title: The HIV epidemic and prevention response in Tigrai, Ethiopia: a synthesis at sub-national level.
abstract: BACKGROUND
  This study, the first of its kind carried out at sub-national level in Ethiopia, was conducted in order to understand the dynamics of HIV transmission at regional and district level in Tigrai, Ethiopia; and to assess the adequacy of the HIV prevention response.
  
  
  METHODS
  Routine data from health centres, data from available published and grey literature and studies, and primary qualitative information were triangulated to draw an updated picture of the HIV epidemic, HIV response and resource allocation in Tigrai.
  
  
  RESULTS
  HIV prevalence in Tigrai was 1.8% in 2011 (EDHS). ANC data show that there has been a continuous decline in the prevalence of HIV in both urban and rural areas (urban: 14.9% in 2001 to 5.0% in 2009; rural: 5.2% in 2001 to 1.3% in 2009, ANC surveillance data). Variability in prevalence by zone and by district was observed. Possible reasons for higher prevalence include the presence of mobile seasonal workers, highly urbanized centres, a high concentration of economic activity and connecting roads and large commercial farms. Sex workers, seasonal farm workers and HIV negative partners in discordant couples were identified as being at higher risk. There is no evidence that programme planning is done on the basis of geographical variations in HIV prevalence and there are gaps in programmes and services for certain high risk population groups.
  
  
  CONCLUSIONS
  Considerable efforts have been invested in the HIV prevention response in Tigrai however, these efforts do not fully respond to the actual needs. For a more effective and targeted HIV prevention response, studies and data syntheses need to be carried out at sub-national level in order to accurately identify local specificities and plan accordingly. Resources should be targeted towards areas where transmission is linked to sex work, mobility and the mobile labour workforce.
authors.forename: GebreAb
authors.initials: G
authors.lastname: Barnabas
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Pegurri
authors.affiliation: UNAIDS, Economic Commission for Africa, Old Building, PO Box 5580, Addis Ababa, Ethiopia. haileselassieh@unaids.org.
authors.forename: Hiwot Haile
authors.initials: HH
authors.lastname: Selassie
authors.forename: Warren
authors.initials: W
authors.lastname: Naamara
authors.forename: Samuel
authors.initials: S
authors.lastname: Zemariam
mesh_terms: D000293:Adolescent; D000328:Adult; D003695:Delivery of Health Care / Q000592:standards*; D058872:Epidemics; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D011477:Sex Work; D012747:Sexual Partners; D014171:Transients and Migrants; D014505:Urban Population; D055815:Young Adult