The HIV/AIDS situation in Namibia

1. The HIV/AIDS situation in Namibia Fabian Mubiana and Immanuel Mwilima

2. Presentation outline • Statistical overview • Meaning of the graphs • What should we do (National result) • What the community suggests should be done (CCE CC) • Strategic response from LA

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

4. HIV prevalence rate by age group, 2008 HIV Sentinel Surveillance, Namibia

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

6. HIV prevalence rate by age group (2009)

7. HIV prevalence rate by site

8. What these graphs do not say What these graphs say • 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 • 5840 new infections annually • In 2009,16 New Infections were occurring daily • 250 000 Orphans • 6130 AIDS related deaths

9. 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.

10. Strategic response from LA • ALAN Declaration on HIV/AIDS 2001 • Adoption of Transformational Leadership • Incorporate the CCE reports into their policies • Promote HIV/AIDS workplace programmes • Community driven approach and not donor driven and prescribed approach

11. Negative Impact on the sector Consequences of not adopting WPP within Local authorities.

12. Time line Progress of HIV/AIDS in the Work force Economic impact on the sector Employee becomes infected Year 0 No cost to the Sector At this stage Year 1 - 5 Morbidity related costs incurred Absenteeism – productivity Medical care Insurance cost Morbidity Sets Year 6 or 7 Termination related cost Pension payouts Funeral expenses Loss of capacity and experience Employee leaves work force Resigns or dies Year 7 or 8 Turnover costs incurred Recruitment Training Reduced productivity Sector recruits replacement employee

13. Is the HIV Situation in Namibia getting better ?? Is it getting better or Worse? What should be my new way of working as a leaders and responsible citizen.

14. Sub – National Level CoordinationResponsibility: MRLGHRD • Regional Level • 13 Regional Councils – Strengthening Regional AIDS Coordinating Committees. (RACOCs) • Chaired by Regional Governors • Deputized by Chief Regional Officer • Secretary – Community Liaison Officer • Local Level • 107 Constituencies • Coordinating constituency AIDS committees. (CACOCs) • Chaired by the local councilor • Deputized by the Head of a government agency or director of a prominent civil society organization

15. What is Fueling the Epidemic in Namibia? • Multiple and concurrent partnerships • Inter-generational sex • Transactional sex • Early sexual debut • Transactional sex • Low and inconsistent condom use • Low perceptions of risk of HIV infection • Low levels of male circumcision • Alcohol abuse • People mobility and migration • Gender inequality

16. 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.

17. 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.

18. 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

19. Methodological framework of CCE-CC

20. How LA can move the CCE-CC agenda • Identify a regional coordinating office for CCE-CC • Put in place a certified CCE-CC coordinator • Identify and train community facilitators (according to the number of communities) • Finance a three to five years program to promote a facilitated community conversation • Evaluate progress at end of each year through a regional/ national reflection and review.

21. 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

22. Thank you