Veteran SFAF Educator Trains Ethiopia's National AIDS Hotline

Ethiopia is ready to do battle against AIDS, with the help of the San Francisco AIDS Foundation. One of the sub-Saharan countries hardest hit by an exploding HIV epidemic, Ethiopia is supported by the President's Emergency Plan for AIDS Relief and has a national treatment plan, distributing antiretroviral medication to 47 thousand people. But with HIV prevalence anywhere from 1% to 3.5%, Ethiopia is in the early stages of what may become an epidemic as crippling as any in the world.

Factual health information travels slowly in this country of 70 million. AIDS remains mired in stigma, discrimination and fear. Most people do not know their HIV status, so they do not seek treatment until they are quite ill. Those who know they are infected do not always understand how to stay healthy and avoid passing the virus on to others.

SFAF Educator Pauli Gray learned that Ethiopia's young are among the most vulnerable to HIV.

Enter Pretty Mehta, coordinator of Ethiopia's Wegen Helpline, a resource that provides information, counseling, and referrals to more than 4,000 callers every day from all over Ethiopia. Pretty traveled to San Francisco in March last year to learn how the San Francisco AIDS Foundation conducts prevention education. Observing the California AIDS Hotline, Pretty met Pauli Gray, SFAF's Volunteer and Community Educator. Struck by his exceptional commitment to the Hotline and its volunteers, she invited him to Addis Ababa to train the counselors and nurses who staff the Helpline.

A ten-year veteran of the San Francisco AIDS Foundation, Pauli knows how to get people to pay attention to AIDS. He has prepared volunteers for the complicated duties of staffing needle exchange sites and serving as public speakers who educate diverse groups about the epidemic and how they can stay safe. And he has taught volunteers on the AIDS Hotline for years, empowering them to handle a high volume of callers from all over California.

"There is a huge difference between a one-on-one counseling session and a telephone call," Pauli said. "A hotline is completely anonymous. Callers share things they don't tell others. And on the phone, you must reduce information to the fewest number of words because you don't know how long you'll have someone's attention. The counselors in Ethiopia were quite knowledgeable about HIV. But they were unaware of the impossibility of diagnosing a medical condition over the phone."

Ethiopia's epidemic is concentrated in urban areas, in particular the capital. But epidemiologists expect HIV to progress rapidly to rural areas, where access to prevention information and treatment is even more limited. The key populations affected are young and adolescent women and young men--groups that can lead a country into a generalized HIV epidemic. But in a place where even the poorest people have access to a cell phone, education provided through the Wegen Helpline may change the course of the epidemic.

Pauli Gray spent two weeks in Addis Ababa, leading daily training sessions to prepare 26 Helpline counselors for their vital work. Adapting curricula he uses at SFAF, he led trainings in harm reduction theory, risk assessment, telephone counseling skills, and crisis calls. A role-play about male and female condoms turned amusing when Pauli was unable to locate a model penis for his students and had to request one from an audience of non-English speakers using only hand gestures and his sense of humor.

Pauli was overwhelmed at the scope of the epidemic in Ethiopia and the paucity of human and informational resources available to address it. He met one doctor who had 5,500 patients under his care. Because AIDS in Ethiopia is mired in cultural and religious prejudice, Pauli compared it to the earliest years of the epidemic in the U.S., when the California AIDS Hotline had to demystify the virus and explain away myths and prejudices that were not supported by science.

"When I came to SFAF in 1996, ARV therapy had just arrived. People who had been on the Hotline from the beginning handled very different calls from those we get today," he said. "People were terrified. They lived with fear and hatred. Callers didn't understand what AIDS was, how it was transmitted, or what they could do about it. In many ways, Ethiopia's hotline reminds me of that awful period in San Francisco."

Pauli has been invited to return to Addis Ababa next year to train people in public speaking techniques. "It's hard to grasp the magnitude of AIDS in Ethiopia without seeing it directly. There is so much stigma, so many myths and so much misinformation," he said. "We've dealt with this epidemic for a long time in San Francisco. It is fitting -- and caring -- that we should share everything we've learned about AIDS with anyone who asks."