HIV and Aids in Ethiopia: urban gardening project turning lives around

More than 1 million people are living with HIV and Aids in Ethiopia. An innovative project run by a local NGO is part of the government's national plan for prevention, treatment and care

In her front garden, Belaynesh shows off her crop of Swiss chard, green pepper, sugar cane, green tomatoes and false banana, a plant unique to Ethiopia.

The plants in Belaynesh's small garden would be any allotment owner's delight. Fourteen growbags are lined neatly against the corrugated-iron fence, sprouting green shoots. Her "urban gardening" has allowed her and her husband to not only feed their seven children, but also make enough cash to build a small barn where four cows are sheltering from the noonday sun.

Yet a year ago Belaynesh, a strong, healthy looking 37-year-old, and Dabe, her husband, were very sick. They were both HIV positive and Dabe was near death. "Thank God we are alive," she said.

The turnaround in the couple's lives has come through an innovative project run by an Ethiopian NGO, Ratson, founded by a former scientific researcher, turned community organiser, Moges Gorfe.

Gorfe set up Ratson five years ago, taking a 50% cut in salary after leaving Save the Children. His NGO is working with the UN's World Food Programme to teach urban gardening to people with HIV, under the WFP's Urban HIV and Aids Programme as part of the Ethiopian government's national plan for universal access to HIV prevention, treatment and care.

'High-risk corridor'

Debre Zeit, a town known for its plant nurseries – flowerpots for sale line the main road – and its pretty lakes, has the misfortune of lying in a "high-risk corridor" for HIV and Aids. Located 50km south of the capital, Addis Ababa, with a population of 117,000, the town has many sex workers catering for the truck drivers who ply the dusty Addis to Djibouti highway. Drug houses, lots of nightclubs and its proximity to the capital combine to make the town an HIV hotspot.

An estimated 1.2 million people are currently living with HIV and Aids in Ethiopia with 804,000 children orphaned or made vulnerable due to HIV and Aids. HIV prevalence averages 2.4%, ranging from 7.7% in urban centres to 0.9% in rural areas. Such figures are well below those in South Africa where the HIV rate among adults is 17.8%, the highest in the world. Such comparisons offer little solace to the women who have turned up at a dusty government compound for food aid. A warehouse houses 50kg sacks of maize and wheat from USAid and Saudi Arabia, along with some sacks from Ethiopia.

Before the women can collect their monthly ration of cereals, pulses and vegetable oil, they listen to nutrition tips from Genet Yemechehal, 45, who has been living with HIV for seven years. One of her three children is also HIV positive. Now working as a volunteer, she says she is much stronger after having enrolling in the WFP's Urban HIV and Aids Programme, which is benefiting 2,860 people in Debre Zeit.

Under the scheme, the WFP provides food aid to "food insecure" people living with HIV enrolled in home-based care, antiretroviral treatment and prevention of mother-to-child transmission. Tizita Yemane, head of the WFP's HIV and Aids programme in the Debre Zeit area, explains why the WFP – normally associated with delivering humanitarian relief on a large scale – is involved in such a scheme. "Those infected have problems ingesting," she said. "It is important for them to have decent food. Medicine without food is nothing, and it takes six months for people to get back to normal nutritional status."

People who enroll are told from the beginning that it is temporary – six months. Once they are healthy enough, they are hooked up to "income-generating activities", development-speak for making money, offered by the government, community groups or NGOs. This is where Ratson comes in with its urban gardening schemes.

Gorfe and his team – Ratson employs 90 people – train people with HIV to grow vegetables in their garden. He explains the simple and inexpensive techniques that can be used in a small garden. He has added an ingenious twist to adapt growbags to Ethiopia's conditions, where water is precious.

Gorfe starts with an empty 50kg grain sack – the kind used by relief agencies – and packs it with soil. He has designed a makeshift irrigation device by joining three plastic bottles end to end that contain water and sponges. Pierced with small holes, the bottles release tiny amounts of moisture slowly into the bag. It is an effective water-saving device.

The plants grow out of the top or through holes in the side of the sack. He shows us sacks growing Swiss chard and cabbages. In a further refinement, several sacks can receive water at the same time through bamboo pipes connecting the plastic bottles. In a makeshift greenhouse with clear plastic sheeting, Gorfe shows two halves of a large tin drum, packed with dark soil containing earthworms, a handy way of making compost for the growbags.

"We are trying to make it very simple for the community to make an income in a small space," he said.

Big plans

Gorfe, who says he wants to bring back traditional ties of kinship so that communities work and help one another, has big plans. He wants to build schools that are able to grow their own food so the children can learn about the ecosystem as well as feed themselves.

"We can grow moringa trees. They grow fast and produce a vegetable like a cabbage. We can grow pigeon pea, a creeping plant. Put them together, you can build a house. You can build schools with these trees – and then we want the children to eat their schools," he said, only half-jokingly.

Gorfe also has his eye on Chinese workers who are arriving in Ethiopia in increasing numbers to work on road construction and other infrastructure projects. Up the road, a brand new hospital with bright white walls is just about finished. It is being built for Chinese workers.

"We want people on our project to raise rabbits. Ethiopians don't eat them, but with 20,000 Chinese coming, we want to exploit them," he said, laughing.

In her garden, Belaynesh said life remains a hard slog, although things have improved. People with HIV are treated as outcasts, and her family keep themselves to themselves. Her gardening, though, has proved a success. "I used to grow things, but very small stuff," she said, crouching among her Swiss chard. "But now I want to produce seedlings."

Ethiopia's Urban HIV/Aids Programme

In 2010, almost 99% of people receiving antiretroviral treatment (ART) under WFP's Urban HIV/Aids Programme stuck to their treatment compared with 76% in 2006. The percentage of adults on ART whose nutritional status improved after six months reached 57%.

The programme was set up in 2003 in Addis Ababa, Dire Dawa and Nazareth. It now covers 23 towns. Project sites are jointly selected by the Ethiopian ministry of health's HIV and Aids prevention and control office with UN agencies and local and international NGOs.

For people with HIV to be eligible to receive WFP help, participants must have a body mass index below 18.5 (normal is considered 18.5 to 24.9).
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