A public health expert recalled a time when hospitals were so overwhelmed with HIV patients that there were no beds available for mothers to give birth. That was two decades ago when HIV/AIDS was officially considered a public health threat, during which the widespread transmission of the virus triggered a massive nationwide response. Policymakers, the media, public health officials, schools, and the film and music industries etccollaborated on a large-scale awareness and prevention campaign.
These efforts were most intense during the mid-2000s, when the national HIV prevalence rate for adults (aged 15–49) peaked at an estimated 3.3 percent. Due in part to the concerted efforts of public health officials under Dr. Tedros Adhanom—then Ethiopian Minister of Health and now Director-General of the World Health Organization (WHO)—the rate declined significantly after 2010.
What happened then? “While government efforts at the time led to a decline in deaths, that commitment has since faded, and the number of new infections is rising again,” the public health expert notes.
Now, the public appears to have largely forgotten the fear and hysteria the disease once inspired. However, public health professionals caution that this calm is deceptive.
In fact, while the national HIV prevalence has dropped below 0.9 percent, certain studies and tests in different parts of the country are raising alarms. Although the national prevalence rate has fallen drastically, regions like Addis Ababa and Gambella remain outliers, reporting more HIV cases per capita than elsewhere in Ethiopia.
Following Gambella-which recorded 3.6 percent in 2023- the estimated adult HIV prevalence rate in Addis Ababa is also notably high at 3.47 percent, according to the 2022/2023 publicly available data. This rate places the capital significantly above the national average.
The United Nations General Assembly’s targets—to reduce new HIV infections by 90 percent from 2010 levels and continue a five percent annual decline after 2030, with the ultimate goal of ending AIDS as a public health threat by the end of the decade—appear to be moving in the opposite direction in Ethiopia.
According to the World Population Review 2023, Ethiopia ranks 11th globally in terms of the number of people living with HIV, with an estimated total of 610,000 individuals.
Despite this already high figure, this article turns to a far more alarming trend: HIV prevalence within the country’s conflict-affected areas. Testshave revealed shocking results, leading public health experts to warn that the true rates are likely far exceeding expectations. This assumption is further corroborated by recent, limited field studies.
The Wrath of Conflict
Conflict has had a severe impact on the health sector. It has created a perfect storm for an HIV resurgence, a situation that experts believe is far more dire than many realize. Medical institutions have been destroyed, many HIV testing facilities have disappeared, and people are unable to get tested due to unsafe conditions.
A study conducted in December 2024 by the Tigray Health Research Institute and the regional health bureau revealed troubling statistics. The regional HIV prevalence in Tigray averaged three percent, with reports that as many as 12.3 percent of patients in some areas are testing positive for the virus.
Fisseha Berhane, head of the HIV prevention and control program at the Tigray Health Bureau, noted that during the northern war, HIV patients were forced to use substandard medicines, including expired drugs, and had little choice but to frequently switchbetween different types, which can have detrimental effects on treatment effectiveness.
Furthermore, disturbing allegations have emerged regarding the deliberate use of HIV as a weapon of war. Fisseha claims that the Eritrean government intentionally “deployed as many as 2,000 HIV-positive soldiers with the specific intent of infecting Tigrayan women.”
Fisseha claims the information came from “the testimonies of some of those soldiers themselves.” The shocking allegations are reflected in a June 2025 report from The Sentry, a US-based non-governmental organization that specializes in investigations into violent conflict and kleptocracy. Titled ‘Power and Plunder: The Eritrean Defence Forces Intervention in Tigray,’ it also reports that Eritrean military officers deliberately used rape and HIV infection as weapons of war.
Similar accounts were reported when the Tigray Defense Force controlled parts of the Amhara region, where victim testimonies allege that soldiers widely used gang rape against civilians, with deliberate HIV infection also reportedly used as a weapon.
In the aftermath of the northern war, a team assessing damage to the health sector in the Amhara region reported a disturbing pattern. According to a member of a team that traveled to TDF-controlled areas in Wollo and South Gondar, women in towns like Nefas-Mewcha reported being deliberately infected with HIV by soldiers. Some of these women were living near church compounds for reasons that included spiritual service.
Fisseha from Tigray also noted a new disturbing trend.
“A trend that was once rare in Tigray has become widespread. It is now common to see women on street corners every evening, many of whom are not traditional commercial sex workers. They have turned to this to survive the immense socioeconomic crisis,” he told The Reporter Magazine.
This new vulnerability underscores the complex and urgent nature of the problem.
IDPs: A Ticking Time Bomb
Though the exact figure is not accepted by the Ethiopian Disaster Risk Management Commission, a report by the UN Office for the Coordination of Humanitarian Affairs (OCHA) indicates that there were an estimated 4.5 million internally displaced people in Ethiopia as of June 2024.
According to the International Organization for Migration (IOM), there were over 2,700 accessible sites across Ethiopia where IDPs were identified as of May 2024. These sites include formal camps as well as various informal and temporary locations.
And these IDP camps have been identified as particularly high-risk zones. The study by the Tigray Health Bureau and Health Research Institute, which focused on four such camps, found a prevalence rate of up to 5.5 percent.
Dr. Negasi Weldu, a medical doctor and immigrant forced to flee by the northern war, spent two years in refugee camps in Sudan. He shared his firsthand experience with The Reporter Magazine, recounting the day he fled.
“It was around 2 or 3 p.m. on that Tuesday afternoon. Everything happened so quickly that no one had time to prepare or make a plan. We had no choice but to flee to save our lives,” he said. “There were 26 of us in that small ambulance, including elderly and critically ill patients.”
After a seven-day journey, they reached Hashaba, a small Sudanese town with a population of fewer than 1,000 people that was overwhelmed by an influx of at least 70,000 migrants in three different camps. Dr. Negasi spent two years there, continuing to practice medicine before immigrating to the United States to pursue a public health degree from Jackson State University. He now works as a public health professional, focusing on underserved communities.
Dr. Negasi believes the health situation in the camps is far worse than reported. He points out that health issues, particularly the spread of sexually transmitted infections like HIV, are unfolding quietly without adequate intervention.
“Many, including international diplomats, NGO leaders, government officials, and the general public, are aware of the socioeconomic struggles IDPs go through. However, when it comes to health issues, especially the spread of STIs like HIV, the situation is unfolding quietly and without adequate intervention,” he said.
Dr. Negasi detailed some of his observations from the time he spent in Hashaba.
“We mostly saw people who were already critically ill, and even that group was quite large. The true number is definitely much higher, as many people hesitated to come forward due to a lack of privacy and the stigma attached to their condition,” he said, arguing that the crisis “warrants a national emergency.”
A System in Decline: Lack of Data and Attention
Aweke Seyoum, a professor of Biostatistics at Bahir Dar University, warns that the current lack of attention risks propagating a dangerous misconception that HIV is no longer a public health problem.
“The widespread silence surrounding HIV might lead one to believe it’s no longer a problem. But is that really the case? Has the prevalence declined, and have new infection cases dropped? The evidence suggests otherwise,” he said.
While data from post-war Tigray shows a staggering increase in the HIV epidemic, the situation in the Amhara Regional State is unclear. Due to ongoing conflict in the region, parts of which have not known peace since the start of the preceding northern war, data from Amhara remains elusive, making it difficult to understand the true scope of the problem.
Professor Aweke is worried about a potential public health crisis. He and his colleagues examined HIV trends in northwest Amhara from 2018 to 2024, revealing the significant drop in the number of HIV tests conducted during that period and an alarming surge in positive results.
The study revealed that towns like Woldia and DebreMarkos had prevalence rates of 1.6 percent and 1.5 percent, respectively. It also showed that up to 64 percent of individuals tested were positive for the virus.
Yet, Professor Aweke clarifies that this is misleading because the data was not from a community-based or mass test. Instead, it was secondary data from health institutions, reflecting a sample of people who sought testing because they were already experiencing certain symptoms.
“People take the test when they get ill or see some signs already. So these resultspertain tothis sample population,” he said, underscoring the need for more comprehensive data.
“Only a primary data analysis can explain that,” Aweke told The Reporter Magazine.
Yet reliable data about the current status of HIV prevalence in the region remains elusive.
Gebrie Nigussie, director ofDisease Prevention and Control at the regional Health Bureau, defends his office’s lack of recent surveys, explaining that the ongoing conflict has made it impossible to collect data safely.
“The conflict has continued. You cannot send your researchers a few kilometers away from Bahir Dar. There is a safety issue,” he stated.
Furthermore, the constant turnover of leadership at the regional health bureau has hampered progress.
“I personally tried to work with the bureau, take the initiative, and come to an agreement with the head,” Professor Aweke recounted. “But the very next day, a new person would be in charge. This constant change has been our unfortunate reality.”
A Different Approach: Beyond Business-as-Usual
According to Gebrie, approximately 86 of the Amhara Regional State’s 247 woredas have been identified as HIV hotspots and are a priority for the regional bureau and its international supporters. These areas typically share common characteristics, such as being affected by conflict, serving as transport routes, or hosting development projects like commercial farms and infrastructure.
In Tigray, similar HIV hotspots have been identified. For example, the town of Mehoni was found to have an HIV prevalence of up to 12.3 percent, while rural areas in Raya Azebo showed a prevalence of no less than seven percent. These areas also contain large farms. More importantly, Mehoni has been a significant center for military movement and reportedly hosts military camps, a factor often associated with a higher prevalence of HIV.
The response has also been complicated by a lack of resources and a flawed strategy. While the government’s approach targets “the most vulnerable” segments of the community, such as commercial sex workers, Fisseha from the Tigray Health Bureau argues that their case is “far more complicated than that level of focus allows.”
“We stressed the need for a different approach, arguing that Tigray’s case is much different,” he said. “We needed to conduct mass testing, but the entire country has only 8,000 test kits”
The ongoing absence of a permanent legal administration in Tigray has also made it impossible to allocate a specific portion of the budget to HIV prevention, unlike other regions.
Funding Cuts and Fading Commitments
Historically, the largest portion of Ethiopia’s total HIV funding came from key donors like the US President’s Emergency Plan for AIDS Relief (PEPFAR) program and the Global Fund. At this particular time in history, funding for HIV is declining worldwide as major donor countries, such as the US, reduce their foreign aid commitments. This shift in priorities and restructuring of aid programs significantly impacts countries like Ethiopia, where the HIV response relies heavily on external financing.
The era of massive international funding for Ethiopia’s health sector, which once exceeded the country’s exports fivefold, is over. Recent contributions have been drastically cut, leaving the country in limbo.
“The CDC [the US Centers for Disease Control] has served as our major funder, and the Global Fund has been another key supporter. We’re now hearing that funding from the CDC will be cut by 40 to 60 percent,” said Fisseha.
Gebrie, also expressed similar concerns, stating, “We are simply hoping for good news until September 30. By then, we’ll know whether the funding will exist or not.”
Ethiopia’s HIV/AIDS National Strategic Plan, which began in 2025 and is slated to last until 2027, estimates that the total cost of the country’s HIV response will be USD 1.1 billion, which breaks down to an average of USD 275.2 million per year.
According to the March edition of The Lancet HIV, a leading online journal for HIV/AIDS research, a potential crisis looms for low and middle-income countries. The journal’s analysis predicts that if planned international funding cuts occur, the world could see up to 10.8 million more HIV cases over the next five years. Additionally, the cuts could contribute to an estimated 2.9 million more HIV-related deaths by 2030.
A National Call to Action
The data and expert opinions all point to one conclusion: the HIV/AIDS crisis in Ethiopia is far from over. The Tigray Health Bureau reported that a recent case-based surveillance study revealed new infections accounted for a staggering 11 percent of all cases.
“The Ministry of Health tends to work with what it calls the ‘most vulnerable’ populations, such as commercial sex workers and drug addicts. However, we must recognize that the situation in Tigray is unique and requires a different set of interventions,” said Fisseha.
He emphasized the need for community-based mass testing.
Professor Aweke agrees with the need for mass testing and underscores that his most recent study only serves as an indication for further investigation.
“Further study needs to be conducted, especially using primary data,” he said.
Gebrie from the Amhara regional health bureau also believes that while HIV prevalence had been on a downward trend for years, a new survey would “no doubt show that the curve has reversed.”
He points out that factors such as conflict, displacement, and an economic crisis have created conditions for an increase in the virus’s spread. He, however, notes that “factual data is needed to speak with certainty.”
He believes the worst is yet to come.
“I can easily imagine the immense public health challenge that awaits us once we are able to begin our studies after the conflict ends,” Gebrie told The Reporter Magazine.
From a public health perspective, there is a firm belief that this situation calls for a formal declaration from the highest levels of government. Dr. Negasi asserts the need to publicly acknowledge that HIV has re-emerged as a national threat and urges the population to take preventive measures seriously. The situation, he says, clearly demands the highest level of urgency and attention.The Reporter Magazine’s attempts to include the Ministry of Health’s perspective were unsuccessful due to the ministry’s unresponsiveness.
Yet, the message is clear: the successes of the past are at risk. Experts warn that Ethiopia’s performance seems to be moving “in the other direction.” Without renewed attention, funding, and a comprehensive strategy, the long-term impact of HIV could be felt at a national level for years or decades to come.
