Birhan lives with her family in Ethiopia’s Tigray region. The area was overtaken by violent conflict between 2020 and 2022.
Prior to the war, Birhan owned a coffee and tea shop. “I used to work and do well,” she says. Her husband, Yirga — with whom she has three children — was an industrial engineer. After he became blind in a factory accident, he started selling lottery tickets.
When conflict broke out, both Birhan’s and Yirga’s livelihoods and health were put in danger. And they weren’t the only ones — thousands of people were killed, and millions were internally displaced.
“We never thought we would [still] be alive,” Birhan says. “I mean, I lost my siblings.”
Both Birhan and Yirga are living with HIV, which requires daily antiretroviral therapy (ART). The conflict in Tigray posed significant challenges for people living with HIV to access health facilities and stay on their lifesaving medication.
“There was no food supply … and no [electricity],” Birhan says. “The situation didn’t allow me to get my medicine even after some time.”
The USAID Caring for Vulnerable Children (CVC) activity, which is implemented by FHI 360, returned to Tigray in May 2021 to increase access to HIV treatment for orphans and vulnerable children and their caregivers. The Organization for Social Services, Health and Development (OSSHD), the project’s local partner, played a critical role in helping Birhan and Yirga regain access to their ART.
Makele Hailu, a program manager at OSSHD, says that prior to the conflict, the Tigray region was progressing well on achieving its HIV care and treatment goals.
But when the conflict began in November 2020, Hailu says, “everything turned around.” Health facilities were not functioning, and health professionals were displaced or joined the army.
Even if people wanted to stay on their ART, Hailu says, they had to stop taking them. This had a grave impact on Birhan and Yirga.
“We were forced to take expired drugs that should have been burned and discarded,” Yirga says. “I discontinued taking my medication for almost a month.”
Staying on their ART was complicated by a severe lack of food. “We had nothing at that time,” Yirga says. “We said, ‘How can we take medicine without having something to eat and drink?’”
To identify families with children or caregivers living with HIV who were experiencing adherence challenges amid the conflict, the USAID CVC activity continued to operate its extensive network of community workers. This included HIV/health linkage facilitators, case workers and social service workers.
One of these social service workers was Manna Leake, from OSSHD. At first, Birhan and Yirga were not receptive to Leake’s offers of help.
“We told [Manna and her team], ‘How can we take medicine when we don’t have food?’” Birhan says.
Leake brought them food and took them to a health facility.
“I used to say I would rather hurt myself than to see my children starve,” Birhan says. “[Manna] comforted me by saying, ‘We will bring food and medicine.’ She told me not to give up.”
Leake says, “My main concern was that I didn’t want to see them die due to a shortage of medicine.”
Hailu notes that during the war, more and more people living with HIV were becoming virally unsuppressed. With FHI 360’s support, however, OSSHD continued to carry out their work.
“The community base that we have built helped our organization stay present in responding to vulnerable communities during the crisis,” Hailu says. “The community feels a sense of ownership of local organizations like ours, because they are included in program development.”
Now, post-conflict, OSSHD continues to support Birhan and Yirga’s family. Importantly, Birhan and Yirga regained access to their ART, and with Leake’s support, both have adhered to treatment and are now virally suppressed. Leake transports them to medical appointments and accompanies them inside.
Leake also suggested they have their three children tested for HIV. All are negative.
Over time, Leake helped Birhan obtain a small-business loan through the OSSHD — provided by the USAID CVC activity — and got her involved in a savings group.
With the loan, Birhan was able to start another small business; she sells roasted peanuts and spices. This provides her family’s income, and they even save some money.
“I help [my children] live a good life,” Birhan says. “I have self-confidence. I work, and I send my children to school … I want to create a better chance for the future.”
Both Birhan and Yirga speak lovingly of their relationship with Leake, who supports more than 300 children and more than 140 caregivers through the USAID CVC activity.
“Manna is very strong, and she is kind,” Birhan says. “She is a second mom to my children.” Leake even helps the children with their homework.
Yirga says, “Manna is like a mother and a sister with what she is able to provide not only for me, but to others who use ART. May God repay her for everything she’s done.”
Birhan and Yirga’s journey is one example of how FHI 360, with crucial support from OSSHD, was able to create resilient HIV services that could be sustained in a time of crisis.
All photos are credited to Genaye Eshetu for FHI 360.
Birhan and Yirga’s family is one of more than 10,300 families that received services through the USAID CVC activity in the Tigray region. The project is funded by USAID and PEPFAR and implemented by FHI 360, working with its partner the Organization for Social Services, Health and Development. The project returned to Tigray in May 2021 to increase access to HIV services for orphans and vulnerable children (OVC) and comprehensive post-violence care for children who have experienced and/or are at risk of experiencing gender-based violence. The project supports Ethiopian governmental structures in facilitating high-quality services, supporting parents and caregivers to access services, and ensuring that high-quality, appropriate services are available to OVC affected by HIV. This integrated approach addresses all aspects of the PEPFAR Framework for the Protection, Care and Support of Orphans and Vulnerable Children.
This article is made possible by the support of the American people through USAID. The contents of this article are the sole responsibility of FHI 360 and do not necessarily reflect the views of USAID or the United States Government.
