Saving the sick and improving the socio-economic conditions of people living with HIV in Ethiopia through traditional burial groups.

Poverty and limited availability of health facilities are major barriers to health care in resource-poor countries. For people living with HIV (PLHIV), these factors are compounded by social stigma and decreased mobility, making delivery of public health services a greater challenge. In 2003, the international development organization FHI (formerly known as Family Health International and now known as FHI 360) collaborated with the Ethiopian government, local non-governmental organizations and traditional burial societies (Idirs) to implement community and home-based care interventions for PLHIV in Addis Ababa and 13 other major cities. Programme activities included capacity building, care and support, stigma reduction, resource mobilization, support of orphans and vulnerable children, and income generation through community savings and loans groups. Programme results from 2003 to 2010 were evaluated using a quasi-experimental design with an intervention group (PLHIV who received community and home-based care programme services) and a control group (PLHIV who did not receive programme interventions). Propensity score matching was used to select matched intervention and control pairs for analysis. McNemar and Wilcoxon signed-ranks tests were used to determine outcomes and impact. Findings from routine monitoring data and a population survey showed that individuals who received the integrated community and home-based care services from Idirs reported significantly more savings, better social relations, more independence and better environments for PLHIV. Programme clients were also shown to have known their HIV status longer than the control respondents. However, a higher percentage of control respondents reported not having had an opportunistic infection in the past 6 months. We conclude that volunteer-based community organizations can be empowered to deliver and sustain health interventions for PLHIV. We also conclude that targeting the multiple needs of PLHIV enables holistic improvements in the quality of life and socio-economic conditions of PLHIV.

Building a palliative care program in Ethiopia: the impact on HIV and AIDS patients and their families.

Home- and community-based care in Ethiopia implements palliative care through the continuum of care in 14 major cities with links to local health facilities. Community support through traditional burial societies (idirs) makes it possible for the program to provide holistic care to people living with HIV (PLHIV) and their family members. The program has been shown to 1) reduce stigma and discrimination of PLHIV and vulnerable children, 2) increase acceptance and use of voluntary testing and counseling for HIV, 3) improve PLHIV health and well-being, 4) improve household economic conditions of PLHIV, orphans and vulnerable children, and other beneficiaries, and 5) increase community support by idirs.