Building the Assets to Thrive: Addressing the HIV-related Vulnerabilities of Adolescent Girls in Ethiopia

"The HIV Prevention for Vulnerable Adolescent Girls in Ethiopia project demonstrates that well-designed programs — based on thorough formative research, planned from the outset to be replicable and scalable, and carefully monitored and adjusted — can reach, support, and improve the protective assets of the most vulnerable girls in the poorest areas, such as married girls, child domestic workers, and migrants."

This is the key finding of an assessment of the Population Council’s HIV Prevention for Vulnerable Adolescent Girls in Ethiopia programme, which is designed to build girls’ social, health, and economic assets so that they can avoid HIV, sexual and gender-based violence, and other risks. The project comprises three interventions - Biruh Tesfa, Meseret Hiwott, Addis Birhan, which each centre on the idea that building girls’ assets can help to reduce vulnerabilities and expand opportunities. This report, along with complementary policy brief and infographic, discuss and share insights gained from these interventions.

The report outlines the three programmes comprising the HIV Prevention for Vulnerable Adolescent Girls in Ethiopia intervention. Biruh Tesfa mobilises out-of-school adolescent girls in urban slums, providing them with adult female mentors and offering education on HIV and AIDS and related issues, as well as non-formal education and links to health services. Meseret Hiwott uses a similar model to reach married adolescent girls in rural areas. Both take place in safe spaces, "locations where girls are respected and where they can develop life and livelihood skills, friendships, and peer support networks and can receive support and education from trusted female mentors." Addis Birhan, an offshoot of Meseret Hiwott, gathers husbands of adolescent girls into discussion.

The report discusses the context of the HIV epidemic in Ethiopia, which disproportionately affects females more than males with a ratio of 3 to 2. It outlines the Population Council’s approach of using safe spaces as a platform for reaching girls and providing them with essential protective assets. The interventions uses a "whole girl" approach to address the multiple vulnerabilities to HIV infection — social isolation, economic insecurity, lack of access to services, and sexual and gender-based violence— experienced by the most marginalised adolescent girls in the poorest communities.

The details the achievements of each of the three programmes are outlined. For example, Biruh Tesfa "used a rigorous house-to-house recruitment method to reach and support the most disadvantaged slum-dwelling girls." As a result, Biruh Tesfa has grown significantly, "reaching more than 63,000 girls in 18 cities by 2013." Nearly half of the beneficiaries had lost one or both parents and 825 had fewer than five years of schooling. "The Meseret Hiwott intervention "provides girls with wider social networks, as well as the assets to avoid HIV infection, improve their reproductive health, and better negotiate the power dynamics that often relegate them to inferior status within their household. Addis Birhan is a male-led HIV prevention programme focusing on reducing behaviours that raise the risk of marital transmission of HIV and on promoting husbands’ healthy support of the family. The two programmes were evaluated together, and it was found that "girls who participated in Meseret Hiwott were more likely than other girls to use family planning, obtain voluntary HIV counselling and testing, and negotiate spousal accompaniment to clinic visits."

Based on these experiences, a number of key lessons are outlined, which are discussed in detail in the report:

• "Conduct and carefully link formative research findings to program design during initial program development."
• "Employ mentors. "
• "Tailor recruitment and involve community gatekeepers."
• Measure girls’ protective assets — e.g., social support, reproductive health knowledge, and control of financial resources — as indicators of program success."
• Monitor and evaluate programs"
• "Design for scale-up by encouraging local ownership and resources from governments and nongovernmental organizations."

Click here to download the policy brief in PDF Format.

Click here to download the infographic.