Methodology


2.1 Objectives
The study attempts to explore the underlying gender norms and values that expose
men and women to HIV/AIDS. It also tries to establish the connection between the
invisible cultural norms, values and customs and the visible behavioural practices. In
addition, the study explores the social capital, which can be used as resources to bring
about behavioural changes to prevent and control HIV infection in the respective
communities. It takes gender as the centre of the study.


Given the need to understand the direct and underlying causes to HIV infection, this
study addresses three main objectives, which are:


       To document and understand the basic cultural norms, values, assumptions,
        beliefs, perceptions, attitudes and practices that render women, and the
        community at large, vulnerable to HIV infection.


       To identify existing social capital (windows of opportunity) that are accepted
        and practiced by the community at large, and to explore the potential that such
        capital has in being used to change norms and values that expose the
        community to HIV infection.


       To suggest community-specific policy and programme interventions, utilising
        existing social capital identified in the communities, to bring about
        fundamental changes in individual and societal thinking towards gender,
        particularly the masculinity and femininity perceptions that are believed to be
        the major macro variables that guide behavioural practices of women and men.


The specific objectives are:
       To assess people's knowledge, beliefs and practices about HIV/AIDS.
       To identify norms and values underlying the observed practices.




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Gender and HIV/AIDS In Ethiopia


        To understand the meaning and expectations regarding masculinity and
         femininity, and how these determine sexual relations between men and
         women.
        To highlight sexual practices, and other practices that predispose the
         respective communities to HIV infection.
        To identify the social capital which can be utilised to change the existing
         norms, beliefs and practices in order to reduce HIV infections.
        Based on findings, to make policy recommendations on what can be done to
         change those perceptions about gender relations that predispose the respective
         communities to HIV/AIDS.


2.2 Target Areas and Population
The study was conducted in 13 rural and 7 urban communities in 10 weredas
(districts) in 2 of the largest regions of the country, Southern Nations and
Nationalities People‟s Region (SNNPR) and Oromia. There were two sites per wereda
and the selection of the weredas, done in consultation with UNDP, was largely based
on cultural diversity, HIV/AIDS prevalence, and proximity to the “AIDS corridor”.
(See Maps 1a and 1b for location of weredas in their respective regions, see appendix
3)


Once the weredas and the main towns were selected, two kebeles from rural and
urban areas respectively, were randomly selected for the study. Table 1 shows the list
of communities and weredas where the study was conducted.


A number of target groups were included in this study in order to capture the variable
views regarding the issues at hand. These include:
        Adult males and females (15 years old and above).
        Headmasters/teachers at schools.
        Traditional local leaders.
        Employees of NGOs.
        Government employees in the areas of health, education, women's affairs
         bureaus, and courts.




                                            18
Gender and HIV/AIDS In Ethiopia


The selection of the 2,000 respondents for the survey was random based on the list of
households provided by each selected kebele. 1,680 respondents were from the 13
rural sites, while the remaining 320 were from the 7 urban sites. This was done in
consideration of the rural- urban population distribution in the country. The Hamer,
Yabelo and Fentele respondents were exclusively rural largely because these
communities are pastoral.


The selection of the participants of the key- informant interviews and focus group
discussions (FGDs) was purposeful.


Table. 1 List of Communities and Weredas where the Study was Conducted
  No      Region            Zone        Wereda             Name of        Urban/Rural
                                                         Community
 1      SNNPR          Guraghe        Miskan         Kebele 01            Urban
 2      SNNPR          Guraghe        Miskan         Dobi                 Rural
 3      SNNPR          Alaba          Alaba          Kebele 02            Urban
 4      SNNPR          Alaba          Alaba          Gedeba               Rural
 5      SNNPR          Welayita       Humbo          Kebele 01            Urban
 6      SNNPR          Welayita       Humbo          Abalafarecho         Rural
 7      SNNPR          Dawro          Mareka         Tercha               Urban
 8      SNNPR          Dawro          Mareka         Gosashash            Rural
 9      SNNPR          Gedio          Wenago         Dilla/Kebele 08      Urban
 10     SNNPR          Gedio          Wenago         Dilla/Chechu         Rural
 11     SNNPR          South Omo      Hammer         Dimeka               Urban
 12     SNNPR          South Omo      Hammer         Shankokelema         Rural
 13     Oromiya        Borena         Yabelo         Arare                Rural
 14     Oromiya        Borena         Yabelo         Didiyabelo           Rural
 15     Oromiya        North Shewa    Yaya           Debretsige/Keble01   Urban
                                      Gulele
 16     Oromiya        North Shewa    Yaya           Tiregiorgis          Rural
                                      Gulele
 17     Oromiya        East Shewa     Fentele        Gola                 Rural
 18     Oromiya        East Shewa     Fentele        Debti                Rural
 19     Oromiya        East Hararge   Fedis          kebele 01            Urban
 20     Oromiya        East Hararge   Fedis          Lencha               Rural




                                           19
Gender and HIV/AIDS In Ethiopia


Table 2. B ackground Characteristics of Key Informants by Sex and Occupation
                                        Sex                       Occupation
       Wereda               N     Men     Women         Govt       NGO Community
Meskan/Butajira             21        8       13              6        4      11
Alaba                       23      15         8              8        5      10
Humbo/Welayita              28      17        11             15       10       3
Dawro                       29      19        10              9        7      13
Wenago/Gedio                30      17        13              6        6      18
Borena/Yabelo               20      11         9              7        2      11
Hamer                       20      14         6              7         -     13
Yaya Gulele/N/Shoa          17      12         5              7        1       9
Fentele                     25      14        11              4        4      17
(Kereyou&Etu)
Fedis (E.Harareghe)          23      17           6           9          4        10
Total                       236     144          92          78         43       115



2.3 Methods of Data Collection
A combination of methods was used for triangulation purposes. The number of target
groups involved, and the breadth and depth of the issues to be studied necessitated
this. A detail description of each method is provided below.


2.3.1 The Survey
The survey covered a sample of 2,000 randomly selected respondents that were
equally divided between adult males and females. This sample is expected to
represent the population of the 10 weredas included in the study. A pilot survey was
carried out in Addis Ababa and its surrounding villages to refine the questionnaires.
The data collection plans with respect to both the content of the instruments and the
logistics to be followed.


2.3.1.1 Identification of Respondents
Within each selected kebele in a wereda, a list of households was obtained from the
kebele administration. Sample households were selected by syste matic sampling,
where a random start was selected and every x + nth household was sampled (n is the
sampling interval which is the total number of households in a kebele divided by the
sample to be selected from the respective kebele, 200 in this case).




                                           20
Gender and HIV/AIDS In Ethiopia


It was particularly important that once in a household, one did not interview all the
eligible members since many such members would share the same belief system, a
situation that would reduce the heterogeneity. Thus, in the selected households, all
eligible members were randomly assigned numbers, and one number was randomly
selected and interviewed.



2.3.1.2 Research Questions

The research questions were designed in order to capture both quantitative and
qualitative data. These would give a comprehensive view of the HIV/AIDS and
gender issues. The questionnaires, which were used to collect quantitative data, were
designed to enable the research team to carry out statistical analysis using SPSS, (See
Appendix). CSPro was used to enter data into the computer. A combination of open
and close-ended questions, with a bias towards the latter, was used. However, as this
area is not well researched, it was necessary to have an open category “other” for
most of the questions in order to capture those answers, which were not anticipated
and included in the questionnaires.



2.3.1.3 Quality Checks

Various mechanisms were put in place to ascertain data validity and reliability.
Firstly, quality control was maintained daily by the supervisors in the field. The
researcher worked with a supervisor. Both the researcher and the supervisor went into
the field with the data collectors to ensure that the data collectors followed
instructions as given both during the training, and also in the field by the researchers.
The researcher held daily debriefings, before getting into the field to reinforce
procedures and quality standards. These debriefings were aimed at highlighting
problems encountered and identifying relevant solutions.



The supervisor randomly drew 5% of the questionnaires that were filled- in daily. The
supervisors visited the homes of the randomly selected 5% interviewees for
verification purposes. Any mismatches were dealt with swiftly during the fieldwork
period to ensure the quality of data. In addition, the supervisor and researcher
identified problems in the data collected, i.e. missing data, inconsistent data,


                                           21
Gender and HIV/AIDS In Ethiopia


incomplete questionnaires and illegibility of handwriting. While there were general
discussions of these problems, there were also one-to-one discussions with the
respective data collectors, who had to individually remedy their respective errors,
some of which entailed revisiting interviewees. Moreover, the questionnaires were
designed in such a manner that some of the questions were used for consistency
checks.



2.3.2 Focus Group Discussions

The main goal of using FGDs was to collect data on assumptions, values, attitudes
and beliefs that underpin prevailing behavioural practices towards sex and sexuality.
The focus was on the variables indicated in Wilber‟s Integral Framework (see
Appendix 2) describing individual (attitude, ways of thinking, enthusiasm, feeling,
commitment, integrity, skills) and collective (culture norms, shared norms, moral
norms, shared assumptions, covenants and traditions) attributes. Generally, while
quantitative data answer the “what?” aspect of research, FGDs answer the “why?”
aspect.


A total of 40 FGDs were undertaken in both regions, with each discussion group
having between 8 and 12 participants. Within the weredas partic ipants were chosen
bearing in mind that the participants must be comfortable with each other, yet they
must also represent the potentially different viewpoints. Gender, age and position in
respective communities were used as selection factors. That is, gro ups were either
exclusively male or female, and influential members of the community were not
included in the FGDs, but rather in the key informant interviews.


The discussions lasted on average for three hours and were conducted in public
places, such as schools, rented facilities, or regular meeting places. Most FGDs were
held outdoors. These locations were neutral so as to avoid either negative or positive
associations with particular settings among the participants. In each wereda 4 FGDs,
2 for males and 2 for females were conducted.




                                          22
Gender and HIV/AIDS In Ethiopia


2.3.3 In-depth Interviews
In-depth interviews were undertaken with the other target groups, which included:
NGO leaders, headmasters/teachers and local leadership at different levels. The in-
depth interviews were guided by structured open-ended questionnaires (See
Appendix). A total of 236 in-depth interviews were conducted. 78 interviewees were
selected from government offices, such as health, education, wereda and kebele
administration, health facilities, women's affairs bureaus, schools and courts. Apart
from the bureaus of women's affairs, men represented all government offices. 43
informants came from NGOs and 115 from community structures such as tribal,
religious leaders, elders and leaders of community associatio ns.




                                          23
Gender and HIV/AIDS In Ethiopia


3. Background Characteristics, Knowledge of HIV/AIDS and Routes to Infection


The findings combine data from both the quantitative survey and the qualitative
sources. The former are used largely to give an indication of the levels and prevalence
of particular indicators, while qualitative data are used to explain factors underlying
the observed levels, with the view of unravelling the entry points for interventions that
can reduce the spread of HIV/AIDS. All the tables with the results are in Appendix 1.


3.1 Demographic and Socio-economic Characteristics of the Respondents
As noted earlier, the survey included 2000 randomly selected respondents, 200 for
each site with a fair gender balance. It targeted males and females who were at least
fifteen years old, and their age distribution reflects that of the country. About 81% of
the respondents were aged between 15 and 45 years (See Appendix). However,
Alaba, Hamer, Fentele and Fedis have slightly younger populations with the
proportion aged between 15-45 years being 86%, 88%, 87% and 90% respectively.
On the other hand, Butajira and Yaya Gulele have older populations with about 62%
and 72% respectively.


The majority of the respondents (81%) reported that they were married. Monogamy
was reported by 76% of the respondents, while polygamy was reported by about 5%
of the respondents. The polygamy is widespread with nine of the ten weredas
reporting polygamous marriages, the highest being in Hamer (14.6%) and Alaba
(7%). Yaya Gulele is the only wereda, which does not report polygamy.


The communities studied are clearly patriarchal with males dominating household
heads. Males headed about 79% of the households interviewed. Male headship is
lower in Butajira (71.5%), Yabelo (77.5%) Fentele (76.8%) and Fedis (74.6%).
Female headship is about 13%. It is highest in Butajira (28%), Yaya Gulele (15.2%)
and Humbo (14.6%). Single women are more likely to be heads of households (7%)
than single men (2%). Single women headship is highest in Fentele (13.4%) and Fedis
(17.8%). As both Fentele and Fedis are affected by drought and men usually migrate
in search for jobs, this might be a possible explanation for the relatively high female
headship.



                                           24
Gender and HIV/AIDS In Ethiopia


The educational attainment of the respondents is quite low. About 66% of the
respondents reported that they had no formal education, while 25% had primary
education (Table 6 Appendix). The lack of education is highest in Hamer (96.5%) and
Yabelo (91.2%). There was no respondent with education above secondary school in
both weredas. The average number of school years completed for the sample is 2.3.
Males report higher levels of education than females (fig I). For instance, while about
56% of males reported no education, about 75% of the females reported the same.
Similarly, while about 14% of the males reported having secondary education or
higher, only 6% of the females reported the same.


Figure I : Educati onal Level by Gender in Study Areas (N=1,939)

            100


             80                                  75.3
                                                                             No Education
             60    55.5
                                                                             1st Cycle Primary
                                                                             2nd Cycle Primary
             40
                                                                             Secondary
                               19.1                                          Above Secondary
             20           12
                                       6.1 7.4          8.3 10.4
                                                                   2.4 3.7
             0
                               M ale                      Female



Literacy is consistently very low, about 31% of the respondents reported that they
were literate. The lowest level of literacy was reported in Hamer (3%) and in Yabelo
(7.5%). Again, males are more literate than females (fig. II). While about 41% of the
males reported that they were literate, about 22% of their female counterparts reported
the same.


Consistent with the high rural residency, the majority of the respondents reported that
they had their own land in which they cultivated crops. This was reported by about
68% of the respondents. Ownership of land was lowest in Fentele, about 45%. This is
largely explained by the fact that people in Fentele are largely dependant on pastoral
farming.




                                                  25
Gender and HIV/AIDS In Ethiopia

Figure II: Literacy by Gender i n Study Areas (N=1,996)

   100


    80


    60                                                                             Male
                      40.5                                                         Female
    40                                                 30.8                        Total
                                        21.6
    20


     0
                                    Literacy Rate




There are minimal differences in ownership of land by gender. For instance, while
72% of the males reported having land, about 65% of females reported the same ( fig.
III). Similarly, while 28% of males reported that they did not have their own land,
about 35% of the females reported the same. The key informants and focus group
discussions revealed that women are the major participants in terms of working in the
fields. Thus, most women would report the land registered under the names of their
husbands as theirs. However, during divorce or separation women are often not able
to share land or livestock.


Figure III: Ownership of Land by Gender in Study Areas (N=1,998)

                100


                 80          72.4
                                               68.4
                                      64.7
                                                                                            Male
                 60
                                                                                            Female

                                                                     35.3                   T otal
                 40
                                                                            31.6
                                                              27.6

                 20


                  0
                                Percent Yes                      Percent No




                                                      26
Gender and HIV/AIDS In Ethiopia


Decisions on crops to be grown and sold are not commensurately made by women.
About 45% of the respondents reported that males make decisions on crops to be
grown. The Hamer are the most likely (55%) to report male dominance in decision-
making. Another 45% reported that both the wife and the husband decide on the crops
to be grown.     This egalitarian decision- making is consistently lowest in Hamer
(32.7%). Decisions on crops to be sold are more equal than decisions on crops to be
grown. This is because women are the ones largely involved in assessing the food
requirements for the family. While about 29% of the respondents reported that
decisions on crops to be sold are made by men, about 59% reported that both spouses
make decisions on what is to be sold. Respondents from Hamer and Fentele were the
least likely to report egalitarian decision- making on crops to be sold, about 47% and
44% reported so, respectively.


Respondents were also asked about their possession of other consumer goods. The
only amenities and goods, which were reported by at least by 10% of the respondents,
were access to electricity and possession of a radio. 12% of the respondents reported
having access to electricity. This figure comprises urban residents only as evinced by
the lack of access to electricity in the exclusively rural communities of Mareka,
Hamer, and Yabelo. Ownership of radio was reported by 38% of the respondents.
Ownership of radio was lowest in Hamer (2.5%), Yabelo (22.1%) and Fentele
(27.5%).


The study includes both pastoralist and sedentary communities. In the sedentary
communities namely Alaba, Humbo, Dawro, Gedio, Yaya Gulele, and Fedis, the
major occupation is farming followed by livestock raising. They also engage in
activities like selling wood and charcoal, and petty trade, such as selling agricultural
produce. Alaba is noted for its pepper market. Kat (moderate stimulant) is also grown
in Alaba, Gedio and Fedis, and is also a source of income. Coffee is a major source of
income in Gedio. In the pastoralist communities namely Borena, Hamer, and Fentele
communities, animal husbandry is the main source of income. Women also sell
charcoal and wood to support their families.




                                          27
Gender and HIV/AIDS In Ethiopia


These findings generally suggest that sample populations are largely rural. Literacy
and access to media is very low. Therefore HIV/AIDS interventions via print and
electronic media cannot possibly be effective.



3.2 HIV/AIDS Perceptions in Studied Communities


3.2.1 HIV/AIDS Occurrences
HIV/AIDS appears to be widespread in all the weredas visited, although figures are
not made available. Circumstantial evidence shows that people are dying of diseases
whose symptoms are consistent with those of HIV/AIDS. According to the Wereda
HIV Office of Alaba, many people have died and many more are showing symptoms
of HIV/AIDS.


In Butajira many youngsters, women and men, have been reported to have died of
AIDS. There are parents who are reported to have
                                                         “Many men get exposed
died of HIV/AIDS and children are being orphaned.
                                                         during the time of harvesting
Many are suspected to be living with the virus, but      pepper. They get money and
                                                         enjoy their time by going to
no official figures have been released. According to
                                                         towns and return home with
the Wereda HIV/AIDS Secretariat, out of 570              HIV”
                                                                Urban Wo man from Butaira
people, 330 men and 240 women, who got tested
voluntarily in order to get married in year 2003, 46 were positive, 27 women, and 19
men. Prevalence in Welayita is estimated at 10% (Sodo Health Centre). In Humbo
out of seventy who were voluntarily tested, 41 (59%) tested positive for HIV.


HIV/AIDS is an epidemic in Gedio/Wenago wereda. According to the medical
director of Dilla, HIV/AIDS has been spreading fast
                                                                “Sexual intercourse is the
especially in the last two to four years, and it is the third   main mode of transmission.
                                                                Sex in Welaita is free;
top disease and fourth killer disease in the wereda. Out of
                                                                young boys start sex early,
70 people tested, 30 (43%) were found to be HIV positive        but do not know about
                                                                condoms”
in one month; five of them had already died at the time of                  Humbo health officer
the survey .




                                           28
Gender and HIV/AIDS In Ethiopia


In Yaya Gulele people die showing physical     “348 women took blood test in the PMTCT and
                                               only 43 husbands came to take the test. Wives
symptoms of AIDS. In Fiche hospital 73         fear to disclose their test results to their
blood tests were taken in one month and        husbands and it is difficult to force men to come
                                               and take the test. The PMTCT program depends
nine (12%) were positive, 4 women and 5        on the cooperation of wives and husbands. If
men.   Tuberculosis is common,       so   is   breast-feeding is to be replaced by other
                                               sources of food the husband must know and
pneumonia. At the time of the survey there     agree to it. In this area men practice multiple
were 20 AIDS patients in the hospital, 13      sexual relationships. In the tests conducted a
                                               woman was found to be negative but her
were women. The Kereyou and Etu in             husband was positive. Positive women try to
Fentele experience high levels of HIV          give other excuses such as undergoing dental
                                               treatment instead of admitting sexual
infection. In, 2000, according to HIV/AIDS     relationships as the source of infection”.
                                                                            PMTCT Hospital Head
centre for information, out of 800 people
who got tested, 600 (75%) were HIV positive at Metahara sugar factory. In Fedis
people have died showing symptoms of HIV/AIDS. Because of the presence of the
army and drought, HIV/AIDS is said to have spread widely and fast in the area.


3.2.2 Knowledge about HIV/AIDS
Regardless of high HIV/AIDS occurrences in the communities, findings from key
informants and FGDs show that most people have only limited knowledge and
sometimes wrong ideas about HIV/AIDS (Tables 6,7 & 8 in Appendix). Knowledge
about the modes of infection is still not universal. Two most commonly reported
modes of HIV infection are sex and use of sharp infected objects. Knowledge about
sexual transmission is almost universal having been reported by about 96% of the
respondents. Proportions reporting sexual transmission range from 89% in Butajira to
99% in Yabelo and Fedis.


The reporting of sharp objects as a mode of transmission ranges from 25% in Hamer
to 92% and 93% in Yabelo and Mareka respectively. Infection through blood was
reported by 33% of the respondents, while blood transfusion was reported by only
4%. Again, Hamer and Yabelo displayed the least knowledge of modes of HIV
infection (Table 7 in Appendix).




                                          29
Gender and HIV/AIDS In Ethiopia

Figure IV: Knowledge of Two Most Common Modes of Transmission by Wereda

                                                                         99        98.5            99
   100 96.5            97        98                                                       95.5             95.6
                                         90.2       93.5
                                                               89

      80
                                               92.6
                                                                              92     87.5
                82.3                                                                                                    Sexual
      60                                                                                                         75.3
                                                                                            83.4
                                                          46                                                            Sharing Sharp
                                  71.2
                            56                                                                         86.4             Objects
      40                                                            55



      20


       0




                                                                                                   s
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The biggest challenge is for people to know that an asymptomatic person can be HIV
positive. This knowledge is quite low. Less than a third of the respondents, 30%,
reported that a healthy looking person could transmit HIV/AIDS. Another 30%
maintained that a healthy looking person could not have the virus that causes AIDS.
The proportion reporting that a healthy looking person cannot transmit the virus
ranges from 23% in Humbo to 36% in Fentele. 40% of the respondents reported that
they did not know whether or not a healthy looking person could transmit the HIV
virus.


Mother-to-child transmission (MTCT) was reported by about 66% of the respondents
with proportions ranging from 34% in Hamer to 77% in Mareka. A lack of knowledge
of MTCT was reported by 28% of all the respondents, while 6% maintained that a
mother could not transmit the virus to the baby. Of those who knew about MTCT,
about 60% reported that the virus could be transmitted during pregnancy, while 52%
reported that the virus could be transmitted during delivery. A further 79% reported
that the virus could be transmitted during breastfeeding.


Asked about the chances of MTCT by HIV positive mothers, about 53% maintained
that HIV positive mothers would always pass the virus to their babies; 32% reported



                                                                                   30
Gender and HIV/AIDS In Ethiopia


that transmission was not guaranteed. Knowledge on the possibility of a virgin being
infected is moderate, with about 53% reporting that a virgin can be infected. The
proportion correctly reporting that a virgin can be infected ranges from 26% in Hamer
to 74% in Mareka. Blood contamination was the mode of infection commonly cited
for virgins by about 73% of the respondents; this proportion ranged from 64% in
Fentele to 92% in Humbo.


Data also show that there is a tendency of apportioning blame to the opposite sex, and
men are more likely to be blamed for infecting partners than women. For instance,
about 72% of the respondents reported that men are more likely to infect women. The
reason for blaming men is that they are unfaithful, which was reported by about 61%
of the respondents. On the other hand, about 48% of the respondents reported that
women are more likely to infect men. Again, unfaithfulness was reported as the
reason for this attitude.


A typical reaction to HIV/AIDS is blame and denial. The communities visited mostly
see HIV as an external factor. Some ethnic groups like the Hamers and Borenas think
that HIV is a disease of the Amharas (highlanders). The rural residents take it as a
disease of the urban population and they do not think that they are at risk. Some think
that it is a disease of sex workers and the ill- mannered youth. Others even deny the
existence of HIV.


Figure V : Atti tude Towards PLHA by Wereda
               50

               40
                                                                    They are promiscuous
               30                                                   They are immoral
                                                                    They are prostitutes
               20

               10

                    0
                              M o




                               Fe e



                                       e
                              W a




                              M r




                           ay ta le
                                       a
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                                       n




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                                              31
Gender and HIV/AIDS In Ethiopia




                                                  “One woman came after staying away forlong
There consistently is stigma and                  from this village. When she returned she had
                                                  wounds on her face and her hair was thin.
discrimination       against        people        Everybody avoided her; many people did not even
who are suspected to be HIV                       shake hands with her. This woman died within a
                                                  short time. Another one who showed similar signs
positive in all the communities.                  and was also isolated and he died within a short
People living with HIV/AIDS                       time; his brother washed the body without any
                                                  assistance.”
(PLHA) are largely seen as                                                                       Woman from Welaita
promiscuous, immoral and as prostitutes (See Figure V). Furthermore, some believe
that casual contact with PLHA can transmit the infection. In Alaba, people still fear
sharing food with a suspected person and do not invite a PLHA to a coffee ceremony.


The most commonly cited public health strategies for the prevention of HIV infection
are: abstinence, faithful monogamy with one uninfected partner, reduction of sexual
partners, condom use and treatment of sexually transmitted diseases. The study
outcomes also correspond to this.


Figure VI: The Most Common Prevention Method by Wereda

             100
                      85.3          84                        83.4          84.9
                             81.8                                                  81
                                         76.6                        77.4               78.3
              80
                                                66.9
                                                       59.5
              60

                                                                                               One to one
              40                                                                               relationshiop

              20


                 0

                      bo eda ago eka me r kan bel e ta le le le edis ot al
                   um wer
                 H l        e n ar Ha             es Ya Fen Gu   F   T
                           W    M              /M              a
                     cia
                                            za            Y ay
                  pe                    jur
                as                  uta
             ab                   B
           Al




The most commonly reported preventive measure against HIV/AIDS by the
respondents is faithful monogamy (78%). The proportions reporting faithful
monogamy as a strategy ranges from 60% in Butajira to 85% in Humbo. Not using


                                                          32
Gender and HIV/AIDS In Ethiopia


infected sharp objects was reported by about 63% of the respondents, while condom
use is reported by only 23%. The proportion reporting condom use ranges from 7% in
Hamer to 29% in Humbo. Abstinence was reported by about 26% of the respondents
and it was generally prescribed for females. Another preventive strategy, which was
mentioned, is the avoidance of casual sex. This was reported by abo ut 24% of the
respondents (Table 8 in Appendix).


3.2.3   Source of Information on HIV/AIDS
There are different sources that people use to get information on HIV/AIDS (Table 9
in Appendix). These include; health providers, family planning agents, anti-AIDS
clubs, kebele and wereda administration, schools, media (particularly the radio),
religious institutions such as churches and mosques, NGOs, community meetings and
social gatherings such as weddings and coffee ceremonies.


The majority of respondents, 75%, however, maintained that people needed more
information on HIV/AIDS. Asked about their sources of information, it was clear that
there is no systematic source of information on HIV/AIDS, which reaches most of the
people in the communities studied. For instance, proportions reporting any source of
information ranged from only 7% for schools to 31% for health providers (See Table
9 in Appendix). Unreliable information tends to spread through inference and rumour
mongering.


Access to information varies by sex and residence. Rural residents have less access to
information than their urban counterparts. Women have less access to information
than men.


3.2.4   Voluntary Counselling and Testing
In all the community attitude‟s towards testing is positive (Table 10 in Appendix).
VCT is highly supported and is made a requirement for marriage in Butajira. Similar
attempts are being made in Alaba, Welayita and Gedio. Respondents noted that it is
good to know one's sero-status. 71% of the respondents in the survey reported that
they would like to be tested for HIV (Table 10 in Appendix). Proportions reporting
this desire to be tested range from 53% in Butajira to 78% in Mareka. The most
important reason given for wanting to be tested (87%) is that they would like to be


                                         33
Gender and HIV/AIDS In Ethiopia


sure of their suspicions. About 16% would like to live more positively. The majority
of the respondents who would like to be
                                                  “A certain men tested positive while the
tested, 75%, also reported that they would
                                                  wife tested negative. The couple was
share the results of the test with someone.       advised to stop sex and return for another
                                                  test; however, the husband insisted that
And the majority, 75%, would share the
                                                  the results should not be disclosed. It was
results with a spouse, while 41% would share      reported that the woman had given birth
                                                  since the first visit but the couple has not
results with family.
                                                  returned for the second test. It is possible
                                                  that eventually the woman would be
                                                  infected”.
The majority of those who would not share                                 Head of PMTCT, Dilla
results, 80%, reported that they were afraid of
being neglected, stigmatised or marginalized. Some of the respondents were afraid of
being judged or labelled.


It should be noted that VCT services are not available in Borena, Hamer, Fedis and
Dawro while a number of respondents in these weredas expressed their desires to be
tested.


The findings in this sub-section show that people fear HIV/AIDS, which is spreading
in the communities like wildfire. Nevertheless, the knowledge they have and the
information they receive is not enough to protect themselves. In fact, peers,
neighbours and spouses whom 10-20% of respondents identified as a source of
information are unlikely to provide them with right knowledge. Coupled with their
low literacy and low access to media, most people are not able to obtain correct and
timely information. While a number of information sources were mentioned, none of
them are comprehensive and effective enough to reach all community members. Given
these facts, responsible agencies, both government offices and NGOs, should revisit
their intervention strategies, targeting not only particular groups such as commercial
sex workers and truck drivers but also all community members. In this process,
special attention should be given to the participation of women, who are not generally
invited in public meetings, which could be very strategic places to distribute and
exchange related information.




                                          34
Gender and HIV/AIDS In Ethiopia


3.3 Routes to HIV Infection and their Underlying Causes
Survey data show that there are several harmful customary practices, which are
practiced in the respective weredas (Table 11 in Appendix). The practices, which
were reported in all the weredas, are female circumcision, polygamy, widow
inheritance (levirate), rape and marriage by abduction.


Female circumcision was reported by about 59% of all respondents. This proportion
ranges from 20% in Butajira to 81% in Fedis. Polygamy was reported by about 48%
of all the respondents, with the proportion ranging from 7% in Yaya Gulele to 74% in
Wenago. Levirate was reported by about 42% of all the respondents. The reporting
of levirate ranges from 10% in Yaya Gulele to 56% in Fentele. Abduction is reported
by 31% of the respondents; this proportion ranges from 4% in Fedis to 67% in Yaya
Gulele.


While a small proportion of all the respondents reported the other harmful practices, it
is important to note that such practices are intense in those weredas where they are
practiced. Therefore, they pose a serious threat of HIV transmission to the respective
populations. For instance, while the practice where the young brother can have sex
with his older brother‟s wife, is reported by about 25% of all the respondents, the
proportion ranges from 0% in Yaya Gulele to a high of 89% in Hamer. On the other
hand, while Jala Jalto is reported by about 20% of all the respondents, it is reported by
about 88% and 65% of the respondents in Yabelo and Fentele. Furthermore, it is also
practiced to some extent in Hamer and Yaya Gulele.


Data from key informants and FGDs corroborate findings from quantitative data. The
ensuing discussion attempts to summarise the respective practices, which result in
enhancing the spread of HIV/AIDS. This section will give few detailed descriptions
of a few practices.


3.3.1 Cultural norms, values and practices that enhance HIV infection
Polygamy, as shown by the quantitative data, is widespread. The qualitative data
show that Muslims in Alaba, Guraghe, Fentele (Etu) and Oromo Hararghe practice
polygamy explicitly (Table 11 in Appendix). Islamic communities maintain that their
religion allows them to marry up to four wives. In Kereyou, even the youngest man in


                                           35
Gender and HIV/AIDS In Ethiopia


the community has a minimum of two wives. As soon as his first wife is pregnant, he
looks for another wife. A man, as long as he can afford to pay the bride price, can
marry as many women as he wants. There are many reasons given for polygamy,
including people‟s desire to increase the number of their descendants and making sure
that all women have husbands, given that many men die during tribal conflicts.


Although the Ethiopian Orthodox Church preaches monogamy, in rural communities
Christians also practice polygamous marriage openly .


One of the practices that enhance polygamous marriage is the marrying of widows.
Warsa is exercised widely in Oromia and SNNPR. It is the inheritance of a widow by
a younger brother or relative, and sometimes the father of the deceased man. The a im
is mostly to protect the property and children of the deceased man from being misused
or abused by the next husband of the widow. Hiricho and Rege are two forms of wife
inheritance in Alaba. Hircho is when a younger brother of the deceased husband
inherits the widow of his brother. Actually a younger brother occasionally makes love
to his brother‟s wife even when he is alive. The woman does not refuse and the
husband does not get angry. Rege is also wife inheritance on the basis of blood
relation with the deceased husband, not a brother. In warsa the woman's consent is not
required, as it is taken for granted. If she refuses to marry, she gets kicked out of the
house empty- handed. Older women are usually not inherited sexually, but they are not
allowed to marry any other man.


Emba madrekya (drying tears) is a rarely used form of marriage, although this
practice exists in all the communities in SNNPR and Oromo. This is a practice in
which a man marries his late wife‟s young sister. This happens especially in those
situations where the relationship between the families is strong. Maintenance of such
strong relationships is thus achieved through husband inheritance. In Alaba when a
wife dies, the husband asks the family to send him one of his late wife‟s younger
sisters for a wife, this is called ribina. Embeto is a practice exercised in Kereyou that a
man can ask for the hand in marriage of his sister-in- law, if his wife dies.


Extra-marital relationships are practised in both Christian and Islamic communities,
although theoretically sex before marriage and outside marriage is forbidden.


                                            36
Gender and HIV/AIDS In Ethiopia


Moreover, once married, faithfulness is expected. However, there are deviations from
these standards. These deviations are determined by existing cultural norms and
values. Muslims practice extramarital sex in hiding, whereas, Christian communities
may practice extramarital sex openly or in hiding in the form of wushima (lover).


In some communities, extramarital relations are widely excised and explicitly or
implicitly sanctioned socially. Among the Borena of Yabelo and the Kereyu of
Fentele, it is acceptable for a man to ask for sex from another man‟s wife, and
normally she agrees. In this relationship, the married man is called the jala (man
lover) while his partner is called the jalto (woman lover). Both legal spouses of jala
and jalto are not only aware of, but also tolerate this relationship. Should the two
spouses be interested in each other, they can also engage in a sexual relationship. If
not, they can be involved with other men and women. This practice was introduced
with an aim to avoid men killing each other for having sexual affairs with each other‟s
women. Having additional sexual partners is a source of pride for both men and
women. Thus, in these communities monogamy does not necessarily preclude
multiple sexual relationships.


Marriage by Abduction is also a widely exercised and tolerated cultural practice in
the studied communities. In the key informant interview and FGDs it was shown that
young men can abduct any unmarried women whom they like with the assistance of
their friends and then send elders to the family of the abducted woman asking
permission to      get   married.
High bridewealth is said to be      Types of Female Genital Mutilation (FGM) – Fedis
                                    There are three types of FGM in Fedis. The first one
one of the major causes for this    is called sunna, the cutting of the clitoris. The
to happen (see section 3.3.3).      second, arbi is cutting the clitoris and the tip of the
                                    labia minora. The third one is called hoda, which is
Most victims are very young         the cutting of the clitoris, the labia minoras and the
and usually end up marrying         stitching. After the mutilation, the legs are tied
                                    tightly together for a month till there is adhesion,
their   abductors.       In   the   leaving a small opening for urination. At marriage,
communities where virginity is      the woman is cut open by a knife and the husband is
                                    expected to have sex with the woman until the
highly valued, it is unlikely for   opening has healed enough to avoid adhesions.
                                        informant from the o ffice of wereda women's affairs
these girls to find husbands in
future, if they refuse to marry
their abductors.


                                          37
Gender and HIV/AIDS In Ethiopia



Female Genital M utilation (FGM) has tremendous negative impacts on an affected
woman both physically and psychologically. Nevertheless, it has been justified in a
way to control women‟s sexuality and ensure her fidelity by mutilating her body. The
Borena think that all females should be circumcised to minimise their sexual desire
and keep them clean. If she is not circumcised,
nobody wants to marry her. Furthermore,              “ If the clitoris is not cut it
                                                     grows and becomes like a
generally, the common sharpened objects are          horn and makes sex with a
used for a number of women / girls.                  man difficult”.
                                                                           Borena Elder


3.3.2 Socialisation of Women and Men
In the communities studied, the birth of a male baby is invariably received with
extreme joy and happiness. The joy is far greater than that expressed for a baby girl.
For instance, most communities celebrate and they ululate at the birth of child.
However, the ululations for a boy are twice as many as those for a girl. It is generally
believed that women are biologically incomplete, as reflected in their physical
weakness. A girl is perceived as property and a source of problems, since she can be
raped or impregnated. On the other hand, a boy is considered a continuation of the
family lineage and a natural heir of the family property, which includes livestock and
land. Pastoralist communities, like the Hamer, value women since they bring them
bride wealth. However, the expected roles of women are not different from those of
sedentary communities.


In these communities, women are socialised
                                                   “Women are not critical thinkers
to serve men. They are also socialised to be
                                                   like men; for example, if a woman
obedient, home-oriented, submissive and good       is invited to a meeting there will
                                                   be no peace in the audience
at housekeeping, preparing food, cooking,
                                                   because women are usually very
collecting wood, fetching water, giving birth      talkative. Moreover, women are
                                                   cruel and should not be given the
and looking after children. Moreover, they         power to make decisions”.
have to assist their husband on the farm. A                                   Hamer Man

woman‟s labour is not valued and is only perceived as supportive of her main role;
reproduction. Women are not allowed to attend most public meetings.




                                          38
Gender and HIV/AIDS In Ethiopia


Women are expected to view sex only in terms of reproduction. They are expected to
please their husbands sexually, while they are assumed to have neither sexual needs
nor rights of their own. Women just have to be sexually submissive and docile.


On the other hand, men are socialised to claim and own property, and to have absolute
decision- making power. They are socialised to be sexually demanding and aggressive.
Men are also expected to seek information by attending community gatherings. For
example, men attend tribal, family and community meetings. Men are allowed to go
out of the home, mix, and attend religious services, even at night. Young men are
favoured to go to schools and learn. They have no fear and inhibition in their
movements.


This socialisation process of both men and women characterises what the society
expects of them.      This expectation has been developed into masculinity and
femininity concepts, which justify what is right or wrong behaviour.


3.3.3 Marriages and Related Practices
Marriage in Ethiopian communities is mostly family-arranged. Family elders, without
the consent of their children, decide on who and when their respective sons and
daughters should marry. In family-arranged marriages, wealth is an important
selection criterion. Parents require bride price and they expect daughters to attract rich
men. Money, livestock, gold, clothes and honey are given to the family of the bride as
bride price. In general, the bride price has been commercialised to the extent that it
signifies that the groom has bought the bride. This is why some men, regardless of
age, marry many women across all age groups, including very young girls.


In all the communities early marriage is common. Women marry at a young age,
normally under 15 years. The age at marriage ranges from a minimum of about 12 for
Gedio and Menja women to a maximum of 18 for Dawro. If women pass the
maximum age limit for marriage, the community stigmatises them to the extent of
giving them names such as “komoker”, which means unwanted. If a woman reaches
the age of twenty before marriage she becomes an embarrassment to the family and
her parents would opt to marry her to any man. Many young girls end up being
married to old men as second, third, or fourth wives.


                                           39
Gender and HIV/AIDS In Ethiopia



Divorce is discouraged, irrespective of the repressive behaviour of the husband. In
Borena, Kereyu and Hamer, women are not allowed to ask for divorce at all. Even in
the communities where divorce is allowed, the process is tiring and finally many
women decide to leave their marriage empty- handed. If a woman gets divorced, she
is forced by her relatives to find another husband, for keeping a divorced woman at
home is a shame.


3.3.4     Virginity
While men get married after getting sexual experiences with other women, virginity
of girls at marriage is demanded, except among the Hamer (Table 12 in Appendix).
The groom has to show the virginity of his bride by deflowering her on the wedding
night. If the bride is not a virgin, she is not acceptable as a wife.


The Borena and Kereyou are very serious             " If a groom does not find the bride a
about their demand for virginity and men            virgin, he beats her and forces her to
                                                    go back to her parents. Virginity is
are not expected to have sex with virgins           announced the very day of marriage
before they are married. If a man takes the         and a piece of cloth is soaked in
                                                    blood as evidence that the bride kept
virginity of a girl before marriage, he is          her virginity till marriage."
severely punished and is excommunicated.                     Dawro, urban, old woman aged 98.

Before the wedding day, a woman is tested for virginity. If she is not a virgin, she
discloses the person who took her virginity. On deflowering a bride, Kereyus sing a
song called “Robile”, which appreciates the strength, success and loyalty of the bride.


The study clearly demonstrated that communities are characterised by asymmetrical
heterosexual relationships, typified by the sexual aggressiveness of males and the
passive nature of females. The majority of respondents, 75%, maintained that a
woman must be a virgin if she is to be married. This compares to only 38% of the
respondents who maintain the same for men.


However, this demand for female virginity is variable, from 34% in Hamer to about
90% in Fentele. The most common reasons given for the need for women to be
virgins upon marriage were that virginity signifies purity and strength. This was
reported by 43% of the respondents. On the other hand, virginity for males was


                                             40
Gender and HIV/AIDS In Ethiopia


largely perceived to mean innocence on the part of the male (45%). Another 43%
reported that male virginity means cleanliness and health. This compares to 32% of
the respondents who reported the same for females.


The findings in this sub-section points out that many customary practices were
initially adopted with the aim of ensuring social harmony and community survival.
However, these practices are exercised at the expense of women‟s rights and
interests, which result in reinforcing the women‟s subordination to men further.
Women and men are socialized in a way to perpetuate the accepted value of gender
relations.


3.4 Sex and Sexuality
Sex remains a central biological and social need for human beings. However, sex and
sexuality is usually perceived in terms of reproduction from a woman's perspective.
The enjoyment part is often considered taboo and thus cannot be discussed openly
even between spouses. Although there is this culture of silence surrounding sex and
sexuality, both males and females have sexual needs and desires, which if unmet,
often result in frustration, extramarital sexual relationships, and sometimes divorce.
This section explores the sexual needs, desires and expectations of the populations
studied (Table 13 and 14 in Appendix).


3.4.1   Sexual Needs and Desires
In all the communities studied, women are
expected to comply with the sexual needs of the      Because I refused to have sex, my
                                                     husband refused to give me
man (See Appendix). 81% of the respondents           money for household needs; he
maintained that men could have sex with their        told me that I could get money
                                                     from my extramarital partner;
wives any time they want and 63% reported that       thinking that I have another
this was culturally acceptable, while 54%            sexual partner.
                                                                  Urban Female, Butajira
agreed that men‟s sexual needs must be met. If
a woman fails her sexual duties, she is likely to get beaten or is suspected of
developing love relations with other man. She may even be kicked out of her home.


On the other hand, all key informants maintained that a woman would be suspected of
infidelity and eventually get beaten, if she shows sexual desire. Women themselves


                                         41
Gender and HIV/AIDS In Ethiopia


also feel impeded to ask for sex by cultural expectations. 88% of respondents reported
that it is deviant behaviour for women to express their sexual desires, while about
44% of all the respondents maintained that it is culturally unacceptable for women to
demand sex.     Most women said that they have to tolerate their lack of sexual
satisfaction for the rest of their marital life. Note this remark from a female
representative at a regional council in Fedis:
         It is difficult to openly ask my husband about sex and tell him
         that he is not meeting my sexual needs. This is indeed a problem.
         If the husband is not interested in one of his wives, during her
         turn he sleeps and tells her that he is sick but has sex with the
         one he is in love with. In a way he denies her the chance to be
         pregnant and have a baby. Fedis men live on food assistance. Let
         alone to satisfy four wives, they cannot satisfy a single woman.
         They chew 'kat' and sleep. They simply marry more than one
         woman on the pretext that 'sheria' permits it. When a husband
         fails to make love to his wife, it is a sign of hatred. This leads to
         conflict and finally to divorce. Many women are chased out of
         their homes because of sexual matters. Men become aggressive
         and they do not want anybody to know of their sexual
         weaknesses. Many wives leave their homes end up becoming
         labourers, sex workers and get exposed to STI and HIV/AIDS.

Men think that if women were allowed to ask for sex it would be difficult to meet
their needs. A religious leader and key informant [Alba, urban, man] explains:
         A man does not need sex daily but a woman does. If she were
         allowed to ask for sex, she would like to have sex daily. If a
         woman wants sex, she can indirectly communicate this by
         making herself attractive, asking children to go to bed, and by
         preparing her husband a special dinner. There is a story about
         this. Once upon a time a husband asked his wife to tell him when
         she wanted to have sex. She said she would do so by preparing a
         small loaf bread and put it on top of his regular dinner. The small
         loaf of bread would be fresh and hot. On the basis of this
         communication the woman started preparing the additional small
         loaf every evening. The farmer thought that his wife would not
         demand sex on a daily basis. One day he came from the farm
         extremely tired. As he sat down, he asked his children what his
         wife had prepared for dinner. The children told him that they saw
         her preparing bread. On hearing this, the man left his home
         telling them that he had a relative who was ill and would pass the
         night with him. He was avoiding showing his wife that he could
         not meet her sexual needs.




                                           42
Gender and HIV/AIDS In Ethiopia


The problem with sex and sexuality is that couples do not discuss it. A man would
talk with pride about his experience with another woman. It is shameful for women,
including a sex worker, to talk about sexual affairs with a man.


If men do not get sexually satisfied in marriage, they usually go to other women even
if they know this exposes them to STIs, including HIV. Sex workers in Dilla reported
that most of their clients are married men, who complain that their wives do not
satisfy them sexually. Some complain about the ill health of their wives, while others
maintain that they are looking for different types of sexual intercourse.


On the other hand, in some cases women also look for sexual partners in secret. Here
is what a male health officer from Welayita explained to the research team:
         Three women came to ask me for advice. Their problem was
         sexual impotence of their husbands. The husbands are merchants
         and they chew 'kat' during the evenings. One woman complained
         that her husband suffers from premature ejaculation; another one
         complained that he rarely makes love to her and the other one
         said that her husband had become impotent. On hearing this, I
         advised them on how they could make their husbands stop
         chewing 'kat' in the evening, by being close to them and directing
         their attention towards sex. The two women succeeded and
         finally brought their husbands to the clinic and introduced them
         to me. They explained what happened to their husbands. I also
         explained to the men that they have to love their wives and meet
         their sexual needs and stop chewing 'kat' in the evening. The
         other one did not succeed and finally decided to have another
         lover, who is young and virile. She reported to me that she is
         enjoying sex with that man. She said that she would not mind
         dying of AIDS, so long as she continues to enjoy sex with that
         man.

The inequality of sexual relationships between men and women is corroborated by
quantitative data. For instance, about 76% of the respondents reported the imbalance
of sexual relationships (Table 13 in Appendix). This perception is highest in Humbo,
83%, and lowest in Yaya Gulele, 69%. Yaya Gulele is predominantly a Christian
community and closer to the capital city, which has more relaxed rules regarding sex
and sexuality.


Consistently, about 83% of the respondents reported that men enjoy sex more than
females, while 81% reported that men tend to want sex more than females. Another


                                           43
Gender and HIV/AIDS In Ethiopia


65% maintained that women are largely passive while men are active in sexual
relationships. 65% maintained that sex tends to stop when a man has orgasm,
irrespective of whether or not the woman herself has experienced orgasm. About 60%
reported that it is more acceptable for men to be experienced in sex than women.


Overall the results indicate that cultural norms and expectations on sex and sexuality
have strong influences over the individuals‟ behaviours and thinking.        Men are
expected to be active and aggressive in sexual relationships and control the sexuality
of partners, while women are expected to be passive and receptive and sexually
pleasing to partners. This asymmetrical relationship between men and women has
little change over twenty years.


3.4.2   Decisions about Having Sex
Again, the respondents maintain that men decide what happens in sexual
relationships. About 50% maintained that men control what happens during sex
(Table 14 in Appendix). Only 10% reported that women, as wives, decide when to
have sex. Even in those communities where it is tolerated to have other sexual
partners, wives have no decision-making power on when they can have sex. About
65% of the men maintained that they are the ones to decide when to have sex. The
majority of the respondents, 71%, maintained that a man would force his wife to have
sex.


Women were also reported to be less likely to decide with whom to have sex than
men. Only 24% of the respondents reported that women are expected to choose their
sexual partners. About 70% of the respondents maintained that women have no power
to choose their sexual partner. On the other hand, about 96% of the respondents
maintained that men decide with whom to have sex.


3.4.3 Perceptions of Vulnerability
The findings suggest that women are expected to satisfy men sexually at their own
expense.   Even when women have extramarital re lationships, they are still not
expected to control what happens in sex. Although men are decision- makers in sexual
relationships, they are perceived to be less concerned about the consequences of sex,
such as pregnancy and HIV infection.


                                         44
Gender and HIV/AIDS In Ethiopia



The respondents have a very low perception of personal vulnerability. Only 16% of
the respondents reported that they had some chance of getting infected (Table 15 in
Appendix). Another 31% could not even assess their chances of getting infected. The
most commonly reported reason by about 78% of the respondents is that they did not
have sex out of marriage.


While 64% stated that they had changed their sexual behavio ur since they heard of
HIV/AIDS, only 13% of those who changed their sexual behaviour answered they had
reduced the number of their sexual partners. On the other hand, 63% of those
respondents who had not changed their sexual behavio ur considered it unnecessary to
do so because they were married.


Apparently, people tend to consider the socially acceptab le sexual relationships as
“normal” and therefore not dangerous (Table 15 in Appendix). The jala jalto practice
of extramarital sexual relationships in Borena, Kereyou, for example, is not perceived
as risky behaviour for HIV/STI. Window inheritance, which is commonly practiced
in every community studied, is also not considered to be risky, regardless of the cause
of death of the deceased. Both extramarital relationships as well as polygamous
marriage have an inherent element of trust because they are performed in the context
of prevailing cultural norms and values. This perception is one of the underlying
factors for non-condom use and undermines any chances of negotiating safe sex
within marriage. HIV is still seen as disease of “other people”, who are promiscuous
and immoral.


Sex is a central biological and social need for human beings. However, to talk about
it openly is usually taboo, even between spouses. Without discussion or questions
both women and men enter into sexual relationships in ways that comply with socially
ascribed roles.


3.5 Women’s Rights to Property Ownership, Work and Access to Services
This section briefly examines how well women‟s rights are observed in the
communities.



                                          45
Gender and HIV/AIDS In Ethiopia


3.5.1 Economic Rights
The most valued material resources in rural communities are land and livestock. The
Constitution and relevant laws, such as the Regional Land Use Policy, assure an equal
right of both women and men to access land. However, these are not actually
observed at grassroots level. Traditionally, women are not allowed to inherit land. In
addition, land is registered in the husband‟s name, a household head. Under such
conditions, it is very difficult for women to claim land upon divorce. So women are
forced to leave their households empty- handed. Cultural norms do not approve of
women claiming land after divorce. Sometimes women are intimidated to abandon
their claim to land, especially if women have no relative to support them (Yared,
1997).


While reproductive activities are considered to be their main responsibility in the
households, they significantly contribute to agricultural production and are often
engaged in different types of income generating activities. However, these productive
activities are mostly overlooked. They are regarded as household labourers within the
confines of their homes and with little, if any, remuneration. The majority of
respondents reported that men do not want their wives to work outside of their homes.
The most important reason is that men are afraid that the ir wives would have sex with
men that they work with. This was reported by about 68% of the respondents. About
58% reported that most men tell their wives that they would cover all the family
needs, which renders their work unnecessary.       38% maintained that women are
expected to take care of the home and children.


As women are part and parcel of the culture, they too, hold similar views with men.
For instance, about 55% of the respondents reported that the women would not do
anything, if their husbands prohibited them from working.


In summary, most women are not allowed by their husband, or cultural, to take up any
job outside their households, which could make them economically independent.




                                         46
Gender and HIV/AIDS In Ethiopia


3.5.2 Legal Rights
About 87% reported that the communities have mechanisms for helping women in
cases of abuse (Table 16 in Appendix). As such mechanisms 76% mentioned
community elders, while only 28% cited government legal structure.


If the husband doesn‟t feed the family, elders intervene and advise him to meet these
responsibilities of feeding and clothing the family members. If he is mistreating his
wife, family elders listen to her and advise him to stop. So, the community
mechanisms function to protect women to some extent. However, it is often observed
that such mechanisms operate along with customary laws in an attempt to ensure
social harmony and community survival at the expense of women‟s interest.


The abduction of young girls is widely accepted in many communities. A young girl
is abducted by an older man, who rapes her and forces her into marriage. Such cases
are often settled by community elders and are not taken to the police or court. If a
victim attempts to report to the police or the court, the girl and her family are often
pressured into withdrawing the case and acceding to the forced marriage. If she
appears before the court, the victim is often forced to testify that she was a willing
party to the abduction. Such a testimony will render the abductor innocent.


The modern police and court system is often very much dissociated from the
community. People are not well informed about modern laws and their benefits.
Thus, the government legal system tends to operate outside of the community
structure, which makes them extremely ineffective to deal with different issues in the
community. In addition, the modern police and court system is also operated by men
who have been socialised with the same patriarchal concepts as any community
members. Therefore, some of the legal structures are less sympathetic to the cases of
women and tend to advise relatives of a perpetuator of the crime to make use of
community leaders to settle the matter outside of the legal system.


3.5.3 Access to Information and Social Services
As stated in previous sections, women‟s access to information is very limited. They
hardly discuss matters that affect their lives. Everything is left to the husband and
what the husband says is taken as correct.


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Gender and HIV/AIDS In Ethiopia



When compared to boys, fewer girls attend schools and most of them disco ntinue
their education. Some are forced to help their mothers and stay at home, while others
are forced to discontinue their education and marry early.


Although many women suffer from different diseases, they hardly ever receive
medical care. Many of them die from diseases that can be easily treated. They rely too
much on traditional healers and many die during delivery. Many women are not
treated for STI and continue to suffer.


To conclude, women's subordination to men is deeply rooted in both the reproductive
and productive arenas. Because women are part and parcel of the communities in
which they live, they are socialised to be part of the oppressive system; inadvertently,
women participate in their own suppression.




                                          48
Gender and HIV/AIDS In Ethiopia


4.Social Capital
The study revealed that there is social capital that each community offers in the fight
against HIV/AIDS, and specifically in addressing gender and HIV/AIDS. This capital
includes the community structures of leadership and networking, the NGOs and other
civil societies involved in HIV related activities and the government policies and
structures, which already deal with issues of human rights, gender, HTPs, economic
empowerment, reproductive health and health in general.


4.1 Community Structures and Networks
Ethiopian communities have social structures and networks for exchanging
information and collectively dealing with social problems. This study also found the
existence of social structures and networks that regulate the social, economic and
political life of such communities. These structures can be used to create values and
norms appropriate to deal with gender and HIV/AIDS. In this section some examples,
like the “Abageda”, “Abawada”, “Abakelecha”, “Damina” and “Beti”, from the
communities are studied.


4.1.1 Community Leaders
Many communities have community leaders, whose decisions are accepted by
community members without question. In Borena the “Abageda” is the head of the
geda system, which is the most elaborate and democratic social system that Ethiopia
offers. Geda leaders are elected every eight years and they make major decisions in a
congress called “Gume-aldelu”. The community automatically accepts what is
decided in the “Gume-aldelu”. Anybody who refuses to accept the decisions will be
punished by excommunication.


Among the Oromo of North Showa the dominant structures are the “Abaweda” and
the “Abakelelcha”. “Abawada” is an accepted chief whose position is unquestioned
and is inherited within the ruling family line. “Abakelecha” is an accepted spiritual
leader. Whatever the Abakelecha says is accepted without question. No one can go
against his instructions. If there is a serious dispute the Abakelecha is asked to
mediate between the families so that they can resolve the case amicably. Oromos in
this region believe that if the Abakelecha curses, the family gets dispersed and
destroyed.


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Gender and HIV/AIDS In Ethiopia



Similarly the “Beti” and “Berje”
                                      “… if the Geda leaders realise all these
still influence the Hamer people      practices are harmful and if they order the
in their thinking and behaviour.      community not to practice them, people will
                                      abandon them The Geda leaders are more
Beti is a local leader and under      acceptable than the government leaders in
him there are local elders. The       Borena. Thus, there is need for collaboration
                                      between the Geda leaders and government if the
Beti has the ultimate power. He       law was to be effectively implemented”
gives final decisions and has the                              Borena Zonal Court President

authority to overrule the decisions of elders. Berje is the creator, God, and the elders
are believed to have authority bestowed upon them by Berje. Old people are respected
and are supposedly protected by Berje. Hamers believe that Berje listens to what
elders say; consequently, they try to get the blessing of old people.


Among the Fedis Oromos, the “Damina” is an important institution. It involves tribal
leaders who make decisions on all social matters affecting their communities.


In view of this, it is apparent that without mobilising these leaders and systems, any
intervention could not achieve its intended objectives.


The community leaders are committed to social harmony in the community a nd the
well being of its members. For instance, Hamer elders maintain that they are ready to
work with the government as long as it is for their good. The government or any
development agency should closely work with the community elders and other
respected local authorities to make campaigns against HIV/AIDS more effective.


4.1.2 Community Associations
All communities studied have different types of community associations where
members can disseminate information, discuss community matters and mobilise
communities. For example “Agote” and “Gogata”, which are meetings of elders, are
widely accepted fora for addressing community and intertribal problems and conflicts
in Alaba.




                                           50
Gender and HIV/AIDS In Ethiopia


The “Idir”, a community association where members contribute money for covering
funeral services, and the “Equib”, a local association for saving and crediting money,
are widely used by both rural and urban communities.


All communities have traditions of networking and cooperation to perform tasks
together. Local associations like “Akuma” (when women gather during mourning and
help each other), “Wujot” (where women contribute money to give to the needy
person first), “Gulo” (a form of association that women as well as men use when
working together) “Jella” (a kind of cooperation done during weddings where people
help materially to make the wedding ceremony successful) and “Gargasa” (working
together during farming) are some examples. Gedio women sing 'aluleyo begisido'
which means “the sun has risen and let's go and bring grass for roofing the house of
our friend”. This community cohesion is a strong social capital for social change.


Care and support is also a feature of every community. Communities care for the sick
and elderly, and help the poor. In Borena, for example, the community contributes
and gives cattle to their poor relatives. “Gofgonoba” is an association for helping the
needy. The Borena like children and have a culture of supporting orphans called
“Gudefecha”. The Hamer have a tradition of helping each other called “Gelsho”. They
share whatever they have with their relatives and do not see their relatives going
hungry.


4.1.3 Religious Organisations
The religious structures, both Islam and Christian, as well as other traditional belief
systems such as “Wakefata” in Borena and Kereyu, foster care and support to those in
need. Religious gatherings are used to teach followers on social issues. In different
communities, both Muslim and Christian, religious leaders are now involved in HIV
prevention, control and care and support activities as well as stopping harmful
customary practices.


4.2 NGOs and Other Civil Societies
A number of NGOs and other civil societies are implementing HIV/AIDS
programmes with different approaches in the studied communities, (see Table 3).
Among these NGOs, some have been making tremendous impact on the respective


                                          51
Gender and HIV/AIDS In Ethiopia


community, focusing on community norms, values and beliefs that expose men and
women to HIV. They are KMG in Alaba, Betel in Yabelo and Progynist in Butajira.


KMG and Betel are applying a community conversation approach with strong
involvement of community and religions leaders. They promote behavioural change
through dialogue, reflection and decision-making. Through the conversation in which
all community members participate, the community are empowered to identify
prevailing problems and solutions. Facilitators are nominated from the target
community, who understand how the community functions and are trusted by the
community. This approach makes the conversations continue both in formal
gatherings and in the neighbourhood, which help to create community consensus for
decision- making. Since this intervention started, a number of changes have been
observed in the communities. People themselves have identified a number of
customary practices as harmful to their well being and decided to scrap long- lasting
practices, including wife sharing, wife inheritance, FGM and child marriage. In the
process of conversation, women‟s rights are also highlighted.


Progynist is promoting the
                                     Women complaining against multiple marriages
rights of women by involving         are on the increase; so are cases related to
communities, the government          sexual incompatibility. Cases related to wife
                                     and husband incompatibility have increased
and other NGOs. Progynist's          from 137 in 2002 to 186 in 2003. The sentence
activities focus on HIV/AIDS,        regarding multiple marriages is up to six-
                                     months, and for abduction it is up to eight years
legal rights of women, harmful       of imprisonment, rape up to 12 years of jail,
traditional practices and the        depending on the age of the raped woman.
                                                                  Butajira Court Registrar
empowerment of women with
economic activities. These activities have had an impact. There are indications even at
the legal level that the law can be reinforced, if judges and police collaborate.


A Muslim religious leader and a member of Progynist are working together to
advocates monogamous marriage, asserting that it is not acceptable to have more than
one wife in Islam, for the husband cannot equally meet the needs of the four wives,
and to stop FGM and other traditional practices that expose people to HIV infection.




                                            52
Gender and HIV/AIDS In Ethiopia

Table 3 Major NGOs operating in the studied communi ties and their acti vi ties
Organisation                     Place              Major Activities / Approaches
KMG                              Alaba              Awareness raising on HIV/AIDS and
                                                    gender issues through community
                                                    conversation
Betel                            Yabelo             Awareness raising on HIV/AIDS and
                                                    gender issues through community
                                                    conversation
CARE                             Yabelo             Awareness raising on HIV/AIDS and
                                                    gender issues
Progynist                        Butajira /         Awareness raising on HIV/AIDS,
                                 Guraghe            Women‟s rights and harmful
                                                    traditional practices and economic
                                                    empowerment of women
FGAE                             Welayita           Awareness raising on HIV/AIDS,
                                                    harmful traditional practices and VCT
World Vision                     Welayita           Awareness raising on HIV/AIDS and
                                                    gender issues and support to PLHA
Wisdom Micro Finance             Welayita           Provision of credit and awareness
                                                    raising on harmful traditional practices
Medane ACT                       Wenago             Awareness raising on family planning
                                                    and HIV/AIDS, focusing on schools
                                                    and support to orphans and PLHA
Abebech Gobena                   Fiche              Support to PLHA and HIV/AIDS
                                                    education
Christian Children Fund          Fentele            HIV/AIDS education and support to
                                                    girl‟s education
Organization of Social           Fentele            HIV/AIDS education
Services for AIDS
Save the Children USA            Metahara           Counselling and IEC services

Collaboration with community leaders, who have absolute authority over community
members, and respect towards existing community structure have made it possible for
the NGOs to be accepted by the communities.


A number of civil societies, NGOs, youth and
women associations, and anti HIV/AIDS                   “We are teaching that both men and
                                                        women are equal and have equal rights
clubs are enthusiastically working across the
                                                        to all services and property. Sexual
region to raise awareness on HIV/AIDS in                satisfaction must be for both. A man
                                                        has responsibility to meet the sexual
both urban and rural communities. They can              needs of his wife and he has to
be networked       together and       learn good        understand his wife‟s sexual needs.
                                                        Those who create problems in the name
practices from each other‟s experiences to
                                                        of religion and culture are selfish and
                                                        only promote their interest.”
                                                                              Muslim religious leader



                                               53
Gender and HIV/AIDS In Ethiopia


further facilitate the fight against HIV/AIDs and promote gender equality.
On the other hand, a number of NGOs and CSOs have been engaged in the issues of
HIV/AIDS and gender at the national level. Ethiopian Women Lawyers Association
has been vigorously working on the promotion of the economic, political, social rights
of women and the elimination of all forms of legal and traditionally sanctioned
discrimination against women. The Network of Ethiopian Women‟s Association,
comprised of 17 organization working on a wide range of gender related issues, was
established in 2003 with an aim to enable women to use constitutional provisions,
legal and political rights in their quest for gender equality. These organisations are
examples that can be of great help in addressing gender and HIV/AIDS at the level of
policy and law.


4.3 Government
In Ethiopia, there are legal bases for addressing gender disparities in the Constitution,
policies and laws. Moreover, implementing structures have been formed from the
Council of Ministers down to kebele level.


4.3.1 Policy Provisions
The government has promulgated several policies, which directly or indirectly,
address the issue of gender.


The Women's Policy (1993) primarily aims to institutionalise the political, economic,
and social rights of women by creating an appropriate structure in government offices
and institutions. The aim is to make public policies and interventions gender-sensitive
and ensure equitable development for all Ethiopian men and women. It recognises the
current status of women, and the need to address women's rights in all socio-cultural
aspects.


The Education and Training Policy (1994) addresses the issue of women's access to
education, and stipulates that education has to be geared towards reorienting society's
attitude and values pertaining to the role and contribution of women in development.
In the overall strategies of the policy, gender issues are addressed through giving
attention to gender issues in the curricula, reviewing the textbooks, extending
financial assistance for education to women, and giving special attention to women's


                                           54
Gender and HIV/AIDS In Ethiopia


participation in the recruitment, training and assignment of teachers. The policy
recognises the low level of girl's school enrolment especially in the rural areas due to
various factors. Actions addressing the problem include, among others, constructing
new schools, helping families afford school fees, and encouraging communities to
educate their girl child. Other means to enhance gender sensitivity include increasing
the number of female teachers and preparing teaching materials that are free of gender
biases.


The Cultural Policy (1997) makes special reference to rights of women, elimination of
biases and prejudices against women and the need to ensure equal participation of
women in cultural activities.


The HIV/AIDS Policy (1998) makes special reference to how gender disparities
expose women to HIV infection, and stresses the need to see gender in relation to
HIV/AIDS prevention and control.


The National Health Policy (1993) and the National Population Policy (1993) have
given emphasis to gender and the need to give special attention to the health of
women. Issues on reproductive health and rights are dealt with in the health and
population policy. The vulnerability of women to HIV infection due to their social
and economic status is highlighted.


Consequently there are an adequate number of policies that can potentially be
exploited to bring about gender equality.


4.3.2 Constitutional and Legal Rights
The Constitution of the Federal Democratic Republic of Ethiopia is the supreme law
of the country and has provisions on women‟s political, economic, social and human
rights. Furthermore, Ethiopia has six major legal codes out of which the criminal code
and civil procedures directly apply to gender and HIV/AIDS. Although both codes
need considerable revision to be consistent with the constitution, there are provisions
that deal with harmful practices that courts can apply.




                                            55
Gender and HIV/AIDS In Ethiopia


The Federal Rural Land Administration Proclamation N0 87/1997, Article 5 (4) states
that the land administration law to be issued by each regional state should confirm the
equal rights of men and women in respect to the use, administration and control of
land, as well as in respect of transferring and bequeathing holding rights.                                  The
proclamation further provides that women should be allowed to use hired labour on
their holding or otherwise make similar arrangements [article 6 (3)]. For the purposes
of assigning holding rights and carrying out distribution of holdings, regional states
are to lay down a system that is transparent and fair, and allow for the participation of
peasants, especially women.


However, there are some issues, which require immediate attention of the
government.         While the Federal Parliament introduced the new Family Code
replacing the old family law, which clearly discriminates against women, in some



The Ethiopian Constitution of the Federal Democratic Republic of Ethiopia, article 35 (1995) recognizes rights of
women and stipulates the following articles:

    1.   Women shall, in all the enjoyment of rights and protections provided for by this constitution, have equal
         rights with men.
    2.   Women have equal rights with men in marriage as prescribed by this constitution.
    3.   The historical legacy of inequality and discrimination suffered by women in Ethiopia taken into account,
         women, in order to remedy this legacy, are entitled to affirmative measures. The purpose of such measures
         shall be to provide special attention to women so as to enable them to compete and participate on the bas is
         of equality with men in political, social and economic life as well as in public and private institutions.
    4.   The state shall enforce the rights of women to eliminate the influences of harmful customs. Laws, customs,
         and practices that oppress or cause bodily or mental harm to women are prohibited.
    5.   (a) Women have a right to maternity leave with full pay. The duration of maternity leave shall be
         determined by the law taking into account the nature of the work, the health of the mother and the well
         being of the child and family. (b) Maternity leave may, in accordance with the provision of law, include
         prenatal leave with full pay.
    6.   Women have the right to full consultation in the formulation of national development policies, the des igning
         and execution of projects, and particularly in the case of projects affecting the interests of women.
    7.   Women have the right to acquire, administer, control, use and transfer property, in particular, transfer,
         administration and control of land. They shall also enjoy equal treatment in the inheritance of property
    8.   Women shall have a right to equality of employment, promotion, pay, and the transfer of pension's
         entitlements.
    9.   To prevent harm arising from pregnancy and childbirth and in order to safeguard their health, women have
         the right of access to family planning, education, information and capacity.
regions the old family law is still in force. Furthermore, no act is in force specifically
addressing an issue of violence against women.


4.3.3 Trends in the Implementation of Policy and Legal Rights of Women
Policy and programme implementation remains complex and slow. A number of
women‟s rights are overlooked in every aspect of their lives. However, there are
indicators that the policies, programmes and legal provisions regarding women could


                                                       56
Gender and HIV/AIDS In Ethiopia


be realised especially if sensitised to the respective local socio-cultural contexts and
enforced.


4.3.3.1 Courts and Police
There are now indications that police and courts are attempting to enforce the laws.
Women have started reporting their cases       Rape is common, an eight-month pregnant
to the legal bodies. In zones where the        woman was raped and her case was
                                               brought to court. The criminal was
office of women's affairs are operational,     sentenced to eight years imprisonment. A
there are attempts to help women get court     four-year old child was raped and the case
                                               is under examination; another nine years
decisions on crimes related to sexual          old girl was raped and the criminal was
violence and violation of marital rights.      sentenced to ten years imprisonment;
                                               there is another 6-year-old girl who was
For example, in the year 2001 in Welayita      raped and the criminal was sentenced to
zone, 310 cases reported by women              ten years imprisonment.
                                                         Former court president of Fedis wereda
appeared in wereda courts: these included
abduction (129), rape (109), and marriage related (72). Out of these, 69 cases received
court decisions while the other 241 cases were still being examined at the time of this
study. In 2002, 227 new cases were reported to the court: these included abduction
(78), rape (90), and marriage related (59) cases. 64 cases received court decisions, 163
cases were still under examination at the time of the research (Zonal office of
Women's Affairs of Welayita).


According to the office of women‟s association in Wenago, two men who raped a
woman and a young girl have been sentenced to imprisonment of 8 and 11 years
respectively. Two Kereyu women in Fentele refused to be inherited and reported their
cases to the police. They are protected by law and are living in their homes along with
their properties.


There are activities to make the community understand the law. In Fedis for example,
the kebele shengo members are given training on the law and in turn, they teach the
community on rights and obligations expressed in the Constitution and the civil and
criminal procedure codes. The people have started coming to court instead of
approaching elders to settle matters. Damina, tribal leaders have also started reporting
criminal cases to court.



                                          57
Gender and HIV/AIDS In Ethiopia


4.3.3.2 Education
School enrolment of girls is on the increase.        The government has aggressively
advocated the importance of girl‟s education. Schools are encouraging families to
send their daughters to school in Butajira, Welayita, Dawro, Wenago, Yabelo, Fedis,
Fentele and Hamer. In Fedis, according to the education officer, class size has grown
in some schools to 170 in grade two while 90-98 is a usual class size. The community
has gone to the extent of employing those who have completed grade twelve to teach
primary students and assist regular teachers. Although this is a positive step to
decrease class size and improve quality, a lot more needs to be done in this area.
Schools are also promoting women teachers to become role models for schoolgirls.


The schools have started sensitising students to gender related harmful practices.
There are student activities on HIV/AIDS in collaboration with residents of different
communities. The number of cases related to harassment of girls has declined.


Because of the efforts of these awareness-raising activities, young schoolgirls are now
resisting cultural practices such as early marriage, especially with old men. The story
of this Hamer girl illustrates that change is underway and similar stories were reported
among the Kereyu and Fedis communities.


Godena Bolinlka is a Hamer girl. She was attending school at Demeca and was
staying in a government hostel. Her parents wanted her to marry an old man because
he was rich and would give them many heads of cattle and dowry. She refused to go
back home and marry the old man. Because the man had already paid the dowry, her
parents agreed that he abduct her. Some people tricked her and she was taken by force
to the house of the old man. The old man did not ask for sex as soon as she arrived in
his house because certain ceremonial activities had to be done first. She became polite
to him and when he loosened his security, she disappeared and reported him to the
police. She was taken to the zonal town where she is continuing her education. She is
now 17 and is living in Jinca zonal town.



4.3.3.3 Health
There is widespread support for VCT and the demand is expanding. People are
demanding HIV tests before marriage. Religious leaders, both Muslims and
Christians, support it, but believe that education involving influential p eople has to be
given to help people realise the advantages of VCT. In Guraghe, over 40% of young


                                           58
Gender and HIV/AIDS In Ethiopia


couples get tested before marriage. Many youth come in groups of four and five and
use VCT services in Dilla and Wenago. The VCT centre of FGAE in Welayita is
active and the number of users is increasing. The VCT centres teach the youth
reproductive health, STI/HIV/AIDS prevention and harmful cultural practices
avoidance. The demand for condoms among the youth is increasing. The centre in
Dilla for example, distributed 2400 condoms in 20 days to youth only. About 400 men
and 200 women have been tested in the last three months.


PMTCT service is being introduced, Dilla hospital, for example, is giving the
services. Women get health education, and the number of PMTCT clients is
increasing. In four months in Dilla PMTCT centre only, 1446 clients became
beneficiaries of the services. 348 took blood tests and 41 were HIV positive. 341 of
those who took the test were married and the 41 positive women were also married.


The wereda administration, HIV/AIDS Bureau and Health Bureau work cooperatively
to   teach   the   community     about
                                           Before introducing the HIV test it is necessary
HIV/AIDS and harmful traditional           to teach the people using religious and
practices. There are committees that       community as well as tribal leaders. People
                                           suspect that the government wants to make
deal with harmful traditional practices    people sterile by injecting them with toxic
in Butajira, Alaba, Fedis, Yaya Gulele,    drugs. People may associate the test with this.
                                                                  Religious leader, Fedis, Man
and Fentele among others.




It is clear that there is demand for change, which can enhance the well being of the
respective communities. As seen above, a number of agents, including the
Government, NGOs/CSOs and communities themselves, have been engaged in the
facilitation and acceleration of such change to happen. It is important for them to
collaborate in order to effectively address the problem. Further, it is necessary to
continuously educate and sensitise local leadership in order to make them feel part
and parcel of the change process from its inception to its implementation.




                                          59
Gender and HIV/AIDS In Ethiopia


5. Discussions and the Way Forward


5.1 Discussions
To halt the spread of the HIV/AIDS pandemic, there is a need for a deeper
understanding of the underpinning factors that, directly and indirectly, contribute to
the infection. Based on such an understanding, it is necessary to put in place relevant
policies and programmes that can address the underpinning factors. The main route of
transmission in Africa appears to be unprotected sexual relations with multiple
partners. Consequently, faithful monogamy, use of condom and abstinence, are the
suggested measures of avoiding the infection. Despite the fact that studies show that
most people have this information, the behavioural practice of sex and sexuality
remain the same and the infection is spreading at an alarming rate, causing many
people to die daily. The question that people raise is, “'Why is that people behave the
same, despite the deadly nature of the infection?”


The current study, undertaken in SNNPR and Oromia, tried to explore the culturally
accepted norms, values, beliefs and practices in communities and how these relate to
HIV infection. The study portrays that there are beliefs, norms and values that justify
the behavioural practices of communities, but in essence expose them to HIV/AIDS.
It also reveals these customary practices are rooted in the masculinity and femininity
concepts of the communities that justify existing gender disparity. Thus, in order to
carry out effective HIV/AIDS prevention and control, policies and programmes must
be designed to redress gender disparities.


Important findings from the study are reviewed below.


5.1.1   Traditional Moral Codes
For the most part, Ethiopian communities remain rural and traditional, and have
values, norms and beliefs on sex and sexuality that result in exposing community
members, particularly women, to HIV infection.


Most communities, directly or indirectly, approve the practice of multiple sexual
relations. Prominent among such harmful practices are; abduction, rape, polygamy,
wife sharing, widow inheritance and extramarital sexual relations.


                                             60
Gender and HIV/AIDS In Ethiopia



Many of the prevailing cultural practices were initially adopted with the intention of
ensuring social harmony and community survival. For instance, jala jalto, which
allows both women and men to have multiple sexual partners outside marriage, aimed
to avoid crimes of jealousy and passion, while marrying several wives allowed for the
shortage of husbands killed in wars.


Communities do not associate their customary sexual practices with HIV infection.
While multiple sexual relationships within and/or outside the marriage are widely
exercised in the studied communities, the self-risk perception is very low due to such
relationships having inherent elements of trust, as they are the custom of the
communities. The prevailing attitude and belief is that HIV infection concerns only
“other” people such as truck drivers or commercial sex workers. Communities still
externalise the infection and try to associate it with cultures other than their own.
Rural communities think that it is the disease of the urban communities. The study
shows that the customary practices created at a certain epoch of a community‟s social
evolution remain insensitive to changes happening locally and globally.


5.1.2   Socialisation Patterns
The socialisation process of men and women right from birth puts men in a position
of absolute authority over women, who are expected to be obedient and submissive to
men. This process puts women in a situation where they cannot use their abilities and
know-how to deal with impending problems.


A “typical man” is defined to be sexually conquering, courageous, assertive and being
able to give protection. He controls his wife/wives and ensures their loyalty and
obedience to him by inflicting fear. A “typical woman” is submissive and meets the
needs of her parents at home before marriage. When she marries her main duty is to
satisfy the needs of her husband. Femininity is equated to submissiveness,
delicateness, seeking protection and agreeing to what a man says.


The gender bias in the communities studied is reflected in the denial of women to own
or have access to property, services such as education and health, and access to
information through the attendance of public gatherings. Women do not have the


                                         61
Gender and HIV/AIDS In Ethiopia


opportunity to participate in decision- making at both the household and the
community levels. Women‟s subordination to men is observed in all aspects of their
lives. Through the socialisation process, this gender disparity is perpetuated and
reinforced.


Similarly, women‟s sexuality and sexual rights are highly oppressed, or even ignored
totally. FGM, high value given to women‟s virginity, and early marriage, are some
examples of means devised to control women‟s sexuality. Furthermore, women are
brought up to be ignorant about sex. Coupled with their economic and social
dependence, it is extremely difficult for women to negotiate for safe sex.


On the other hand, men are socialized to be sexually and physically dominant over
women and are expected to be knowledgeable and experienced in sex. To be engaged
in multiple sexual relationships is also condoned. This increases their vulnerability to
HIV infection.


5.1.3   Partial Implementation of Laws
The government legal structures have not yet penetrated the communities and the
rights of women stipulated in the constitution of the country have not yet been
realized.


The gap between the government laws and policies, and customary laws remains
wide. This is because the communities are hardly aware of policies and constitutional
laws. Thus, the customary law supersedes the criminal law. In all the communities, it
has been reported that even if women bring their cases to the attention of the police
and the court, they hardly ever see their cases concluded. The community elders, who
are guardians of customary laws, pressurize such women and their families to
withdraw their cases through social sanctions. In most cases, the perpetuator of the
crime is protected, as has been seen in relation to cases of abduction, rape and marital
disputes.


In the communities covered by the study, men occupy all offices of the government,
with the exception of the women's affairs office. This has a major implication to the
implementation of government programmes on women and related issues. Some of


                                          62
Gender and HIV/AIDS In Ethiopia


the legal structures and courts are less sympathetic to the cases of women. They tend
to use delaying tactics and advise relatives of the perpetuator of the crime to make use
of community elders to settle the matter outside the legal system.


5.1.4   Skewed Intervention Programmes
Generic HIV/AIDS programmes have been focusing on the behavioural aspects of
individuals and mainly targeting “high-risk groups”.


A number of interventions have tried to address HIV/AIDS in an attempt to modify
individual‟s behaviour through the promotion of condom use, abstinence and
faithfulness to one sexual partner, without considering the underlying causes of the
behaviour. Other HIV/AIDS programmes have been based on paradigms, which
identify high-risk groups and intervene accordingly.


Rural communities, especially women, who don‟t fit in a “high-risk group”, have little
access to information on HIV/AIDS.         As a consequence, they have limited and
sometimes wrong knowledge. Gaps in knowledge and a lack of in-depth information
about HIV/AIDS aggravate the discrimination and stigmatisation of PLWHA, and
negatively affect the disclosure of sero-status.


5.1.5   Neglected Groups
Pastoral communities are more vulnerable to the HIV/AIDS infections, due to
mobility. Their access to social services and information is very limited.
Furthermore, in pastoral communities, multiple sexual relationships are more
institutionalised compared with sedentary communities.


5.1.6   Possible Points of Entry
Although there are serious constraints that are culturally determined and also
exacerbated by the lack of effective interventions on the side of the government and
civil societies, communities do offer opportunities for change. Each community has a
set of social capital that can be used to stop harmful customary practices. The study
showed that it is possible to effect social change, and the ingredients for such a
process are readily available in the communities.



                                            63
Gender and HIV/AIDS In Ethiopia


To begin with, the communities are enthusiastic to deal with the problems that they
are facing, particularly HIV/AIDS. People are afraid of HIV/AIDS, and would like to
protect themselves from the infection, and hence, will appreciate additional
information on prevention and transmission. The communities are prepared to
cooperate with government and the NGO community to change certain practices, if
such changes actually reduce HIV infection.


In addition to the willingness, there exist social institutions that could be used to bring
about changes that would enhance the health and survival of the respective
communities. Traditional and religious leaders play a key role in maintaining social
harmony and remain influential. So leaders identified in this study, like the Abageda,
Abawada, Abakalecha, Damina and Beti, could be used for disseminating
information. Moreover, community based associations, such as Idir, mahber, and
debo, are social assets of cooperation and working together. Such structures and their
leadership can be mobilised to introduce new values and practices towards gender
equity and eventually stop practices that increase HIV infection. The feasibility of
such interventions has been shown in Yabelo, Alaba and Butajira, where community
leadership is being mobilised to deal with harmful customary practices. Reports show
that major changes are occurring in these areas.


5.1.7   Windows of Opportunity
There is a growing sensitivity that the fight against HIV/AIDS requires a deeper
understanding of the gender relations and their underpinning values in the target
communities.


The political leadership is eager to deal with HIV/AIDS and gender issues. The
government has placed an HIV/AIDS policy in place and is trying to strengthen the
National HIV/AIDS Prevention and Control Office with human resources. The
government is aware that gender disparities affect its development endeavours.
Consequently, it has a women‟s policy in place and has made provisions for gender in
all its development policies, such as the education, health, economic and population
policies. It has initiated to revise the civil code and criminal code procedure to
incorporate legal provisions that address gender and HIV/AIDS. This environment
creates a supportive environment for effective responses to HIV/AIDS.


                                            64
Gender and HIV/AIDS In Ethiopia



Furthermore, there is growing sensitivity among the civil societies and NGOs that the
customary practices that expose people to the infection have to be addressed. This
concept is being transformed into a programme in some areas visited. The work of
KMG in Alaba, Betel in Yabelo, and Progynist in Butajira, are going along with this
thinking and are attracting more attention to the necessity of increasing the impact of
HIV/AIDS intervention through developing a better understanding of the specific
communities targeted.




5.2 The Way Forward


The current study has clearly corroborated the strong linkages among existing gender
disparities and HIV/AIDS transmission. Effectively combating the epidemic requires
cultural and social transformation in communities in which cultural harmful practices
are sanctioned and practiced, based on accepted concepts of masculinity and
femininity.   To facilitate the social transformation, the concerted efforts of all
stakeholders are required at various levels, from policymakers and political and
religious leaders down to communities. Based on the findings of this study, the
following recommendations and actions are proposed.

5.2.1   A key finding of the study is that communities share values, beliefs and norms
on sexuality that create vulnerability to HIV transmission. Practices such as jala jalto
and widow inheritance have been practiced with functionalist purposes i.e. to
maintain community cohesion, peace and security of households. Since these
practices have defined purposes, their association with HIV transmission has never
been questioned. Also some gaps have been identified in the knowledge of
community members as regards to HIV.


There is thus the need for IEC/BCC messages to draw the links between local
traditions and HIV, both at national policy levels and at community intervention
levels. At community levels, there is the need for strengthening community based
participatory IEC/BCC strategies that allow for discussions and questioning of




                                          65
Gender and HIV/AIDS In Ethiopia


underlying factors that pre-dispose communities, particularly women to HIV and
AIDS.


During the past twenty years the HIV/AIDS interventions have largely focused on
behaviours, systems and structures, which are visible from outside. For example, in
the ABC approach, abstinence, being faithful and using condoms have been
vigorously promoted as major public health interventions to combat HIV/AIDS.
However, these approaches are designed without fully taking into account culture,
values, norms and traditions, which are invisible but have a strong influence on
visible aspects of individual behaviours and societal structures. Moreover, these
approaches have focused on „what to do‟ rather than „why‟ people continue to engage
in risky behaviour through community based, participatory conversations. Thus,
IEC/BCC messages must be redesigned to target the „invisible‟ to address underlying
factors. In particular, given the low literacy rate and a low access to mass media, the
delivery of messages should be done mainly through community conversation
approaches.


The literature review of the study suggests that many harmful traditional practices are
exercised throughout the nation although not all are socially condoned and
sanctioned in some communities. For example, in the communities in Amhara and
Tigray regions – though multiple sexual relationships may not be openly accepted by
communities, they are widely practiced in hiding (see DHS study and BSS data 1/3 of
marital   couples    practice    extra-marital    sexual   relationships).   Thus,    the
recommendations drawn from the study can be applicable to a significant population
in the country. This will also have implications on the IEC/BCC messages that
currently target traditionally defined „risk groups‟.


5.2.2. As stated above, communities do not perceive that their traditional practices
are creating vulnerabilities to HIV transmission. There is thus limited perception of
risk within extra- marital relationships (jala jalto), widow inheritance or other
practices that are sanctioned/condoned. The justification for this has been „tradition‟
or „trust‟. There is also this association of HIV with risk groups such as truck drivers,
CSWs, generally groups that are outside the mainstream community.



                                           66
Gender and HIV/AIDS In Ethiopia


There is thus the need for re-defining „risk groups‟ both at policy level and at
program intervention levels e.g. marital groups are not identified within any category
of risk groups although they are. In particular, IEC/BCC approaches should be
redesigned, targeting women and girls, since traditionally their access to information
is considerably limited and they are more vulnerable to HIV infection and morbidity
and mortality related to reproductive health. In this regard, the way to effectively
reach women and girls should be carefully re-examined taking into consideration
their mobility.


5.2.3. The research findings have established that most of the traditional practices in
the Oromiya and SNNPR communities pre-dispose women to HIV e.g. practices of
wife sharing, widow inheritance, early marriage, abduction, FGM etc. More
importantly, the study has established that there are underlying gender related values
and norms that determine these practices. These relate to definitions of masculinity
and femininity and the roles and status of men vis-à-vis women that are culturally
defined and are carried-on through a process of socialization, starting from an early
stage of infancy. Thus, these values predetermine why women are abducted, why they
should be circumcised and why they are forced to get married at a very young age.
These are all society‟s „instruments‟ of suppressing the sexual desire of female. They
also insinuate the opposite sex to be the prime sex to initiate sex and to be sexual
gratified. The premise of these practices in fact relate to the subordinate economic and
social status of women.


Based on the above analysis, gender issues and HIV/AIDS are inseparably
interrelated. Thus, any HIV related interventions need to implicitly and explicitly
address gender concerns, looking at women‟s vulnerability vis-à-vis men‟s. The
empowerment of women and a change in status quo become a prerequisite if
communities are to reduce not only women‟s but also men‟s vulnerability to HIV (or
to end the practice of these risky practices). This has relevance for policy level and
programme level interventions. Interventions that target the livelihood, literacy,
health and legal needs of women are imperative and need to be reinforced. They
should not be treated as add-on components. Addressing the gender needs of women
should be further reinforced, if we are to empower women to influence changes in
their status. Such intervention will facilitate social change that will change the self -


                                           67
Gender and HIV/AIDS In Ethiopia


image and the social image of women against harmful traditional practices.         Also
note the commitment of the Government in its HIV prevention and control efforts:
wherein there is the clear recognition of targeting women and girls in IEC/BCC
interventions. Reference is made to increasing awareness of women and men,
reducing women‟s economic dependency and fighting harmful traditional practices
(see National Strategic Framework –2002-05).


5.2.4   The other key finding that the study corroborates is that laws and policies
enacted at national level have very little bearing on community level norms and
sanctions (e.g. policy that promotes right of women to property, minimum age of
marriage). These laws/policies are not enforced at community levels since community
norms supersede these laws and policies.


There is thus the need to build the capacity of law enforcing institutions at grassroots
as well as to raise their awareness on cultures and traditions of communities. Also,
community representatives should be informed of the laws and policies through
community-centred dialogues (as against coercive/prescriptive approaches). A very
good example of decision-making through community-based processes (with
facilitation of community conversations) is the recent decisions made by the Geda
leaders (among the Borena) to implement punitive measures against risky practices
such as Jala Jalto. Also women, together with men, need to be engaged in these
informative processes based on community-centred dialogues, based on experiences
in similar communities (e.g. through examples of the harmful effects of certain
traditional practices).


Also, there is the need to design policies, taking into account the social values and
cultures of the people as well as past experiences as a country, to make them more
acceptable and easier to follow by local communities.


5.2.5. Pastoral communities have been found to be particularly vulnerable to HIV
infection through the research findings. In most cases, they have not benefited from
social services and social infrastructures, which are enjoyed by sedentary
communities and their knowledge on HIV transmission is considerably limited.



                                           68
Gender and HIV/AIDS In Ethiopia


Thus, political priorities should be given to the provision of basic social services and
infrastructures in pastoral communities. Given their mobility and cultural values and
norms, any intervention programme should be delivered through culturally sensitive
approaches to be accepted by communities. To this end, further research and studies
will be useful to understand situations of communities better in order to make
intervention programmes more effective and aligned to their cultures and traditions.


5.2.6 The research findings have also indicated that there are community-based entry
points for interventions targeted at bringing about social change. These include
traditional institutions and individuals that are influential and that have importance in
the respective communities (Geda, Beti, Damina or idir, debo etc.).


These entry points/social capitals such as traditional values and community leaders
should be used in any community-based interventions targeting social change. Also
positive examples that have actually influenced change should be documented and
disseminated (e.g. the recent decisions made by the Geda Forum among the Borana
and the Guji). Community Conversation approaches implemented in Alaba by KMG
in collaboration with UNDP can be cited as a good practice on how to address
gender disparities and HIV transmission effectively in rural communities through
dialogue among community members.


5.2.7 There is an indication that there are gaps between needs and addressing these
needs through service delivery. For example, the case of VCT services or health
services for pastoralist communities.


Thus there is the need for strengthening Government and NGO service delivery in
communities where these gaps have been indicated. In the dissemination of the
research findings, relevant implementers need to be targeted to strengthen service
delivery.


Although HIV/AID poses a serious threat to the country, it has also opened doors of
opportunities for cultural change – through questioning of values, norms and attitudes
that condone risky practices for HIV and practices that reinforce gender inequality. It
has created the opportunity for dialogue on cultural issues that perhaps would never


                                           69
Gender and HIV/AIDS In Ethiopia


have been challenged. Like a silver lining on a dark cloud, HIV/AIDS has provided
the opportunity for stakeholders to revisit and accelerate development interventions
i.e. with HIV, the need for accelerating literacy goals, the need for strengthening
health coverage etc. have become absolute priorities.




                                          70
Gender and HIV/AIDS In Ethiopia


References

Central Statistical Authority (CSA). 1993. The 1990 National Family and Fertility
Survey, Ethiopia. Central Statistical Authority.

Central Statistical Authority (CSA). 1999. The 1994 Population and Housing Census:
Results at Country Level. Volume 2. Analytical Report. Addis Ababa, Ethiopia. CSA.

Central Statistical Authority (CSA) and ORC Macro International. 2001. The 2000
Ethiopia Demographic and Health Survey. Central Statistical Authority Addis Ababa,
Ethiopia and ORC Macro Calverton, Maryland, USA.

Federal democratic Republic of Ethiopia (FDRE) (1995). The constitution of the
Federal Democratic Republic of Ethiopia). Proclamation No.1/1995.Addis Ababa,
Ethiopia.

_____________. 1998. Policy on HIV/AIDS of the Federal Democratic Republic of
Ethiopia. Addis Ababa, Ethiopia.

_____________. 1997: Cultural Policy. Addis Ababa.

Gender and HIV/AIDS: Taking stock of research and programmes. UNAIDS, March
1999.

HIV/AIDS Behavioural Surveillance Survey (BSS), Ethiopia 2002, Round one.

HIV/AIDS Prevention and Control Office, 2001. Strategic framework for the National
Response to HIV/AIDS in Ethiopia (2001-2005). HIV/AIDS Prevention and Control
Office, Addis Ababa, Ethiopia

International Institute of Rural Reconstruction - Ethiopia 2000. Integrating Gender in
Development Projects. Ethiopia pp12-13

Ministry of Education 1999. Educational Statistics: Annual Abstracts 1998-1999.
Ministry of Education, Addis Ababa, Ethiopia.


National Committee on Traditional Practices in Ethiopia. (NCTPE). 1998. Baseline
Survey on Harmful Traditional Practices in Ethiopia. National Committee on
Traditional Practices in Ethiopia, Addis Ababa, Ethiopia.

____________.2003. Old Beyond imaginings: Ethiopia Harmful Traditional
Practices. Addis Ababa.

Organisation for Social Services for AIDS (OSSA) and German Foundation for
World Population. 1999. KAP of Adolescents on Sexual Reproductive Health.
Adolescent Reproductive Health Initiative (ARH) Project, Organization for Social
Services for AIDS and German Foundation for World Population. Addis Ababa,
Ethiopia.



                                         71
Gender and HIV/AIDS In Ethiopia



Transitional Government of Ethiopia (TGE). 1994. Education and Training Policy of
Ethiopia. Transitional Government of Ethiopia. Addis Ababa, Ethiopia.

____________. 1993. National Health Policy of Ethiopia. Transitional Government
of Ethiopia. Addis Ababa, Ethiopia.

____________. 1993. National Policy on Ethiopian Women. Transitional Government
of Ethiopia. Addis Ababa, Ethiopia.

Yared Amare. 1997. Women‟s Access to Resources in Amhara Households of Wegda,
Central Ethiopia. Unpublished Paper, Boston University




                                       72
     Gender and HIV/AIDS In Ethiopia


     Appendix 1: Tables of Results
     Table 5: Percentage Distributi on of Demographic Characteristics of Respondents by Wereda
                            Alaba
                           special Wenag              Butajira/             Yaya
 Age              Humbo    we reda   o    MarekaHamer Meskan Yabelo Fentele Gulele               Fedis Total
 15-19              3.0        4.0    1.5   3.5   5.5    0.5     7.1 13.0 2.5                     3.5 4.4
 20-24             10.7      12.6   10.8   17.8 14.6     4.5    11.1 13.0 10.1                   15.6 12.1
 25-29             20.8      26.3   23.1   18.3 19.1    13.5    18.2 19.5 14.1                   25.1 19.8
 30-34             18.3      18.2   17.9   20.8 19.6    15.0    17.7 17.0 12.1                   21.1 17.8
 35-39             13.2      16.7   14.4   13.4 14.1    17.0    13.6 13.0 15.2                   13.1 14.4
 40-44             14.7        8.6  13.3    8.9 15.1    11.5    10.1 11.0 18.2                   11.1 12.2
 45-49             11.2        7.6    7.2   8.4   6.0   19.0     9.6   5.5 9.1                    3.0 8.7
 50-54              4.1        3.5    3.6   3.0   5.5    8.5     4.0   5.5 7.6                    5.0 5.0
 55-59              1.5        1.0    1.5   4.0     -    4.5     5.6     - 6.6                    1.0 2.6
 60+                2.5        1.5    7.7   2.0   0.5    6.0     3.0   2.5 4.5                    1.5 3.1
 Male              55.6      49.5   42.7   42.7 52.8    51.5    45.5 41.0 50.3                   54.8 48.7
 Marital
Status
 Never
married              9.1     10.0       3.5     8.3   17.6        5.5      9.5    14.0    9.0     7.0   9.4
 Married,
Mono.              77.3      75.0     82.8     75.6   59.3      81.9      77.5    73.0 80.4      78.9 76.2
 Married,
poly.                1.5      7.0       1.5     4.4   14.6        3.0      3.0     4.5       -    6.0   4.6

Divorced/separ.      3.5      2.5       4.5     4.4       -       3.5      1.5     4.0    5.0     5.0   3.4
 Widowed             8.6      5.5       7.6     7.3     8.5       6.0      8.5     4.5    5.5     3.0   6.5
 Headship
 Adult male        79.3      81.5     83.8     80.1   81.4      71.5      77.5    76.8 78.3      74.6 78.5
 Adult female      14.6      11.0     11.6     12.6    9.0      28.0      13.0     4.6 15.2       6.1 12.6
 Young male         1.0       1.0      1.0      1.5    1.0       0.5       3.5     5.2 1.5        1.5 1.8
 Young female       5.1       6.5      3.5      5.8    8.5         -       6.0    13.4 5.1       17.8 7.1
 Religion
 Orthodox           8.6      10.6     30.3     32.7      -      86.0        .5     4.0 97.0  6.6 27.7
 Catholic          12.1         -        -      1.5    1.0       3.0        .5      .5   .5    - 1.9
 Protestant        78.8       3.0     68.2     64.9    3.0       6.0       9.5       - 2.5    .5 23.7
 Muslim               -      86.4      1.5        -      -       4.5      30.0    69.8    - 92.9 28.4
 Other               .5         -        -      1.0   96.0        .5      59.5    25.6    -    - 18.3




                                                 73
 Gender and HIV/AIDS In Ethiopia

 Table 6: Percentage Distri bution of Soci o-economic Characteristics of Respondents by Wereda
                  Alaba
                  special Wenag                     Butajurza/                Yaya
Education Humbo wereda        o     Mareka Hamer Meskan Yabelo Fentele        Gulele Fedis Total
No educ.    35.4 60.5        43.1       45.4 96.5        64.2 91.2 83.0 73.2 64.3 65.7
1st cycle
Prim.       11.3 11.4        19.0        9.8 2.0         16.8     6.2 8.0       8.1 9.7 10.1
2nd cycle
Prim.        31.3   18.4     27.7      22.9    0.5      11.0     2.1   8.0     5.1 18.4 14.5
Secondary    11.8    3.2      2.6       8.8    1.0       2.3     0.5   1.0     4.5 5.6 4.2
Above
seco.        10.3    6.5      7.7      13.2        -      5.8      -      -    9.1   2.0    5.5

Literate     57.6   37.0     51.5      52.7    2.5      29.6     7.5 13.0     25.6 30.8 30.8

Own
land         68.7   74.5     74.7      67.0 78.4        74.0    56.8 44.5     71.9 73.9 68.4
Decision
on crops
grown
Husband      36.8   41.6     48.0      40.1 55.1        39.9 46.9 47.2 44.8 46.9 44.7
Wife         10.3    4.7      7.4      13.9 10.3         8.8  7.1 7.9   5.6 4.1 8.0
Both         47.8   48.3     43.2      44.5 32.7        49.3 43.4 42.7 48.3 48.3 44.9
Others       13.8   27.6      6.9       6.9 1.9          2.0  1.8 2.2   1.4 0.7 2.1
Decision
on crops
sold
Husband      25.0   37.6     20.3      24.1 39.7        22.3 25.7 39.3 20.3 32.7 28.5
Wife          9.6    4.0      8.1      12.4 11.5         8.1  8.0 6.7   5.6 4.1 7.8
Both         60.3   51.0     69.6      61.3 47.4        60.1 63.7 43.8 64.3 61.9 58.7
Others        4.4    7.4      2.0       2.2 1.3          9.5  1.8 10.1  9.8 1.4 4.8
Own
Elect.       19.2   19.0     47.5         -        -    17.5       -   0.5 10.1      1.5 11.5
Own
Radio        49.5   44.5     55.6      44.2    2.5      43.0    22.1 27.5     34.2 57.3 38.0




                                              74
Gender and HIV/AIDS In Ethiopia

Table 7: Percentage Distribution of Knowledge on Modes of HIV Infecti on by Wereda
                                                     Butajira/ Yabel         Yaya
Education        Humbo Alaba Wenag o Mareka Hamer Meskan o                   Gulele Fedis Total
                                                                       Fentele
Blood             30.3  41.0 39.4      36.8     15.5 55.0       27.6 31.5      24.1 30.7 33.2
Sexual            96.5  97.0 98.0      90.2     93.5 89.0       99.0 98.5      95.5 99.0 95.6
PMTCT             43.4  42.5 57.6      50.5     24.5 46.0       34.4 43.5      49.2 50.3 44.2
Sharing sharp
objects           82.3  56.0 71.2      92.6     46.0 55.0       92.0 87.5      83.4 86.4 75.3
Blood
transfusion       6.1   4.5  3.0       3.9      0.5   7.0       2.5    2.0     3.0 4.5     3.7
Healthy
looking
person coul d
have HIV
Yes               38.9  30.0 35.4      32.8     10.0 38.5       18.6 21.0      33.7 36.7 29.5
No                23.2  28.5 35.4      35.3     32.0 25.5       31.7 35.5      27.6 28.1 30.3
Don't Know        37.9  41.5 29.3      31.9     58.0 36.0       49.7 43.5      38.7 35.2 40.2
MTCT
Possible
Yes               75.8  70.5 76.3      77.0     34.0 70.5       51.3 70.5      66.8 64.8 65.7
No                5.1   6.5  4.5       6.4      7.5   4.5       7.5    4.5     7.0 5.5     5.9
Don't Know        19.2  23.0 19.2      16.7     58.5 25.0       41.2 25.0      26.1 29.6 28.3
During
pregnancy
Yes               56.1  59.6 67.5      65.2     73.5 74.3       66.7 53.2      47.0 48.4 60.6
No                24.3  22.1 25.2      21.9     17.6 7.9        23.5 3.6       20.5 4.7    17.2
Don't Know        19.6  18.4 7.3       12.9     8.8   17.9      9.8    43.2    32.6 46.9 22.2
During
deli very
Yes               43.5  46.0 58.9      58.3     61.8 55.7       69.3 49.3      47.3 38.0 52.1
No                29.3  22.6 23.8      25.0     14.7 11.4       9.9    5.1     11.5 12.4 17.2
Don't Know        27.2  31.4 17.2      16.7     23.5 32.9       20.8 45.7      41.2 49.6 30.7
By
breastfeeding
Yes               86.6  85.5 70.9      78.2     66.2 75.2       61.4 85.7      78.2 92.2 79.0
No                4.0   2.2  14.6      10.9     17.6 7.8        18.8 1.4       5.3   2.3 7.8
Don't Know        9.4   12.3 14.6      10.9     16.2 17.0       19.8 12.9      16.5 5.4 13.2
How often
Always            49.0  42.9 49.0      50.3     61.8 56.0       50.5 52.5      64.9 64.3 53.5
Somet imes        39.5  46.4 39.7      33.1     23.5 31.9       30.1 27.0      17.2 24.8 32.0
Don't Know        11.6  10.7 11.3      16.6     14.7 12.1       19.4 20.6      17.9 10.9 14.4
Attitude to
gender & sex
Men       infect
wo man            73.2  67.8 62.6      78.4     70.0 78.0       79.5 76.4      75.5 59.3 72.1
Men
unfaithful        74.5  81.5 71.8      64.4     44.3 65.4       50.9 57.2      55.6 43.2 60.9
Woman infect
men               60.9  52.3 46.0      56.9     43.0 43.5       38.0 38.7      52.5 49.7 48.1
Women
unfaithful        71.1  63.5 72.5      69.8     50.6 69.0       73.7 74.0      59.0 60.6 66.3
Attitude to
virginity
Virgin can be
infected          66.2  47.7 57.1      73.5     25.5 57.0       36.0 51.8      51.5 59.8 52.6
Through
blood
contamination 92.4      85.3 80.5      88.7     60.8 83.3       68.1 64.1      82.5 66.4 79.1


                                              75
Gender and HIV/AIDS In Ethiopia



Table 8: Percentage Distribution of Knowledge on Preventi ve Strategies by Wereda
                    Alaba
                    specialWenag             Butajira/ Yabel         Yaya
               Humbowereda o     Mareka HamerMeskan o        Fentele GuleleFedisTotal N
What can a
person do
to avoid
AIDS
Yes            92.9   88.4    91.4    92.1    74.0    84.0      84.5   84.0     83.0 87.4 86.2 1997
Don't Know     5.6    9.5     7.1     5.4     20.0    10.0      15.5   15.5     17.0 11.6 11.7
Use
condoms        29.3   25.6    22.7    34.6    6.8     36.3      8.3    11.9     19.9 28.7 22.8 1722
Fewer
partners       4.9    8.5     11.6    6.9     4.1     8.9       4.1    8.3      -     0.6 5.9   1722
No casual
sex            31.0   22.2    35.4    28.2    17.6    20.8      33.1   19.6     15.7 13.2 23.9 1722
One to one
Relationship   85.3   81.8    84.0    76.6    66.9    59.5      83.4   77.4     84.9 81.0 78.3 1722
Abstinence     25.0   25.6    27.1    29.3    11.5    38.1      17.2   31.0     28.9 22.4 25.8 1722
Avoid
injections
with
contaminated
needles        58.2   34.1    66.9    75.0    60.1    33.3      90.5   67.9     67.5 76.4 63.1 1722
Avoid blood
transfusion    16.3   20.5    12.7    16.0    13.5    23.2      17.8   8.9      14.5 9.2   15.3 1722
Treat STIs     0.5    -       1.1     1.1     -       -         0.6    -        -    0.6   0.4 1722




                                             76
Gender and HIV/AIDS In Ethiopia

Table 9: Percentage Distributi on of Level and Source of Information on HIV/AIDS by Wereda
                     Alaba
                     special                      Butajiza Yabel         Yaya
                                     o
               Humbo wereda WenagMarekaHamer /Meskan o                   Gulele FedisTotal N
                                                                   Fentele
Men       more
informed        57.6  66.0      66.7 68.6 73.0 70.0          68.5 67.8 70.9 60.4 67.0 1995
Need      more
info.           72.7  59.0      79.8 84.3 80.5 52.0          78.5 79.4 78.4 86.3 75.1 1995
Source      of
Information
Peers           13.1  14.5      16.7 14.7 20.0 30.5          18.5 19.1 17.6 17.3 18.2 1995
Neighbours      2.5   12.0      3.5    6.4   15.0 14.5       12.5 3.5      12.6 7.6 9.0     1995
Overhearing     10.6  14.0      21.2 11.3 48.0 13.0          39.0 44.7 49.2 36.0 28.7 1995
Health
providers       38.4  27.0      40.9 50.5 35.5 12.0          31.5 21.6 29.1 18.8 30.6 1995
School          8.6   5.0       11.6 15.7 -        2.5       3.5   11.1 4.5      9.1 7.2    1995
Spouse          17.7  34.5      10.6 12.3 0.5      27.5      6.5   2.5     4.5   8.6 12.5 1995
Media           48.5  27.0      53.5 41.2 1.5      28.5      34.5 31.2 34.7 60.4 36.0 1995
Preferred
Source      of
Information
Peers           12.1  23.5      11.7 10.8 20.0 21.0          19.1 17.8 17.6 16.2 17.0 338
Family          1.0   -         0.5    -     0.5   1.5       -     0.5     -     -     0.4  8
Neighbours      5.0   2.0       -      1.0   2.0   2.0       -     1.0     0.5   -     0.9  18
Overhearing     1.5   0.5       1.0    1.5   11.0 2.5        1.0   5.1     8.5   8.1 4.1    81
Spouse          13.1  22.5      9.6    6.9   0.5   23.5      4.0   1.5     2.0   4.5 8.8    176
Health
providers       43.9  28.5      31.5 53.4 54.0 18.0          35.7 37.6 47.7 20.7 37.1 740
School          3.0   3.0       4.1    2.9   -     1.5       0.5   6.6     3.0     2.0 2.7  53
Media           20.7  14.5      36.5 20.1 1.0      22.0      18.1 15.2 19.6 45.5 21.3 424
Other           4.0   5.5       5.1    3.4   11.0 8.0        21.6 14.7 1.0        3.0 7.7   154




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Gender and HIV/AIDS In Ethiopia



 Table 10: Percentage Distri butions of Perceptions and Atti tudes Towards Voluntary Counselling
 and Testing by Wereda
                      Alaba
                      special Wenag                  Butajira Yabel         Yaya
                Humbo wereda o         MarekaHamer Meskan o          FenteleGuleleFedisTotal N
Want to be
tested           71.7  74.5    74.7     77.5    72.0 52.5       73.0 74.7    69.8 65.8 70.6 1996
Reasons
To know fo r
sure             88.7  92.6    85.1     94.9    78.5 91.4       89.0 82.4    83.5 87.0 87.3 1410
To live better   16.2  13.4    18.2     10.1    19.4 9.5        11.6 16.2    20.1 21.4 15.7 1410
To       know
before getting
married          0.7   3.4     2.7      1.3     8.3   1.0       5.5   5.4    2.9   2.3 3.4    1410
To          get
treatment        5.6   10.7    3.4      8.9     8.3   13.3      3.4   5.4    5.8   3.8 6.7    1410
Share results    55.1  64.0    66.2     61.8    63.0 40.0       56.0 59.1    66.3 59.3 59.1 1996
Person       to
Share with
Partner/spouse     75.2   75.8   80.9   80.2   61.1     82.5   75.9   68.6   73.7   74.6 74.6     1181
Father     and
mother             18.3   13.3   17.6   24.6   28.6     13.8   21.4   13.6   6.0    10.2   16.8   1181
Family             47.7   41.4   36.6   38.9   42.9     65.0   49.1   27.1   35.3   32.2   40.6   1181
Neighbors          30.3   25.8   35.1   30.2   36.5     25.0   41.1   33.1   22.6   26.3   30.7   1181
Friends            14.7   14.8   32.8   16.7   15.1     18.8   5.4    23.7   11.3   22.9   17.7   1181
Reasons for
not Sharing
Fear of neglect,
isolation
avoidance          77.0   92.9   89.4   93.1   73.3     82.4   98.1   61.0   59.5   69.6 80.4     562
Fear of verbal
abuse, teasing     16.2   21.4   6.4    19.0   -        16.5   5.6    3.4    -      1.8 10.5      562
I       wouldn't
receive      any
care & support     17.6   10.7   14.9   10.3   10.0     14.3   9.3    20.3   35.1   19.6 15.8     562
People would
think that I am
bad/ immo ral      21.6   17.9   42.6   17.2   16.7     9.9    16.7   16.9   18.9   21.4 19.2     562
People would
think that I am
promiscuous        5.4    3.6    2.1    3.4    10.0     11.0   5.6    -      -      1.8 4.6       562




                                                   78
         Gender and HIV/AIDS In Ethiopia

         Table 11: Percentage Distri buti on of Knowledge on Harmful Practices that Enhance the Spread
         of HIV/ AIDS by Wereda

                            Wenag             Butajira/             Yaya
                Humbo Alaba o     MarekaHamer Meskan Yabelo Fentele Gulele Fedis Total N
Jalla           1.5   15.0   0.5  2.0    -    -         24.5 4.5     -     -      4.8 1995
Younger
brother has
sex      with
sister- in-
law             15.7    18.5       14.6   12.3     88.5     10.5     35.0     49.7      -       9.1 25.4 1995
Abduction*      29.3    14.5       22.7   38.2     34.5     26.0     26.0     50.8      66.8    4.1 31.3 1995
Polygamy        55.1    52.0       73.7   61.8     45.0     54.0     28.5     49.7      6.5     49.7 47.6 1995
Wife
sharing         9.1     9.0        14.1   9.8      10.5     12.0     7.5      21.1      -       4.1      9.7   1995
Widow
inheritance     28.8    45.0       36.9   36.3     48.5     47.0     29.0     55.8      10.1    79.7 41.7 1995
Female
circumcision    31.8    28.0       46.5   49.0     27.0     20.2     53.5     75.4      78.9    81.7 49.2 1993
Uvula
cutting         12.1    4.4        16.4   14.7     -        -        0.5      8.5       15.1    38.6 12.3 1776
Wipe my
tears           1.0     1.5        -      2.0      -        4.5      3.5      2.5       -       4.1      1.9 1995
Jala Jalto      1.0     5.5        -      -        18.5     2.5      87.5     65.3      15.6    1.0      19.7 1995

         * Abduction was defined as the case where a man forcefully takes a girl to be his wife
         without her consent, or when the young lady runs away to be married wit hout the
         consent of her parents.




                                                       79
Gender and HIV/AIDS In Ethiopia

Table 12: Percentage Distribution of Attitudes Towards Virginity by Wereda

                          Wenag            Butajira/Yabel         Yaya
               Humbo Alabao     MarekaHamerMeskan o       Fentele Gulele Fedis Total N
Virginity
attitude
Woman
must      be
virgin         78.8    85.5   69.2     81.9     33.7   76.0    94.5    89.9   69.3 73.7   75.3 1995
Meaning of
female
virginity
Purity         27.6    25.7   29.9     35.9     62.7   43.4    53.4    48.6   61.6 52.1   42.9 1502
Honesty        17.9    14.6   35.0     28.1     41.8   34.9    23.8    7.3    10.9 12.3   21.3 1502
Innocence      46.8    55.0   54.0     40.1     22.4   50.0    41.8    44.1   58.7 54.1   47.7 1502
Cleanliness/
healthy        53.2    40.4   30.7     40.7     35.8   12.5    38.6    17.9   26.8 24.7   32.2 1502
Chastity       23.1    24.6   31.4     24.6     3.0    7.9     28.0    29.6   25.4 17.8   22.8 1502
Virginity
attitude
Man must
be virgin      52.0    50.0   50.0     51.5     10.1   58.5    38.5    18.1   29.6 23.2   38.2 1995
Meaning of
male
Virginity
Purity         16.5    14.0   22.2     23.8     40.0   28.2    39.0    13.9   47.5 17.4   24.9 762
Honesty        21.4    12.0   29.3     35.2     15.0   37.6    18.2    -      5.1 17.4    22.6 762
Innocence      42.7    58.0   50.5     39.0     10.0   53.0    33.8    38.9   50.8 41.3   45.4 762
Cleanliness/
Healthy        54.4    43.0   40.4     39.0     75.0   17.1    48.1    52.8   49.2 52.2   42.5 762
Chastity       20.4    26.0   21.2     21.0     -      7.7     26.0    36.1   35.6 15.2   21.0 762




                                              80
Gender and HIV/AIDS In Ethiopia

Table 13: Percentage Distribution of Gender Sexuality and HIV/AIDS by Wereda
                             Wenag            Butajira/             Yaya
                 Humbo Alaba o     MarekaHamerMeskan Yabelo Fentele Gulele Fedis Total N
Sexual r/ship
b/n men and
women are
not equal        83.3   74.4   79.3   81.8        79.5   75.5   74.0   75.4    69.0 71.1   76.4 1994
Men enjoy
sex more
than women       90.4   85.9   85.9   81.3        79.0   85.0   87.5   78.9    77.0 81.7   83.2 1994
The best sex
involves
sexual
intercourse      84.3   70.1   83.8   77.3        81.0   61.0   78.5   77.9    77.0 82.2   77.3 1992
Men want
more sexual
intercourse
than women       84.8   84.9   79.8   77.3        77.0   87.9   78.4   75.9    78.0 81.2   80.5 1992
In sex men
are active,
women are
passive          72.2   69.2   68.7   67.5        52.0   70.0   61.5   65.8    53.5 68.5   64.9 1993
love and
closeness
more
important
than sexual
pleasure         88.9   78.9   85.9   75.4        75.5   76.4   72.0   76.4    78.0 78.2   78.5 1993
Women want
pleasure from
sex, as much
as men           75.6   74.4   83.3   68.0        72.5   67.5   66.8   75.1    76.5 75.9   73.5 1981
Men more
interested in
sexual
performance      71.2   77.9   82.8   73.9        74.5   76.0   71.5   75.9    76.5 79.1   75.9 1993
Sex stops
when man
has orgasm,      65.7   63.3   65.2   59.6        56.0   73.0   55.0   68.7    64.5 76.6   64.7 1993
Acceptable
for man to be
sexually
experienced
than woman       62.6   64.3   59.1   55.2        63.0   70.4   55.5   50.0    59.6 63.6   60.3 1985
Young
women talk
about sex &
love different
from men         68.7   68.8   72.7   61.6        72.5   57.3   61.5   64.8    71.0 72.1   67.1 1993
Young men
have as many
anxieties
about sex as
women            49.0   22.6   48.5   36.5        52.0   16.1   25.5   34.7    34.5 39.1   35.8 1993


                                             81
Gender and HIV/AIDS In Ethiopia


R/ship b/n
men and
women are
more equal
now than 20
years ago        35.4   33.7   40.4   36.9        29.5   34.0   35.5   25.1   39.5 34.5   34.5 1994
Young
women are
often
pressured to
have sex         68.2   70.4   58.1   57.1        63.5   69.5   62.5   67.8   62.0 67.0   64.6 1994
Young
women are
more worried
about
consequences
of sex than
young men        49.0   63.3   63.1   59.1        67.0   75.5   58.0   55.3   56.5 52.8   60.0 1994
Women are
keener to
please their
partner
sexually ,than
to seek their
own pleasure     62.1   64.8   60.6   53.7        55.5   65.0   54.5   58.6   62.0 70.6   60.7 1993
Woman
more
interested in
love men
more in sex      86.9   82.4   85.9   86.0        70.5   87.5   85.0   77.8   75.5 74.6   81.2 1990
Women often
go into
relations with
men without
clear sexual
agenda           54.5   48.5   61.1   54.0        57.5   63.0   46.7   48.5   60.5 58.1   55.3 1989
Women are
concerned
more about
unwanted
pregnancy
and STIs         48.5   62.8   65.7   61.5        57.0   75.5   56.5   55.3   56.5 53.5   59.3 1992
Many men
don‟t feel
confident
using
condoms          55.6   43.2   57.6   59.5        38.5   51.5   33.7   38.4   37.5 39.4   45.5 1990




                                             82
Gender and HIV/AIDS In Ethiopia



Table 14: Percentage Distri bution of Attitude Towards Gender and Sexuality by Wereda
                             Wenag                  Butajira/              Yaya
               Humbo Alaba o          Mareka Hamer Meskan Yabelo FenteleGulele Fedis Total    N
Men tend to
control what
happens in
sex mo re than
wo men do      41.9   35.0     50.0    46.8    51.5 42.0      38.5  44.4    49.5 48.7 44.9    1991
Woman
decide when
to have sex
as a wife      9.1    6.0      17.2    16.2    5.5  10.0      5.5   6.8     9.5   12.6 9.8    874
Reason for
not
deci di ng
Husband
may
disagree       7.4    15.9     16.1    11.9    18.8 19.4      7.9   2.2     1.6   3.4  10.4   684
Husband is
the one to
decide         29.6   45.1     51.6    47.8    65.6 43.3      39.5  42.0    51.6 56.9 47.1    682
I am
ashamed to
ask husband 25.9      26.8     30.6    29.9    31.3 19.4      59.2  37.5    32.8 39.7 33.7    682
I don't
expect that
fro m wife     24.6   29.4     13.2    12.2    20.0 50.7      20.6  18.2    16.7 19.3 23.4    627
I am the one
to decide      49.2   33.8     71.7    61.0    91.4 38.4      81.0  76.4    78.3 73.5 65.2    627
It is
culturally
unacceptable 36.1     54.4     41.5    34.1    32.9 45.2      33.3  41.8    23.3 28.9 37.2    627
Women
aren't
expected to
choose
sexual
partner        36.0   32.2     35.7    18.3    23.3 31.6      22.8  15.6    16.8 15.3 24.1    1124
Women
have no
power to
choose their
partner        52.3   53.7     56.1    62.2    79.5 54.7      70.7  83.0    85.1 84.7 69.8    1124
Men decide
with who to
have sex       94.4   94.0     94.9    93.6    97.0 92.5      100.0 99.0    99.0 96.0 96.0    1993
men have
power to
choose
partners       43.9   45.2     52.1    61.6    83.0 50.3      73.0  82.9    74.7 80.6 65.0    1914
Men have
sex with
wife any
time they
want           77.3   75.0     82.8    85.7    96.5 80.5      91.0  73.3    70.5 78.9 81.2    1993
Reasons
It is          52.9   63.3     67.1    60.3    77.7 61.5      74.7  59.4    59.6 51.6 63.4    1618



                                            83
Gender and HIV/AIDS In Ethiopia


culturally
acceptable
Men's sexual
needs must
be met          48.4   42.7   56.7   47.7   60.6   29.8   64.3   63.6   61.0   58.6   53.5   1618
Woman must
serve her
husband         13.7   14.7   14.0   14.9   6.2    14.9   4.9    8.4    5.7    15.9   11.2   1618
Woman has
sex with
husband any
time            14.6   4.5    17.2   13.3   12.0   11.0   8.0    3.0    7.0    11.1   10.2   1996
Reason for
not havi ng
sex anyti me
It is a
deviant
behaviour
for wo men
to show
sexual desire   90.2   88.6   91.7   87.1   95.7   93.2   94.6   78.0   87.4   75.7   88.1   1676
If man
suspects
wi fe
Beat the
wo man          40.9   56.0   38.9   26.6   87.0   24.0   53.0   83.9   65.5   58.3   53.4   1997
Divorce her     54.5   49.0   43.9   53.2   9.5    66.5   32.0   17.1   23.5   39.7   38.9   1997
Kicks her
out of house    29.3   33.5   26.8   22.2   9.0    34.0   14.5   18.1   45.5   29.1   26.2   1474
If wife
suspects
husband of
havi ng an
affair
Nothing         29.8   59.0   22.2   27.1   77.5   65.5   22.0   71.9   30.0   45.2   45.0   1997
Ask for
divorce         34.8   16.5   35.9   35.0   0.5    22.5   39.5   7.0    32.0   21.6   24.5   1997
Reports to
relatives       28.8   18.0   32.8   28.1   11.0   16.5   26.0   14.6   27.5   26.6   23.0   1538
A wo man
can ask safe
sex             32.1   15.2   28.8   41.4   18.9   27.6   20.8   9.6    32.9   17.5   24.6   1690
A man can
ask safe sex    52.0   42.4   45.9   60.8   47.2   58.1   50.6   36.8   46.4   34.9   47.7   1718
Husband
may force
sex             50.3   56.8   71.0   50.0   96.3   41.0   83.6   87.1   84.2   79.4   70.5   1553




                                            84
Gender and HIV/AIDS In Ethiopia

Table 15: Percentage Distribution of Perception of Risk and Attitude Towards HIV Infection by
Wereda
                               Alaba
                              special Wenag                 Butajira/              Yaya
                        Humbo wereda     o   MarekaHamer Meskan Yabelo Fentele Gulele Fedis      Total    N
Your chances of
getting AIDS
Some chance              15.2   22.5    14.1   19.6 17.0      16.0     7.5   21.2 12.1     9.6   15.5    1995
Don't know               20.7   28.0    27.8   26.0 47.0      29.5    36.5   30.8 37.7 27.3      31.1
Reason for no
chance
Follow religious
rules                    40.2    5.1    24.3   18.9      -     4.6     0.9    1.1      -   0.8   10.6    1065
No sex outside
marriage                 77.2   73.7    80.0   79.3 79.2      82.6    77.7   71.6 70.0 83.2      77.7    1065
No sex                   12.6   19.2    11.3   10.8    9.7    11.9    18.8   23.2 22.0     8.8   14.6    1065
AIDS cannot infect
me                        4.7    8.1    16.5   20.7 11.1       2.8    15.2      - 10.0     3.2    9.2    1065
Reason for chance
Can get infected
blood                    60.0   62.2    53.6   62.5 35.3      59.4    46.7   33.3 58.3 57.9      52.8     309
Has your sexual
behaviour changed
since you heard of
HIV/AIDS                 70.2   60.0    72.2   67.6 62.5      34.5    67.0   67.2 72.9 66.2      64.0    1995
Behavi oural
change
Reduced number of
partners                  5.0   15.8     9.8     7.2 22.4     15.9     9.7   18.8 15.9 15.3      13.3    1277
Abstaining fro m sex     43.9   35.8    37.1   36.2 47.2      39.1    47.8   30.8 31.0 23.7      37.1    1277
Stopped sharing
needles                  87.1   76.7    87.4   88.4 57.6      65.2    94.8   82.0 91.7 94.7      83.8    1277
Reasons for not
changing
I am married             61.5   75.0    50.0   55.0 68.2      76.7    70.4   50.8 57.1 47.0      62.8     646
I am in a
monogamous r/ship        25.0   32.4    36.0   36.7    6.1    35.0    39.6   27.9 49.0 59.1      34.4     645
Don't think I am at
risk                     17.3   13.2    16.0   15.0 25.8       5.0     1.9   31.1 26.5 30.3      17.2     645
Steps taken if
positi ve
Get tested               84.3   81.0    85.9   82.8 64.5      73.5    83.0   79.4 81.9 81.4      79.8    1997
Worry                     7.1   10.5     3.5     2.9   9.5    19.0     6.0    6.0    7.0   6.5    7.8    1997
Fearfu l of other's
reaction                  4.0    5.5     1.5     4.4   5.0     6.0     4.0    3.0    4.5   4.0    4.2    1997
Where tested
Gov't
clin ic/hospital/health
centre                   95.5   80.0    97.0   95.6 65.0      95.5    90.0   81.4 90.5 87.4      87.8    1997
Private
clin ic/hospital          5.6    4.5     4.0     5.9     -    13.5     0.5      -      -   3.5    3.8    1997




                                            85
Gender and HIV/AIDS In Ethiopia



Table 16: Percentage Distributi on of Woman’s Right by Wereda
                              Wenag                Butajira/             Yaya
                Humbo Alaba       o   Mareka Hamer Meskan Yabelo Fentele Gulele   Fedis Total    N
Most men
don't want
wife to work
outside home     70.7 64.5       59.1  68.8 61.5     71.5    56.5  49.0 22.0      32.2   55.6   1995
Reasons
Afraid wives
have sex         56.4 51.9       79.5  57.6 74.8     60.8    82.3  73.2 90.9      89.1   68.4   1109
Wants to
control
through
dependency        3.6    9.3      6.8   4.3   1.6    14.7     0.9  10.3   9.1     12.5    6.9   1109
Culturally
unacceptable     25.0 25.6       20.5  33.8 35.8     15.4    20.4  27.8 22.7       7.8   24.3   1109
Women
expected to
care for ho me
and children     48.6 55.0       37.6  54.0 25.2     23.1    41.6  32.0 25.0      21.9   38.3   1109
Men
expected
breadwinners     11.4    7.0     19.7  20.9   0.8    16.8    11.5   9.3   6.8     15.6   12.4   1109
Husband has
enough source
of inco me       64.3 56.6       64.1  62.6 21.1     45.5    43.4  11.3 20.5      43.8   46.3   1109
I will cover
for your
needs            63.6 45.7       62.4  67.6 53.7     42.0    56.6  59.8 84.1      62.5   57.7   1109
Women’s
Reaction
Accept           57.1 56.5       55.1  55.4 60.0     65.0    48.0  48.5 53.5      53.8   55.3   1995
Run away
fro m the ho me  24.2 25.0       16.2  24.8   3.0    26.0    18.0   4.0   6.0     10.6   15.8   1995
Report to
family
members          15.7 11.5       23.7  13.9 32.5     16.0    37.5  40.9 30.5      23.6   24.6   1995
Ask for
divorce          11.1 10.5       10.1  10.9     -      9.0    6.0   0.5   9.0     14.1    8.1   1995
Co mmunity
mechanis ms
to protect
wo men exist     89.4 88.0       94.4  93.6 81.5     50.0    97.0  87.9 92.5      98.0   87.2   1994
Family elder
intervene        27.1 15.3       48.1  25.9 50.3     48.0    37.6   5.2   5.4     14.4   26.7   1740
Co mmunity
elders
intervene        69.5 77.8       54.5  74.1 79.8     62.0    84.0  94.3 85.9      72.8   76.0   1740
Govern ment
legal system     46.9 19.3       39.6  42.3   0.6    31.0    21.1  13.8 31.4      29.7   27.8   1740




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Gender and HIV/AIDS In Ethiopia

Appendix 2: Wilber’s Integral Frame work


                      Subjectivity, Interior,        Objectivity, Exterior, Visible,
                            Invisible                         Measurable
  Individual      - Attitude                         - Behavior
                  - Ways of thinking                 - Work Plan
                  - Enthusiasm                       - Action
                  - Feeling                          - Performance
                  - Commitment
                  - Integrity
                  - Skills
  Collective      - Culture, norms                   - System, structures
                  - Shared values                    - Processes
                  - Moral/ethics                     - Policies
                  - Shared assumptions               - Technology
                  - Covenants                        - Money
                  - Traditions                       - Contracts


Whereas the “Objectivity” axis describe the visible aspects of individual and societal
behavior and structures that affect the response to HIV/AIDS, the “Subjectivity” axis
describe the invisible values, attitudes and cultural norms that support the „Objectivity‟
side of the quadrant and thus represent equally important and more profound dynamics
influencing the success of the response to HIV/AIDS.




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Gender and HIV/AIDS In Ethiopia

Annex 1:       Wereda and Community Profiles

Alaba Special Wereda, SNNPR
Alaba wereda has 74 kebeles with a total population of 187,034, out of which 16,723, 9%
live in towns. Alaba town is a trade centre and has the biggest market in SNNPR. The
majority of Alaban people are Muslims. Agriculture is the main economic activity.
Pepper is the main cash crop. Alaba town has social service giving institutions. There is
one government health centre, three private polyclinics, one private laboratory and FGAE
run VCT; 3 primary, 1 secondary and 2 junior secondary schools. NGOs (like KMG,
FGAE, World Vision and Water Action) are implementing development programmes.

Kebele 02 in Alaba town and Gedeba Farmers Association were selected for the study.
The data collection involved 21 key informants, 14 men and 7 women. The informants
were from government, NGO and religious institutions, and community leaders, people
identified. Four focus group discussions, two with men and two with women, and two
hundred structured interviews with an equal number of men and women. Major
institutions    interviewed     with      in-depth    interviews    included     the
Office of Wereda HIV/AIDS Prevention and Control, Alaba mosque Imam, Alaba
Islamic Development and HIV/AIDS Coordinating Office, Kembata Women's Self Help
Association (local NGO), Head of Islamic Affairs (SNNPR), Islamic Affairs Alaba, the
head of the health centre, Alba Women's Affairs, a high school and a rural primary
school.

Butajira Wereda in Guraghe Zone, SNNPR
Butajira, located in Guraghe zone, has a population estimated at 240,000. 40,000 live in
urban areas. The major occupation is agriculture and the wereda is known for its sale of
pepper. There are civil servants, businessmen and daily labourers. Inset is a major staple
crop. Butajira town has one public hospital and one health centre as well as few private
clinics and drug vendors. The town has four primary schools, one secondary and one
technical school. NGOs operating in the wereda include: Progynist, Goal Ethiopia, GTZ,
Kawedo, Synodos, and Mersi Ethiopia. Progynist works on HIV/AIDS education, support
for PLHAs and HIV/AIDS orphans, family planning, and it advocates the enrolment of
girls in school. It also advocates for the economic empowerment and rights of women.
Mersi and Goal Ethiopia provide educational support, while Kawdeo, GTZ and Synodos
supply water. Self Help Ethiopia and Irish Aid work in collaboration with the government
hospital for the betterment of health facilities including the minimisation of health service
costs.

Butajira town, Kebele 03, and Debi Peasant Association were selected as study sites as
per the research design. 21 key informants were interviewed, in addition to 200 structured
interviews and two FGDs. The key informants included heads of government offices:
women's affairs, wereda court, high school, health office, HIV/AIDS office, and kebele
leaders. NGO and civil organizations including staff of Progynist, a local NGO, religious
leaders, Anti HIV/AIDS club leaders and knowledgeable women and men identified.




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Gender and HIV/AIDS In Ethiopia

Humbo Wereda in Welayita Zone and Mareka Wereda in Dawro Zone, SNNPR
Welayita and Dawro communities have a lot in common. Humbo is the wereda selected
from Welayita. Its population is estimated at about 130,000, out of which 30,000 are
urban residents. The major economic activity is agriculture. The majority of the people
are engaged in petty trade like merchandising teff, maize, and beans. Some people are
civil servants. Most women get their income from selling local beverages. The majority
of the population are followers of the protestant church. In the wereda town, Humbo,
there is one secondary, one primary school, one health centre and three private drug
vendors. The peasant site has one primary school and a nearby protestant church and
World Vision food distribution camp. There are churches of Kalehiwot, Mulu Wengel,
Meserete Kirstos, and Hawariyate.

Two sites were selected; the wereda town Humbo and Abele Farecho peasant association.
28 key informants, 17 men and 11 women, were interviewed. The institutions consulted
include the wereda administration, health bureau, health centre, women democratic
association, kebele administration, high school, HIV/AIDS secretariat, Berhan Anti AIDS
club, Kalehiwot Protestant church, wereda court, women's affairs zonal bureau, World
Vision, zonal administration, zonal head of HIV/AIDS bureau and distinguished kebele
residents. Four FGDs, two for women and the other two for men, were conducted in both
the urban and rural sites. Two hundred structured interviews with equal numbers of
women and men were conducted in the urban and rural sites.

Dawro, Mareka wereda in Dawro zone was selected for the study. The major occupation
is agriculture. The economy is mainly based on petty trade, and the cultivation of maize
and „Inset‟. The main major resources are land and livestock. The people are mostly
followers of protestant and orthodox Christian churches, with some animists. There are
three tribes namely, Manea, Mnja and Mala. NGOs that are presently working in the
wereda include ActionAid Ethiopia „koyesha programme‟, UNICEF, and the Catholic
Mission. Mareka town is the wereda and zonal administration seat. It has one primary,
one junior secondary, one high school and one technical and vocational school and a
health centre.

Two sites were selected in Mareka wereda: Mareka town is one kebele and Goze Shesh
Farmers association. 26 key informants, 16 men and 14 women, four FGDs, 2 for women
and 2 for men and 200 structured interviews with equal numbers of men and women were
undertaken. The institutions consulted include the zonal, wereda and kebele
administration, the health bureau, zonal and wereda civil and social affairs, religious
institutions, rural and agricultural development offices, and distinguished personalities
and elders.


Wenago Wereda in Gedio Zone, SNNPR
Wenago has 41 kebeles, nine of which are in towns; eight of the urban kebeles are in
Dilla. The major source of income is coffee and inset is the staple crop. Coffee and qat
are principal cash crops, while vegetables and fruits also grow in the area. The rural
people depend on income earned from agriculture and animal husbandry.



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Gender and HIV/AIDS In Ethiopia

Dilla town has several businesses; hotels, shops, bars and cafes. Dilla has several
educational institutions; 1 secondary, 5 junior secondary schools, kindergartens and a
university. It has one big hospital, a health centre and several private clinics and
pharmacies. The majority are Christians and followers of Kalehiwot, Mekane Eyesus, and
the Ethiopian Orthodox church. Muslims are mostly in towns. Kalehiwet protestant
church is active in the rural sites and runs educational and health programmes in addition
to its spiritual mission.

Kebele 08 in Dilla town and Chucha Farmers association were selected for the study. The
data collection involved interviews with thirty key informants, 17 men and 13 women.
The institutions consulted include; the wereda administration, health bureau, information
bureau, women's affairs, kebeles, wereda court, Dilla College of health Sciences,
distinguished men and women in the wereda, and Medane ACTS (a local NGO working
on HIV/AIDS and reproductive Health).

Hamer Wereda in South Omo Zone, SNNPR
Hamer has a population of about 40,000, with 25 villages. The people are predominantly
pastoralists. Agriculture is practiced to some extent. The main source of livelihood is
livestock. Two sites were selected for the study: Demeka market and Shako peasant
association. Demeka market was selected because people from the nearby areas come to
the town. Otherwise Hamers do not live in the town. Demeka has one government
primary school, one kindergarten and one government hostel for students. Religious
institutions like orthodox and protestant churches, and one mosque are also in the town.
There is an NGO of the Catholic Mission, one clinic and one pharmacy. The catholic
mission gives food aid and sends Hamer children to government schools. In the other
rural site, there is a 1-3 grade primary school, a health post and a church. The church
provides informal lesson on subjects like English, Amharic and mathematics for its
students. There is also a health post, although it does not have drugs to give to patients.
People here are expected to walk for about 3 hours carrying a patient with stretcher to a
place called Debeka for medical service.


Yabelo Wereda in Borena Zone, Oromia
Yabelo wereda is located in Borena Zone in Oromia. The people are mostly pastoralists
and live in the rural areas. Those that live in Yabelo and other road towns belong to other
ethnic groups mostly Amhara and Guraghe. Cattle raising is a dominant economy. There
are limited agricultural and trade activities.

There are government structures and civil societies in the wereda. NGOs like Goal
Ethiopia, Action Aid, Care Ethiopia, Betel local NGO Action for Development (AFD) all
have projects in Yabelo. Three primary schools, one junior secondary school and one
high school are available. One government health centre and a private pharmacy exist. In
the rural peasant site studied there is a primary school, a health post, a catholic mission,
and a mosque. There is an NGO called Fayu, which is constructing schools for the
community and is providing micro- financing services. There are community agents that
give education on HIV/AIDS.



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Gender and HIV/AIDS In Ethiopia

Two rural sites were selected for the study. Arero is settled with people totally dependent
on cattle raising and Didabello with people supplementing their cattle raising with some
agricultural activities. 20 key informants were selected, 11 men and 9 women. The key
informants included; wereda and zonal leaders of sector ministries, wereda and kebele
leaders, heads of education and health, the president of Yabelo Court, the head of the
zonal women's affairs, programme coordinators of CARE and BETEL NGOs, and
distinguished community leaders and elders.


Yaya Gulele in Se mien Shoa, Oromia
Yaya Gulele is located in Oromia, North Shewa. It has a population of 98,000 in 29
kebeles composed of 2 towns and 27 rural kebeles. Agriculture is the major occupation.
In the towns there are small trade activities like hotels, bars and shops. There is one
government clinic, one private clinic and a pharmacy. There are also government primary
schools from grade 1-8 and 1-6, but there is no high school. An organization called
OSHO (Oromo Self Help Organisation) lends 1000 birr to farmers, who can pay back the
loan by breeding and selling cattle and selling grain at a profit when there is a shortage of
grain supply.

The two sites selected were Debre Tsighe and Tere Gherghis PAs. 19 key informant
interviews, 13 men and 6 women, four FGDs and 200 structured interviews were made.
The key informant interviews included representatives from government and NGOs;
namely wereda administration, kebele leaders and representatives of education and
health offices, clinics and offices of women's affairs.

Fentele in East Shoa Zone, Oromia
Fentele wereda is located in Eastern Shoa and its wereda town is Metahara, which is on
the main highway going from Addis Ababa to Djibuti. There are 18 PAs and 2 urban
kebeles in Metahra and Addis Ketema. The population is about 90,000 of which the rural
population is about 60,000. The Kereyus and Etu Oromos live in rural areas. The
population in the road towns belong to other ethnic groups such Amhara, Guraghe, Tigre
and others.

The two sites selected were Gola PA and Debiti PA pastoralists. 28 key informants, 17
men and 11 women were selected. Four FGDs and 200 structured interviews were
conducted.

Two ethnic groups that have distinct features of livelihood and religion inhabit the
Wereda. The Etu, migrants from Harar, are predominantly followers of Islam and are
agriculturalists, while the Kereyu, the natives of the Wereda, are pastoralists and are
largely animists, with Islam now being adopted. Urbanisation has influenced the
behaviour of the young generation in the wereda, who formerly never consumed
alcoholic drinks nor visited prostitutes. This practice has now become a common
occurrence. The main sources of information for the community are radio, kebele
officials and rumour. NGOs like Care Ethiopia, CCF and Goal Ethiopia are found there.
There is one mosque.



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Gender and HIV/AIDS In Ethiopia

Fedis in East Haraghe Zone, Oromia
Fedis is a wereda located in East Hararghe. It consists of 26 kebeles, out of which one is a
town kebele called Boko. Boko is the wereda headquarter. The population of the wereda
is about 165,000, of which about 5000 live in the town. There are 28 schools: 1-8 (3); 1-4
(21) and 1-7 (4). The participation of girls in second primary is low. In 2003 there were
2,249 girls and 6,354 boys attending grades 1-4, and 278 girls and 1,350 boys attending
grades 5-8. The people, predominantly Oromo Muslims, are agriculturalists and traders.
CISP is a German NGO, which gives water, seed and food support. It involves in
development activities in this community. RRC is the governmental organisation that
gives food aid during starvation in collaboration with international organisations.
Menschen fur Menschen used to teach the community how to avoid harmful traditions,
especially FGM, but now they left this area.

The study was conducted in two sites, Boko and Lencha, a rural farmers association,
which is described as an HIV/AIDS corridor. The key informants included
representatives of government offices: wereda administration wereda health and
education offices, women's affairs offices, wereda court, health office, youth leaders, kadi
court, bureau for Islamic affairs, regional women wereda representatives, clinic heads,
kebele leaders and distinguished elders, both men and women.




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