Important note: Information in this article was accurate in 2004. The state of the art may have changed since the publication date.

Reuters NewMedia - Saturday, July 24, 2004
Ed Harris

Competition is plentiful, but in her revealing red top, Helen still makes a better living as a prostitute here than she would in her poverty stricken homeland.

"I will return to Ethiopia when I am rich," she said, comparing the monthly 100,000 Djibouti Francs ($563) that she makes each month with the prospect of unemployment back home.

In the Calypso's restaurant next door, Yussuf, a Djiboutian civil servant, is drinking a beer, watching Ethiopian satellite television and following the girls with his gaze.

"They are poor! If you offer 5,000 ($28) to have sex without a condom, they will accept immediately," he said.

Ethiopia, Djibouti's neighbor, faces an alarming spread of the HIV/AIDS pandemic with an estimated 1,000 people infected each day. About three million of Ethiopia's 67 million people are already infected, giving the Horn of Africa country one of the largest caseloads in the world.

PROSTITUTES FUEL SPREAD

While the estimated spread of HIV in Djibouti is still low, only 2.9 percent of adults aged 15 to 49 are infected, authorities are concerned that prostitutes arriving from Ethiopia could fuel an increase in what experts call the HIV rate of prevalence.

"We cannot control HIV in Djibouti unless we control it in Ethiopia," said Dr Mohamed Ali Kamil, director of the Health Ministry's Prevention Department.

"When prevalence is higher than one percent, we call it a generalized epidemic, and to see a young man dying of AIDS is very disturbing."

In September 2003, Djibouti expelled 100,000 immigrants, most of them from Ethiopia working as laborers and sex workers. Officials say some of those have returned to work at night clubs and other place of entertainment.

Ethiopia accounts for 60 percent of the trade that passes through Djibouti's booming port.

The porous border between the two countries means that an estimated 40-50 percent of tuberculosis patients in Djibouti come from neighboring countries in search of better treatment.

To increase awareness, aid agencies such as Save the Children and UNICEF are distributing information about HIV/AIDS at the places where Ethiopians have the first contact with Djibouti, such as at the port and truck stops for Ethiopian drivers coming into the country.

CONDOMS

The rising concerns of the Djibouti government are more dramatically revealed in a 2002 ministry of health study which shows a much higher prevalence rate of 5.6 percent for people in the 15-29 age group, where sexual activity with multiple partners is at its highest and HIV infection numbers begin to increase exponentially.

The survey also found out that for 50 percent of Djibouti men, their first sexual experience was with somebody other than a wife or fiancee.

According to Aicha Ibrahim of the United Nations Population Fund (UNFPA) those who have sex rarely use condoms.

"Use of the condom is not automatic, not systematic, even if they are available in pharmacies," Ibrahim said.

About 90 percent of the HIV-Infected people in Djibouti, a small country of some 600,000 people, live in Djibouti District, in or near the capital, officials say.

To curb the spread of the disease the government's strategy is to focus on prevention, said Kamil.

In May 2003, the World Bank approved a $12 million grant to Djibouti to help change sexual behavior.

The funds have also helped to enable all the ministries to develop their own HIV/AIDS program, coordinated, ultimately, by the prime minister.

In addition the ministry of health distributes anti-AIDS drugs at the capital's Peltier Hospital, while the ministry of communication publishes lengthy articles and slogans to educate the people about the dangers of HIV/AIDS.

Experts are also studying the impact of female genital mutilation on the spread of HIV/AIDS in Djibouti.

Aid workers estimate that 95 percent of women in Djibouti have undergone female genital mutilation, significantly increasing the likelihood of HIV transmission.

"The links between FGM and HIV have barely been researched," says Thomas Davin, Program Officer at UNICEF, "But there is clear evidence of a link."

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