‘They were about to take out their guns on us’: accessing rural Afar communities in Ethiopia with HIV-related interventions

Abstract

Although pastoralists are a significant proportion of the rural population in many African countries, they are often underserved with regard to health-related interventions. This paper presents data on an effort to provide information about HIV prevention and treatment to Afar people living in remote, northeastern Ethiopia. Using an evidence-based approach, we worked together with the National Network of Positive Women Ethiopians to build relations with Afar communities to design and test an intervention to improve HIV awareness. In this study we observed how multi-directional, local level perceptions--of Afar regarding HIV and existing health-related interventions, of staff from organisations regarding Afar and of the researchers conducting this study regarding Afar--shape the ways in which health-related interventions are offered to Afar and how these are understood by them. While the Afar people express a desire for culturally appropriate HIV-related interventions, few such initiatives have reached them to date. Organisations working in the area often believed that Afar people did not want to accept HIV and were therefore not responsive to their interventions. We argue that the specific history of the Afar people and how this affects their understanding of HIV needs to be better understood and integrated into HIV interventions.

Health interventions among mobile pastoralists: a systematic review to guide health service design

“…This finding is consistent with previous literature on pastoralists and other hard‐to‐reach populations [11,31]. An array of participatory approaches were utilised, including participatory mapping of transhumance patterns, iterative stakeholder meetings, involvement of traditional leaders, and fully community‐directed interventions [16,27,32–40]. In one example, members of nomadic Fulani communities were trained in antimalarial administration, increasing appropriate treatment of uncomplicated malaria from 2% to 82% over a one‐year study period [16].…”

“…Specific issues described by reports in this review included discrimination towards pastoralists, inability or unwillingness to observe traditions surrounding childbirth and lack of female healthcare providers [46–49]. Participatory methods may also prevent adverse consequences resulting from mistrust of formal health services and government interventions, particularly in regions affected by long‐standing conflict [40,43].…”

Prevalence of tuberculosis, HIV, and TB-HIV co-infection among pulmonary tuberculosis suspects in a predominantly pastoralist area, northeast Ethiopia

“…Third, pastoralists are migratory people who move with their animals from season to season in search of water and pasture, which implies that the current TB control strategy (directly observed treatment, short course at fixed health facilities), antiretroviral therapy, and counseling and testing for controlling HIV infection, which are primarily designed for settled population, are not easily available to them as documented in other mobile populations ( 28 ). When such health services are available, they are easily interrupted because of seasonal migration with their animals, suggesting the need for designing a suitable TB/HIV control strategy pertinent to pastoral way of life to contain the spread of HIV infection ( 29 ).…”