AIDS in Namibia
In the years since independence in 1990, Namibia has made impressive gains in economic, political and social development. A politically stable, open country with an abundance of natural resources and a well-developed infrastructure, Namibia is potentially one of Africa’s leading models of successful development. However, huge income disparities exist, poverty remains a serious problem, and the country’s human resource base, is being devastated by the HIV/AIDS epidemic.
AIDS is currently the #1 cause of death in Namibia, a country with only a population size of 2.1 million but with a very high prevalence of HIV-AIDS amongst adults (15-49) at 19.6% (2005).
Namibia has a severe, generalized HIV epidemic with an estimated 230,000 HIV-infected individuals in a population of 2.1 million people. Namibia's HIV prevalence of 19.9% in pregnant women is one of the five highest in the world. HIV transmission occurs almost exclusively through heterosexual contact or through mother-to-child transmission. Social, economic, and cultural factors such as population migrations, disempowered women, alcohol abuse, stigma, lack of awareness, and lack of male circumcision help drive the epidemic. The TB case rate in Namibia is the highest in the world, with HIV co-infection estimated at 60%. TB continues to be the leading cause of death for people with HIV, even with the widespread availability of ART.
Namibia has one of the highest HIV/AIDS prevalence rates (the percent of people living with the disease) in the world, a much higher rate than the sub-Saharan African region overall (21.3% compared to 7.5%). Although recent evidence suggests that prevalence may be starting to decline, the epidemic already poses significant challenges to this middle-income country, and high levels of unemployment and income disparity may further the spread of diseases such as HIV/AIDS
The first case of AIDS was diagnosed in Namibia in 1986.
Namibia has almost a quarter of a million people estimated to be living with HIV/AIDS (210,000 as of the end of 2003).
The HIV/AIDS prevalence rate in Namibia is 21.3%, much higher than the prevalence rate of the sub-Saharan African region overall (7.5%) and the global rate (1.1%). In 2003, an estimated 16,000 Namibians died of HIV/AIDS, which is the leading cause of death among adults and children in Namibia.
Mother-to-child transmission is also a major route of transmission in Namibia.
Populations and Regions Affected
Women account for more than half (55%) of adults estimated to be living with HIV/AIDS in Namibia.
In 2003, 15,000 children in Namibia were estimated to be living with HIV/AIDS and there were an estimated 57,000 AIDS orphans. The number of AIDS orphans is expected to continue to grow.
Other Key Data
Knowledge of HIV/AIDS: Studies have found that general awareness of HIV/AIDS in Namibia is relatively high. For example, among young people ages 15-24, 82% of young women and 87% of young men knew that a healthy looking person could be infected with HIV. However, significant stigma and misconceptions about HIV disease remain.
2,044,147: population (July 2006 est.)
230,000: Estimated number of people living with HIV/AIDS by the end of 2005
19.6%: Estimated percentage of adults (ages 15-49) living with HIV/AIDS by the end of 2005
62%: Estimated percentage of HIV cases that occurred among women (ages 15-49) by the end of 2005
17,000: Estimated number of children (ages 0-15) living with HIV/AIDS by the end of 2005
17,000: Estimated number of deaths due to AIDS during 2005
85,000: Estimated number of children who have lost one or both parents to AIDS and who were alive and under the age of 17 end of 2005
Namibia is on of the 15 countries benefiting from (US) The President's Emergency Plan for AIDS Relief (PEPFAR), a five-year, $15 billion American Government initiative to combat the global HIV/AIDS epidemic. PEPFAR (the President's Emergency Plan for AIDS Relief) is America's $15 billion initiative to combat the global HIV/AIDS pandemic.
Namibia has a generalized AIDS epidemic, with HIV primarily transmitted through heterosexual contacts.
Between 2002 and 2004, HIV prevalence decreased marginally in all age groups except the group 35 – 39 years, in which it increased. HIV prevalence is highest in people between 25 and 39 years of age. The reduction in prevalence between 2002 and 2004 represents the first drop in prevalence since Namibia began biannual sentinel surveillance.
The government has demonstrated willingness to expand both political and financial resources to respond to AIDS. The national effort to act against HIV is rooted in the Namibian Constitution, which addresses the issue as one involving human rights. The national AIDS response is guided by five-year strategic frameworks (Medium Term Plans); the current framework runs from 2004 to 2009.
The National AIDS Committee is the highest policy-making decision body providing national leadership. Lower-level bodies include the National Multi-sectoral AIDS Coordination Committee (multi-sectoral response) and the National AIDS Executive Committee (implementation across the board).
Civil society organizations are active partners in the response through the Namibia Network of AIDS Service Organizations, a major umbrella body. Leadership and coordination of private-sector efforts is provided by the Namibia Business Coalition on AIDS. Due to the ranking of Namibia as a lower middle-income country, the donor base is relatively small and narrowing as donor agencies and governments phase out operations in the country. Current donors involved in the AIDS response include the United States Government through the President’s Emergency Plan for AIDS Relief, the European Union, the Global Fund, the United Nations (UN), Finland, Germany, Spain and Sweden, among others. Support from these and other partners has made it possible to make progress through a considerable increase in levels of financial resource commitments, expansion of prevention, treatment, care and support services, and an increase in geographical coverage. For example, all 35 public hospitals across the country provide antiretroviral therapy and prevention of mother-to-child transmission services. In 2006, an estimated 28 000 people living with HIV received antiretroviral therapy out of 58 000 in need; 4800 women received a complete course of antiretroviral therapy prophylaxis for prevention of mother-to-child transmission; and 76 000 people completed the counseling and testing process.
Women, young people, orphans and other children made vulnerable by HIV, and migrant workers remain by far the most likely to be exposed to HIV. Risk factors include poverty, mobility, high prevalence of other sexually transmitted infections, alcohol and substance abuse, and gender inequalities. Barriers to prevention, treatment, care and support include, among other things, limitations in human resources, access issues and stigma.
Challenges and emerging issues for 2007
Some of the challenges that stakeholders will have to deal with in 2007 are management of funds, coordination and generating bolder participation of various national leaders in social mobilization.
The Global Fund is expected to disburse about US$ 80 million for three years under Phase 2 of its Round 2 funding and the United States President’s Emergency Plan for AIDS Relief is planning to bring in US$ 77 million for the 2007 fiscal year. There is also other funding from the government itself and development partners. The challenge remains building the necessary capacity to make all these monies work for the people.
Coordination, to minimize duplication of effort, is also related to the management of funds. It is of vital importance for the government to provide direction in the spirit of the “Three Ones” if the country is to get the most out of the funding that is made available by partners. For this to happen, it is critical for the top national leaders to consistently support and participate in the response.
|HIV/AIDS in Namibia
living with HIV/AIDS, 2005
(aged 15+) with HIV/AIDS, 2005
with HIV/AIDS, 2005
HIV prevalence (%), 2005
HIV infections, 2005
|nd = No data
Population Reference Bureau & UNAIDS
3. Impact of HIV-AIDS in Namibia:
Impact on Life Expectancy: Increased mortality rates lead to declining population growth rates and drastic changes in the age structure.
In many countries of sub-Saharan Africa, AIDS is erasing decades of progress made in extending life expectancy. Millions of adults are dying from AIDS while they are still young, or in early middle age. Average life expectancy in Sub-Saharan Africa is now 47 years, when it could have been 62 without AIDS.
Impact on Children: The effect of the AIDS epidemic on households can be very severe. Many families are losing their income earners. In other cases, income earners are forced to stay at home to care for relatives who are ill from AIDS. Many of those dying from AIDS have surviving partners who are themselves infected and in need of care. They leave behind orphans, grieving and struggling to survive without a parent's care. As the epidemic progresses, orphans and street children will become even more vulnerable to
HIV/AIDS, violence and other social ills
Impact on Labor force: HIV/AIDS dramatically affects labor, setting back economic activity and social progress. The vast majority of people living with HIV/AIDS in Africa are between the ages of 15 and 49 - in the prime of their working lives. Employers, schools, factories and hospitals have to train other staff to replace those at the workplace who become too ill to work. HIV/AIDS affects those in the most productive age group, resulting in a drop in productivity, a reduction of the gross domestic product and an increase in medical costs. Replacement of human resources is a problem for a newly independent nation like Namibia.
Impact on Namibia’s Economy: Through its impacts on the labor force, households and enterprises, HIV/AIDS can act as a significant brake on economic growth and development. HIV/AIDS is already having a major affect on Africa's economic development, and in turn, this affects Africa's ability to cope with the epidemic. The loss of a trained, skilled and experienced workforce has a devastating impact on national development.
4. Help Namibia!
One of the most important ways in which the HIV-AIDS situation in Namibia can be improved is through increased funding. More money would help to improve both prevention campaigns and the provision of treatment and care for those living with HIV-AIDS and orphans and vulnerable children who are affected by the disease.
5. Combating HIV-AIDS in Namibia:
•A is for Abstinence before marriage.
•B stands for Be faithful in marriage. This is the Christian way, and it guarantees life. But if you find that you cannot follow this teaching, then choose
•C for Condom, because the alternative is
•D for Death.
A multi-sectoral National Strategic Plan on HIV/AIDS (1999-2004) was launched by Namibia’s President in 1999, and all sectors have developed specific action plans. A multi-sectoral National AIDS Executive Committee, consisting of ministers and prominent leaders, drives the country’s fight against HIV/AIDS. Strong leadership at all levels of society is essential for an effective response to the epidemic.
The Namibian government has responded to these challenges with a strong commitment to reverse the course of the disease by expanding its health care system to provide broad affordable access, and in establishing effective partnerships with civil society, the private sector, and donor community.
HIV/AIDS Activities in Namibia
Prevention of HIV-AIDS:
Supporting programs that promote abstinence, faithfulness, and reduction of the number of sexual partners, as well as programs that address male behavior.
• Supporting activities that mitigate the role of alcohol abuse in HIV transmission.
• Promoting the involvement of HIV-positive individuals in delivering prevention messages.
Care for HIV-AIDS Orphans and people living with the disease:
- Supporting dissemination of Integrated Management of Adult Illness (IMAI) practices.
- Expanding access to palliative care.
- Promoting routine provider-initiated counseling and testing in order to improve access to prevention, care, and treatment for people living with HIV/AIDS.
Treatment of HIV-AIDS:
- Increasing coverage to women eligible for prevention of mother-to-child transmission services with a full course of ART prophylaxis and plans to add a second drug to the current protocol.
- Supporting the medical facilities providing HIV care by providing rapid test kits, antiretroviral drugs, laboratory testing, personnel, training, management support, and technical assistance.
- Increasing linkages between TB and HIV testing and care and treatment services.
The introduction of Anti-Retro Viral (ARV) therapy had become necessary because of the high number of HIV-positive Namibians and has been described as a success. The service, which started off with six pilot hospitals in 2003, rolled out rapidly to all 34 state hospitals in Namibia as well as numerous private medical practitioners.
To date, more than 40 000 Namibians receive ARV therapy and 93 percent of patients that have so far enrolled in the program are continuing their treatment.
Sexual Education: Namibia has identified the need to strengthen sexual health education in the school curriculum in response to the threat being posed by the HIV/AIDS pandemic. The ministry of education has made significant inroads as far as the inclusion and integration of health education, particularly HIV/AIDS.
About Catholic AIDS Action:
Catholic AIDS Action (CAA) is the largest NGO responding to AIDS in Namibia, currently operating 14 offices in 9 of the 13 regions. Working closely with local parishes and faith communities, the work and mission of Catholic AIDS Action has four principal focuses: home-based family care and counseling, youth education and prevention, care and support to orphans and vulnerable children, and voluntary counseling and testing. Services are available to all, irrespective of religion, race or back-ground with a preferential option for the very poorest affected by this pandemic.
CAA has a track record for extensive community based work throughout Namibia. Their volunteers and programs are well known and respected by community leaders, the general population and the Government of the Republic of Namibia. CAA is registered in Namibia both as an independent trust and as a welfare organization. Funding for Catholic AIDS Action comes primarily from international donors with local support coming in the form of dedicated volunteer time and talent. More about Catholic AIDS Action at: www.caa.org.na