The Scale of the Crisis
In the years since independence in 1990, Namibia has made impressive gains in economic, political and social development. A stable, open country with considerable 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.
According to the 2004 HIV sentinel sero-survey, the prevalence rate of HIV infection among pregnant women in Namibia varies by region from 9 percent to 43 percent, with an overall estimated prevalence rate of 19.7 percent for all pregnant women. A complex assortment of socio-economic and cultural factors specific to Southern Africa and Namibia drives the epidemic: poverty; internal labor migration; the presence of major transportation corridors connecting Namibia to other high prevalence countries; sexual norms and attitudes; geographical inequities in access to services and information; and unequal power dynamics between men and women. Women bear the greater burden of the HIV/AIDS epidemic, both as victims of the disease, and as the primary caregivers for others who are afflicted. Moreover, their unequal social and economic status places them at risk for earlier infection, leads to their stigmatization, and allows them to be unfairly blamed for transmission of the disease.
Heterosexual sex is the main transmission route for HIV infection in Namibia. Since the first HIV/AIDS case was reported in Namibia in 1986 the epidemic has grown to infect an estimated 230,000 Namibians. Today HIV/AIDS is the primary cause of death and hospitalization. In 2000/2001, AIDS-related deaths accounted for 50 percent of deaths among individuals aged 15-49. AIDS-related hospitalizations accounted for over 75 percent of all hospitalizations in public sector hospitals. The 2004 survey found an estimated 108,000 orphans and vulnerable children (OVC) in Namibia.
Despite heavy public investments in health and education since independence, human development indicators are reversing. Life expectancy at birth - 61 years in 1991 dropped to less than 44 years by 2005. Moreover, HIV/AIDS is exacerbating shortages of skilled workers in certain sectors (e.g., teachers and nurses), reducing productivity, and impeding economic growth. The International Labor Organization estimates that, without widespread treatment, Namibia could lose a quarter to a third of its work force by 2020 as a result of HIV/AIDS. The World Bank estimates that, with decreased investments and productivity on account of HIV/AIDS, there is likely to be a reduction in the annual GDP growth rate of 0.8 to 1.4 percentage points per year, and a 0.3 percentage reduction in the annual growth rate of GDP per capita.
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.
Back to Top
Overview of USAID`s Support
USAID began its HIV/AIDS program in early 2001 with a set of prevention activities (primarily behavioral change, working with youth and in the workplace) that sought to slow, and ultimately reverse, the progression of the AIDS epidemic in Namibia. Soon thereafter, additional programs to provide for the support and care of orphans were added. USAID further expanded its programs in 2003 under President George W. Bush`s Initiative for the Prevention of Mother to Child Transmission (PMTCT) of HIV and again in 2004 when Namibia was chosen as one of the 14 countries to benefit under the President`s Emergency Plan for AIDS Relief (PEPFAR). Under PEPFAR USAID rapidly scaled up its efforts and now assists in providing Namibians with a broad range of prevention, care and support and treatment programs, including support for Highly Active Antiretroviral Therapy (HAART).
USAID is assisting Namibia with the prevention of HIV/AIDS through behavioral change interventions such as Voluntary Counseling and Testing (VCT), prevention of mother-to-child transmission (PMTCT), care and support of orphans and vulnerable children and people living with HIV/AIDS, and treatment through a network of municipalities and townships in high prevalence regions along major transport corridors.
Non-governmental organizations (NGOs) faith-based organizations (FBOs) and government-supported hospitals and health care facilities are among USAID’s primary partners in extending services across Namibia. At the national level, USAID works closely with the Ministries of Health and Social Services, Women Affairs and Child Welfare, Basic Education, Sports and Culture and other governmental entities to help deepen their capacity and technical skill to support a range of community-based programs and initiatives.
Strategic Objective
USAID`s strategic objective is to "Reduce the Spread and Impact of HIV/AIDS in Namibia."To achieve the objective, USAID has targeted four intermediate results: behavior changes reducing the risk of HIV transmission; increased use of quality PMTCT services; people living with HIV/AIDS and families receiving quality care, support and treatment, including highly-active anti-retroviral therapy (HAART); and orphans and vulnerable children provided quality care and support services.
Back to Top
Reducing the risk of HIV transmission
USAID and its Namibian partners are employing a range of behavior change interventions to delay the start of sexual activity among young people, to provide them with the skills to make better lifestyle choices, such as responsible drinking, and to encourage lifelong, mutually monogamous partnerships among adults. Recognizing that abstinence and monogamy, while desirable, may not always be possible to achieve, and at the request of the Namibian government, program efforts also seek to motivate the target groups to reduce the overall numbers of sexual partners and to correctly and consistently use condoms. Finally, the program promotes voluntary counseling and testing, given evidence that when individuals are aware of their status, whether negative or positive, they will take steps to change their behavior to avoid infection or transmission. Working to reduce the stigma associated with being HIV-positive is an important aspect of all components of this activity.
Back to Top
Prevention of mother-to-child transmission of HIV
Mother-to-child transmission is the second leading cause of HIV/AIDS in Namibia. With funds made available under the President`s Emergency Plan for Aids Relief (PEPFAR), USAID is partnering with the Ministry of Health and Social Services to provide services to pregnant women, their partners, children, and families at faith-based facilities, complementing the work of the Centers for Disease Control at other government hospitals. USAID is strengthening the capacity of the health care system to deliver PMTCT and ART services through training, and upgrading staff skills, the provision of antiretroviral drugs (ARVs) and an expansion of counseling services.
Back to Top
Care and support services for people living with HIV/AIDS
Providing care and treatment can help to stabilize and improve the physical and mental health of individuals living with or affected by HIV/AIDS, and can also reduce the social, psychological, and economic burden of HIV/AIDS on families and communities. Working with the Ministry of Health and Social Services, USAID is assisting with the development of capacity for management of drugs and commodities for anti-retroviral therapy and treating opportunistic infections, training both private and public sector healthcare providers in standards of care, and working with faith based organizations to expand and develop linkages with community programs for home-based and palliative care.
Back to Top
Care and support services for Orphans and Vulnerable Children
HIV/AIDS represents a significant threat to the well-being and safety of children, with their vulnerability often beginning long before a parent dies. Increasing numbers of orphans and vulnerable children represent a significant challenge to communities and society to provide care, support and educational opportunities for these children. Working with the Ministry of Women Affairs and Child Welfare, FBOs and NGOs, USAID seeks to mobilize and build community capacity to address the needs of orphans and vulnerable children in Namibia. USAID supports programs at the local level to keep children in school, strengthen psychosocial and other support systems, and ensure that families and children themselves are aware of and able to access benefits and exercise their rights. At the national level, USAID supports the OVC Permanent Task Force and provides technical assistance to the OVC Trust Fund.
Back to Top
Partners in the fight against the HIV/AIDS epidemic
The success of USAID/Namibia`s HIV/AIDS program is due in large measure to the collaborative partnerships established with international and local partners, whose efforts are highly coordinated and integrated.
· John Hopkins University, through the Health Communications Program and in partnership with the University of Namibia, the Ministry of Information and Broadcasting, and the Ministry of Health and Social Services, works to build local capacity for designing and implementing communication messages about HIV/AIDS and HIV/AIDS services, as well as working to establish monitoring and evaluation systems.
· Population Services International and the Social Marketing Association of Namibia support Voluntary Counselling and Testing (VCT) services and the social marketing of those services.
· Supply Chain Management Systems in partnership with the Rational Pharmaceutical Management Plus program and the Ministry of Health and Social Services, has begun to build government capacity to procure and manage HIV/AIDS-related commodities.
· The Capacity Project and Pact support the Ministry of Women Affairs and Child Welfare, Catholic Health Services, Lutheran Medical Services, Catholic AIDS Action, Evangelical Lutheran Church AIDS Program, and the Lutheran World Federation, to build capacity in community outreach, workplace education, VCT, anti retroviral treatment, and support for OVC.
Back to Top
Accomplishments
The program has been able to achieve an impressive set of results due largely to the dedication of its governmental, local NGO and FBO, municipal, and private sector partners who have effectively utilized USAID support to strengthen and expand ongoing successful HIV/AIDS programs.
Since its inception in May 2001, the Walvis Bay Multi-Purpose Center (MPC) has provided services to over 25,000 community members, of which 43 percent were youth. The MPC sponsors behavioral change programs for youth and workforce, home-based care, outreach to the community and schools, a support group for people living with HIV/AIDS, a soup kitchen for orphans, computer training, and school holiday programs. Recently, with joint funding from USAID and the European Union, the MPC opened a VCT Center in September 2003, providing the first of such services in the Walvis Bay area. The Municipality of Walvis Bay donated land for the Center and construction was funded by the U.S. Department of Defense. USAID provides staff salaries and operating expenses, and Peace Corps has provided a succession of volunteers. The MPC generates revenue through its workplace peer education program and receives additional support from a total of 49 private and public sector partners.
Based on the successful Walvis Bay model and the subsequent demand created for such support in other municipalities, the Sam Nujoma Multi-Purpose Center was opened in Ongwediva in April 2003. This center was built by the Ongwediva Town Council (OTC) with assistance from its two Belgium sister cities. The OTC worked with the community and other stakeholders in a USAID supported workshop to develop programming for the center, including youth programs, OVC support, HIV/AIDS prevention, care and support programs. USAID in partnership with the Peace Corps has provided on-going technical assistance and other support to the Center.
In a further effort to reach the nation`s youth, a partnership with a national commercial newspaper has been established. Through this partnership, a weekly newspaper for youth is produced and disseminated to every public school in the country. The weekly contains informative easy to understand articles on reproductive health issues including information on HIV/AIDS and sexually transmitted infections (STIs). In addition, a survey of 800 greater Windhoek youth indicated that 60% of those surveyed learned about ways to prevent HIV/AIDS from the Youth Paper while 70% looked to the Youth Paper for guidance and advice.
USAID through its partners Johns Hopkins University, the University of Namibia, the College of the Arts, and other public and private organizations, has developed an innovative youth radio program that focuses on HIV/AIDS awareness and lifestyle choices. This 26-episode series was written, produced and performed by Namibian youth and launched in September 2003. It is expected to reach approximately 50,000 in-and-out of school urban youth ages 15-24 in the greater Windhoek area.
Growth in employer participation in USAID`s workplace program is reversing the perception that the private sector in Namibia is indifferent to HIV/AIDS, and demonstrating that attention to HIV/AIDS in the workplace is good business, as well as good practice. Over thirty firms are currently participating in the workplace program. Thus far, over 21,000 employees from the banking, fishing and mining industries, commercial farms and parastatals such as NamPower and NamWater have been trained to provide quality peer education programs in the workplace. These peer educators and participating firms provided services to over 21,000 employees and family members in 2005. The workplace peer educator training manual and toolkit developed under this program have been adopted by the UNAIDS Partnership Forum for its programs. In conjunction with these workplace interventions, the AIDS Law Unit of the Legal Assistance Center, another local partner, works with companies to develop and implement appropriate work place policies.
The number of OVC receiving USAID supported services rose to over 22,000 in 2005. Particularly impressive is the participation of the private sector in meeting OVC needs and the government’s action to significantly increase its budget for OVC maintenance grants. USAID and its partners have mobilized community and social support to reduce discrimination and stigmatization, and have provided psychosocial support, food, books, uniforms and counseling.
An August 2002 UNICEF report stated that, of 22 countries evaluated, Namibia is the only country meeting all five principles agreed upon at the Lusaka Conference as essential to establishing and coordinating a responsive country approach to OVC needs. The development of a national OVC five-year strategy and an OVC draft policy became a reality as a result of USAID`s technical assistance to the then line ministry responsible for OVC, the Ministry of Health and Social Services, and the creation of an OVC Permanent Task Force under the aegis of the Ministry of Women’s Affairs and Child Welfare (MCACW), now responsible for OVC.
Back to Top
|
