To reconstruct the onset date and evolutionary history of the HIV-1 subtype C epidemic in Ethiopia – one of the earliest recorded subtype C epidemics in the world. Evolutionary parameters including origin and demographic growth patterns were estimated using a Bayesian coalescent-based approach under either strict or relaxed molecular clock models. Bayesian evolutionary analysis indicated a most recent common ancestor date of with three distinct epidemic growth phases. Regression analysis of root-to-tip distances revealed a highly similar estimate for the origin of the clade. Reconstruction of the epidemic history in Ethiopia revealed that subtype C likely originated from either a single lineage or multiple descendents in the late s or early s where it grew exponentially throughout the mids and early s, corresponding to a wave of urbanization and migration. In light of these findings we suggest that subtype C strains were circulating at least a decade before previous estimates and the first recognition of symptomatic patients in Ethiopia. HIV-1 infections in Ethiopia were first documented in a young man and woman in in Addis Ababa when serum samples of hospitalized patients with Bell’s palsy were tested for anti-HIV-1 antibodies [ 1 ]. Subsequently, the first clinically overt case of AIDS was diagnosed in [ 2 ]. The explosion of HIV into a major AIDS epidemic is almost solely attributed to subtype C with transmission largely sustained through heterosexual contact and to a lesser extent mother-to-child transmission. Phylogenetic analyses have also revealed that two genetically distinct viruses co-circulate in similar prevalence in all geographic regions and risk populations [ 5 , 6 ].
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This paper is a systematic review of previously published data. All data generated or analysed during this study are included in this published article. HIV prevalence in the Addis Ababa is still higher in key and priority populations. The documents relevant to address the objectives were collected from online databases Google scholar and PubMed for published works. It appears that the HIV prevalence stabilizes, but varies along areas and socio-demographic groups. The most common hot spots in Addis Ababa are areas where bars, groceries, pensions, guest houses, hotels, brothels, massage houses, khat houses, shisha houses, night clubs, drinking establishments and tourist frequented settings are concentrated.
There is sexual mixing of key and priority populations KPPs with the general population. There are various behavioural, biological and socio-economic predisposing risk factors that drive HIV epidemic, and respective behavioural, biomedical and structural intervention measures are identified in the presence of gaps and challenges to address the problem.