i. HIV in a Namibian context
Namibia has one of the highest HIV infection rates in the world, with a national prevalence of 13.3% (UNAIDS 2016). Among the affected demographic groups, HIV peaks in those aged 15-24 years with new HIV incidence rates recorded among this age group. There are more than 200,000 people living with HIV and AIDS (PLWHA) in the country. Many factors are driving the HIV pandemic, including poverty, gender inequality, alcohol and substance misuse and the overall poor health and nutritional status of large sections of the population. Additionally, high levels of new infections are sustained by extensive population migration and complex sexual networks with multiple concurrent partners.
ii. Women and HIV
Women are disproportionately at risk of contracting HIV due to a range of social, economic and biological issues which make them more vulnerable to infection. For example, women’s weak social and economic position may inhibit them from avoiding sex with an infected partner or demanding condom use, and economic desperation may force them to engage in transactional sex in order to ensure their survival or that of their children. Consequently, women constitute the majority of new cases in Namibia. As society’s traditional caregivers, women also bear the burden of disease even if they are themselves not infected, as they are expected to care for family members who are ill with HIV, while simultaneously trying to find ways to financially support their family.
Both the immediate and long term impacts of HIV and AIDS are destructive. Despite Namibia wrestling with the HIV/AIDS pandemic for a long time, the subject is still very much a taboo (particularly in rural areas) and HIV-positive individuals often face stigma and social rejection. Families are being destroyed as parents or breadwinners succumb to AIDS, leaving an estimated 250,000 – or more than 10% of the population – as orphans or vulnerable children.
In 2003 the government implemented an ARV therapy programme through the public sector, which has resulted in Namibia making remarkable progress in meeting its goals on ARV coverage. There is currently 88% coverage for adults and 95% for children with CD4 of 200, and under the new WHO guidelines of CD4 of 350 there is 73% coverage of adults and 82% of children. However access still remains a large challenge due to the long distances which many PLWHA need to travel to reach health facilities; unfortunately, increasing access is difficult due to inadequate human resource capacity in most remote and rural areas.
Namibia’s PMTCT programme has been incredibly successful in attaining 96% coverage nationwide. ANC services are now provided in over 80% of health facilities and of those facilities (95% are providing PMTCT services).
Although much has been done much to stabilise the pandemic and to provide treatment for those infected, considerable effort is still required, particularly in terms of increasing preventative measures. Unsafe sexual behaviours – notably among the youth – are the key drivers of the epidemic, which highlights the need for greater emphasis on identifying relevant and effective methods to bring about sustained behaviour change