fabian mubiana and immanuel mwilima the hiv/aids situation in namibia
TRANSCRIPT
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