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Tigray was once a model region in Ethiopia’s fight against HIV, with years of awareness campaigns bringing the prevalence rate down to 1.4%—one of the lowest in the country.
Then, in 2020, war erupted between Ethiopia’s government, backed by Eritrea, and Tigray forces. The devastating two-year conflict left behind mass killings, starvation, and widespread sexual violence—triggering a sharp rise in HIV cases.
“The average monthly positive rate has increased considerably,” said Akberet Mengesha, the Antiretroviral Therapy Department Coordinator at Ayder Referral Hospital in Mekelle.
War and Sexual Violence Drive HIV Surge
A 2023 study published by BMJ Global Health estimated that as many as 10% of women and girls aged 15 to 49 in Tigray—home to 6 million people—were subjected to sexual violence, including rape and gang rape.
At the same time, the region’s health system was systematically looted and destroyed. Only 17% of health centers remained operational, according to another study in BMJ Global Health. A joint report by the Tigray Regional Health Bureau, Ethiopia’s Ministry of Health, and the World Health Organization found that 86% of health facilities were “partially damaged” and 3% were “completely destroyed.” As a result, 90% of sexual violence survivors did not receive timely medical support.
“Mother-to-child transmission, which had previously been reduced to zero, has risen sharply,” Mengesha added. The number of HIV-positive diagnoses in children under two has increased, a direct result of interrupted access to crucial medications during the war.
HIV Prevalence More Than Doubles
Before the war, Tigray’s HIV prevalence rate stood at 1.4%. Today, it has soared to 3%—more than double the prewar average, according to local health authorities and the United Nations. Among the region’s roughly 1 million displaced people, the rate is even higher at 5.5%, while among sexual violence survivors, it has reached a staggering 8.6%.
Health workers attribute the increase to multiple factors. During the war, Tigray was cut off from the rest of Ethiopia, leaving condoms in short supply. Today, some desperate displaced people have turned to sex work to survive, further fueling the epidemic.
Aid Cuts Exacerbate the Crisis
The situation is worsening due to drastic cuts in U.S. aid. The Trump administration slashed 83% of U.S. Agency for International Development (USAID) HIV programs worldwide, severely impacting Ethiopia.
“Unfortunately, there is still a shortage of essential medications to address this growing crisis,” said Teame Aregay, head of the pharmacy at Ayder Referral Hospital. “The patient count is climbing, with new diagnoses reported every day.”
Ethiopia has already laid off 5,000 health workers funded by U.S. aid to combat HIV. Meanwhile, charities that provided treatment and support to HIV patients have been forced to shut down.
One such organization, the Organization for Social Services, Health and Development, was testing people for HIV and offering food and financial assistance to patients. With its operations halted, thousands of vulnerable individuals are now left without vital support.
As Tigray struggles to rebuild, the HIV crisis threatens to erase years of progress—leaving survivors of war and sexual violence to face yet another battle.
