Everywhere in Addis Ababa, the Ethiopian capital, modern buildings are popping up and wide roads are being built. The country's booming construction sector is attracting thousands of labourers, and government officials are increasingly recognizing the need to target these workers with HIV prevention services.
"We don't yet have a [clear idea of] Ethiopia's construction labourers' status and lifestyles, though the sector is growing massively," Bekele Desalegn, social mobilization expert at the Federal HIV/AIDS Prevention and Control Office (HAPCO), told IRIN/PlusNews.
"We need to assess how increasing labourers - mainly youth - employed by the construction sector are living away from their family; are they informed about HIV/AIDS and how to protect themselves? Do they take HIV tests when they go back to their families? All this needs to be answered and necessary interventions should be put in place," he added.
A visit to a construction site near Addis provides some answers. Bikila Gurmu makes 30 Ethiopian Birr - about US$1.85 - a day working at a construction project in the Sendafa area, 42km north of the capital. The married father of two admits he sleeps with local women when he is away from his family, who live a four-and-a-half hour walk away; he only manages the trek once a week.
Lack of knowledge
"Few times; I do it only sometimes," he said. Until he came to the city, Bikila had never used or even seen a condom. "I first saw a condom when a woman I paid for sex insisted I wore it first before we had sex."
He has since got into the habit of using condoms when he has sex with women other than his wife, but is still hesitant to take an HIV test.
Bikila says the way he found out about condoms highlights the need for HIV prevention programmes in the construction sector, where men often spend weeks away from their families. Evenings are spent in local bars where waitresses and bar owners sometimes double up as sex workers.
In addition, unlike other construction sectors in East Africa, women form an important part of the construction labour force.
"When you have a big group of employees, there is also a good chance of dating among them; I have seen girls getting pregnant and [losing] work subsequently," Bethlehem Endalkachew, civil engineer in charge of the Sendafa site where Bikila works. "Most of labourers are not aware of pregnancy or sexually transmitted disease prevention methods."
However, while a national policy for the construction sector is not yet in place, some of the sectors' main actors are taking steps to address HIV among construction workers.
"When we award any road project, we include in a contractual agreement a clause that obliges a contractor to allocate 1 percent of the total project cost to combat HIV/AIDS and protect labourers against the epidemic," said Ethiopia's Roads Authority spokesman, Samson Wondimu.
And some of the larger private companies are also working to protect their workforces. Sunshine Construction, which is undertaking road projects worth more than $100 million, has created a department dedicated to HIV.
"It is responsible to educate labourers and give them necessary support, including providing condoms," said Samuel Tafesse, managing director of Sunshine Construction.
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A three-year project, run by the NGO, World Learning, and funded by the US government, is also working with government agencies to create workplace interventions and policies to reduce the HIV risk among construction workers.
Ethiopia's construction sector has increased from an annual growth rate of about 3 percent in 2000 to 11.3 percent by 2008, and covers wide areas of the country. Experts say urban areas, where HIV prevalence is estimated at about 7 percent, clearly need HIV prevention urgently. However, rural areas - where prevalence remains relatively low at 0.9 percent - must not be left behind as small towns crop up along the country's growing road network, blurring the distinction between rural and urban.