FABIAN MUBIANA AND IMMANUEL MWILIMA

The HIV/AIDS situation in Namibia

1.Statistical overview

2.Meaning of the graphs

3.What should we do (National result)

4.What the community suggests should be

done (CCE CC)

5.Strategic response from LA

Presentation outline

HIV Prevalence rate of pregnant women, biannual surveys 1992-2008

17.8

4.2

8.4

15.4

17.4

19.919.7

22.0

19.3

0

5

10

15

20

25

1992 1994 1996 1998 2000 2002 2004 2006 2008

Year

% H

IV P

rev

ale

nc

e

HIV prevalence rate by age group, 2008 HIV Sentinel Surveillance,

Namibia

5.1

14.0

23.8

27.226.0

17.7

13.8

17.8

0

5

10

15

20

25

30

15-19 20-24 25-29 30-34 35-39 40-44 45-49 Namibia

Age group

% H

IV P

reva

lenc

e

4.7

5.96.3

7.910.5

10.8

10.911.4

11.612.0

12.713.1

14.2

14.214.9

15.216.9

17.1

17.818.0

18.318.8

19.519.6

20.1

20.120.7

21.421.7

21.7

21.922.4

25.927.4

31.717.8

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0

WINDHOEK CENTRAL HOSPITAL

ARANOSREHOBOTH

OPUWO

NANKUDUMARIENTAL

KHORIXASOKAKARARA

EENHANA

OMARURUKEETMANSHOOP

GOBABISANDARA

SWAKOPMUNDOKAHANDJA

OTJIWARONGO

GROOTFONTEINTSUMEB

USAKOSOUTJO

KARASBURG

RUNDUNYANGANA

OUTAPIENGELA

LUDERITZOKONGO

WALVISBAY

KATATURA STATE HOSPITALOSHIKUKU

ONANDJOKWEOSHAKATI INTERMEDIATE

TSANDI

OKAHAOKATIMA MULILO

NAMIBIA

Site

% HIV Prev alence

HIV prevalence rate by site, 2008 HIV Sentinel Surveillance, Namibia

HIV prevalence rate by age group (2009)

7

HIV prevalence rate by site

174 000 people living with HIV and AIDS

77% New infections within age group 15 – 24 is occurring among women,

Women in Namibia are getting infected at an early age with 10% of adolescents aged 15 to 19 infected

What these graphs do not say

• 5840 new infections annually

• In 2009,16 New Infections were occurring daily

• 250 000 Orphans• 6130 AIDS related

deaths

What these graphs say

What should be the aim for programs?(Broad national results)

Focus on monitoring incidence rate (rate of new infections Vs. prevalence rate)

•Reduce possible exposure to HV by changing sexual behaviour•Changing underlying social norms reducing poverty and vulnerability•Increasing Bio Medical interventions to reduce possible transmission.•Reduce annual numbers of people getting infected by 59%•Increase life expectancy from 51.6 in 2008 to 55yrs in 2015•Poor households have reduced from 28% to 20%•Effective and Efficient management contributing to the national response to ensure service delivery for those infected and affected by HIV and AIDS.

Strategic response from LAALAN Declaration on HIV/AIDS 2001Adoption of Transformational Leadership Incorporate the CCE reports into their

policiesPromote HIV/AIDS workplace

programmes Community driven approach and not

donor driven and prescribed approach

Negative Impact on the sector

Consequences of not adopting WPP within Local authorities.

Economic impact on the sectorProgress of HIV/AIDS in the Work force

Time line

Year 0

Year 1 - 5

Year 6 or 7

Year 7 or 8

Employee becomes infected

Morbidity Sets

Employee leaves work forceResigns or dies

Sector recruits replacementemployee

No cost to the Sector At this stage

Morbidity related costs incurred

Absenteeism – productivityMedical care Insurance cost

Termination related cost Pension payoutsFuneral expenses

Loss of capacity and experience

Turnover costs incurredRecruitment

TrainingReduced productivity

Is the HIV Situation in Namibia getting better ??

1. IS IT GETTING BETTER OR WORSE?2. WHAT SHOULD BE MY NEW WAY OF

WORKING AS A LEADERS AND RESPONSIBLE CITIZEN.

1. Regional Leveli. 13 Regional Councils – Strengthening Regional

AIDS Coordinating Committees. (RACOCs)ii. Chaired by Regional Governorsiii. Deputized by Chief Regional Officeriv. Secretary – Community Liaison Officer

2. Local Leveli. 107 Constituenciesii. Coordinating constituency AIDS committees.

(CACOCs)iii. Chaired by the local councilor iv. Deputized by the Head of a government agency or

director of a prominent civil society organization

Sub – National Level CoordinationResponsibility: MRLGHRD

Multiple and concurrent partnershipsInter-generational sexTransactional sexEarly sexual debutTransactional sexLow and inconsistent condom useLow perceptions of risk of HIV infectionLow levels of male circumcisionAlcohol abusePeople mobility and migrationGender inequality

What is Fueling the Epidemic in Namibia?

But why Capacity Enhancement

There is growing feminization of the epidemic with very serious consequences on women and girls.

HIV and AIDS intricately woven in the fabric of society

Communities at the epi center of the

HIVandAIDS response. Local Leaders and community members have

the ability and experience to address the challenge in their own way, using their existing social capital and community structures.

Community Capacity Enhancement approach is used to:

Stimulate individual and community reflection on values, attitudes, culture, beliefs, traditions and practices that fuel the epidemic.

Initiate conversations on issues of gender, stigma and discrimination, rights of people living with HIV and AIDS, responsible drinking habits within communities.

Investigate and address concerns around prevention, care, treatment and support including increasing demand and uptake of existing HIV/AIDS services such as VCT, PMTCT, ARV.

CCE-CC continue

Identify and utilize the strengths in the community’s social capital that will contribute to addressing the underlying causes and impacts of the epidemic.

Explore and address community perspectives and attitudes towards people living with HIV/AIDS (PLWHA); respecting their rights and involving them in processes affecting their life and that of the community in which they live.

Support communities in developing empowering, sustained actions and interventions (including prevention, care, support and treatment as well as reducing vulnerability to infection and mitigating socio and economic impacts

Methodological framework of CCE-CC

How LA can move the CCE-CC agenda

Identify a regional coordinating office for CCE-CC

Put in place a certified CCE-CC coordinatorIdentify and train community facilitators

(according to the number of communities)Finance a three to five years program to

promote a facilitated community conversationEvaluate progress at end of each year through

a regional/ national reflection and review.

Conclusion

The problem of HIV/AIDS in Namibia is still

growing concern

Incidence rate preferred over Prevalence rate

as a measure of HIV pandemic

Behavior change is a priority strategic approach

CCE-CC viewed as the future strategic

approach for behavior change

Thank you