Prior to late 2020, Ethiopia’s Tigray region was making progress toward achieving its goals in controlling the HIV epidemic. Over 140 clinics across the region distributed antiretroviral therapy (ART), which must be taken every day by people living with HIV to effectively suppress the virus.
But because of war in the region between 2020 and 2022, people who were living with HIV experienced significant challenges in staying on their medication. Six months into the war, 72% of hospitals and 83% of health centers were nonfunctional.
The USAID Caring for Vulnerable Children (CVC) activity, implemented by FHI 360, returned to Tigray in May 2021 to support HIV treatment for orphans and vulnerable children and their caregivers. An Ethiopian partner, the Organization for Social Services, Health and Development (OSSHD), played a critical role by helping people in the region regain access to ART.
OSSHD’s program manager, Makele Hailu, explains what transpired in Tigray and how OSSHD worked with FHI 360 to ensure that lifesaving ART was available to those who needed it.
How were you personally affected by the war?
I was born here. The crisis affected every single household in the region. My father died during the siege due to a lack of medication at the hospitals. My siblings were displaced and are still living with me.
When the war began in November 2020, what were some of the immediate consequences on people living with HIV?
Health professionals were displaced or joined the army, which left the hospitals empty. Health systems were looted and destroyed.
The siege caused a shortage of medical supplies, and health facilities ran out of ART. People were not getting any kind of health services. Even if people living with HIV had the desire to follow their treatment, many had to stop taking their medicine — and they became virally unsuppressed.
How did your organization (OSSHD) help families with children or caregivers living with HIV stay on their ART amid the war?
We support the four benchmarks of PEPFAR’s Orphans and Vulnerable Children program: health, safety, stability and education. Within the health pillar, we provide services related to HIV. The program used — and we still use — caseworkers and volunteers to help ensure that people stay virally suppressed.
During the war, OSSHD maintained strong communication with local communities, helping to identify and prioritize the needs of people living with HIV.
What made it possible for your organization to keep functioning and serving people?
During the war there were many humanitarian organizations working in emergency response — but for people with HIV, it was mainly our program that continued implementing.
The community base we built was the main reason we were able to continue responding. The community is included in our program development, so they feel a sense of ownership of local organizations like ours.
We also have a strong, community-based staff, which gives us a lot of social capital. People were supporting one another.
What role did FHI 360 play in helping OSSHD continue the implementation of the USAID Caring for Vulnerable Children in Tigray?
The support from FHI 360, which has been our prime partner since April 2021, was a big reason we stayed present during the crisis.
Banks were not functioning, so our staff didn’t receive a salary for about 10 months. But starting in June 2021, FHI 360 transported money from Addis to Tigray so that our staff could be paid.
FHI 360 was also by our side, supporting us in sustaining our programming. The UN agencies in the region also helped us sustain our presence. We worked with many other partners during the crisis, but FHI 360’s commitment was unique and very strong.
How has your relationship with FHI 360 grown?
FHI 360 believes in localization. They want to ensure that most of the program implementations in the region, even all over the country, are led by the organizations within the communities.
We are now a partner with FHI 360 for two projects. They have helped us improve our program management and fundraising skills. They’ve also helped us apply for more funds beyond their organization.
What motivates you to do this work?
I have been working to support people with HIV since I was in high school. I also volunteered for OSSHD in the Amhara region, doing HIV prevention for university students.
The resilience I see from people living with HIV, despite the stigma and social isolation they have faced in the region and all over, makes me passionate to work for this program. They deserve to live a better life the same way the other segments of the population do.
All photos are credited to Genaye Eshetu for FHI 360.
More than 10,300 families received services through the USAID CVC activity in the Tigray region. The project is funded by USAID and PEPFAR and implemented by FHI 360. The project returned to Tigray in May 2021 to increase access to HIV services for orphans and vulnerable children (OVC) and post-violence care services 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.
