New Era (Windhoek)

30 November 2012

Namibia: Dr Kamwi On HIV Day

interview

Article Views (non — New Era journalist Alvine Kapitako interviewed Dr Richard Kamwi, the Minister of Health and Social Services on the HIV/AIDS pandemic.

Honourable Minister, how did Namibia manage to reduce HIV infections by 68 percent as stated in the latest UNAIDS report? And how accurate are these statistics?

"The rapid scale-up of a combination of high impact prevention strategies since the late 1990's. You'll recall the slogan or the theme on condomise. We strictly said the ABC concept - condom use, behaviour change, communication campaigns be intensified in this country. You'll recall the 'Take Control' programme spearheaded by the ministry of information, but of course created by the Ministry of Health and Social Services. The HIV testing and counseling, school-based programmes such as 'My Future Is My Choice', the prevention of mother-to-child transmission (of HIV) and the effect of treatment as prevention - you see when you treat, what you are trying to do is to bring down the viral load, resulting in (if it's a male) what he will be transmitting is very low, that's why they are talking of treatment as prevention. You are querying the accuracy - are these statistics accurate you ask. I want to tell you, yes - they are accurate. The estimate is based on the bi-annual sentinel surveillance of HIV prevalence among pregnant women. We are not reinventing the wheel. We are using methods that are working elsewhere."

What were the previous reductions percentage-wise?

"Well, the 68 percent reduction refers to 2001 to 2011, the reduction is steady and is expected to continue, which is good news. It does not include where we are today because if it was to include where we are today, I can tell you we are now even much better. We expect to reach the National Strategic Framework target of further reducing HIV by 50 percent between 2010-2011 to 2015-2016 - that is our target."

According to the Namibian National Sentinel Survey on HIV, prevalence among pregnant women reduced to 18.8 percent in 2010 compared to 22 percent in 2002. The current adult prevalence rate is at 13.1 percent. To what would you attribute the reduction of HIV/AIDS in Namibia?

"The answer is the same as the first one. I would explain to you that due to the survival of people with HIV who are on treatment, adult HIV prevalence estimates based on the antenatal care services will be steady or even increase. Therefore, we should now look at the prevalence among young women between the ages of 15 to 24 years. This gives a better picture of the trend of new infections. In terms of mortality due to HIV/AIDS, it has also decreased significantly from approximately 12 600 during the fiscal year 2005-2006 to 5 000 during the fiscal year 2011-2012. I sometimes say the way we are working, the industry of those who took the AIDS related deaths as lucrative business, I think they must be feeling the pinch because I'm telling you, you hardly see those convoys that we used to see."

Why are people still getting infected with HIV despite the numerous messages and campaigns aimed at educating people about the dangers of HIV/AIDS?

"It's a very good question. We have approximately 8 170 new infections said to have occurred during the course of 2011-2012. Behavioural change requires more than just information. People have to get adapted, people need to be empowered to be able to act upon information. Remember information is power. Many people such as women, young people, marginalised and poor populations are vulnerable because they do not have control over their sexuality. There's the issue of gender-based violence or certain population groups in remote rural areas, informal settlements, they do not have adequate access to HIV prevention and care services. It must be an ongoing (effort) to make sure that all get this message loud and clear. Other practices such as alcohol abuse are still a factor and cultural practices and tradition by the way can also lead to risky behaviour."

When we talk about progress on the reduction of HIV infections can you quantify how many Namibians still get infected with HIV per day?

"The estimated number of new infections in the fiscal year 2011/2012 in this country is 8 170, but this is from approximately 9 640 in the fiscal year 2010/2011 and over 20 000 in 2001, so it has reduced. This means on a daily basis you are talking of 22 new infections during the fiscal year 2011/2012. I mean for a population like Namibia it's quite high."

Why are men generally reluctant to get tested for HIV/AIDS when compared to women?

"(Laughs) You know, I'm an African man and I know what is happening there so I'll try to respond the way I see things. First many women in this country and elsewhere have access to HIV testing, especially in this country, when they go for consulting in antenatal care services - they are doing that. But how many of those women are being accompanied by their spouses? You see traditionally men do not accompany their wives or partners to ANC (antenatal care) services - they don't, traditionally. It's not African culture and that we must understand. But at the same time there is a need for us to educate those men to say 'yes I'm an African' but there's need for us to adopt the good practices which work. Women seek testing and care because of a strong sense of responsibility about the future of their children and I understand the need for them to do so. But there is need now for us to inform these cultural men and say 'look a woman does not make a child herself'. For a child to be made there must be a man and woman coming together and it's only when you play the black and white notes that you'll enjoy your music. So we should not just impregnate them and then leave them alone, but this is a process that we should not just do one day and expect them to understand - no. There is also the issue of stigma and discrimination we need to work on."

There have been reports of Namibia running out of condoms, what happened to previous plans to establish a condom-manufacturing factory in Namibia?

"During 2010 and 2011 there have indeed been challenges with the procurement and distribution of condoms. Condom promotion remains a key strategy for HIV, for STI's (sexually transmitted infections), prevention and family planning and government is now paying for the procurement of condoms, we are now buying condoms. On the question of the condom factory, this condom factory was built with resources from the Global Fund. Now production of condoms is financially not viable in Namibia, because of very competitive rates in the global market and the relatively small market that we find ourselves in. So for us to come up with a fully-fledged condom factory and you are just targeting Namibia, the profit is likely to be marginal because of the giants we'll be competing with. However, government is in the process of acquiring the property rights over the Smile condom. We believe that is ours and talks to that effect are at an advanced stage."

In your view do you think condoms should be distributed to learners in schools?

"Ja ... (laughs) I am going to answer you, first and foremost in my capacity as Minister of Health and Social Services and indeed as a professional. Unwanted pregnancies and HIV and STI's are a problem among young people who are sexually active. This means that young people must have access to condoms in order to protect themselves against HIV, STI's or indeed unwanted pregnancies. We need to examine what are the best ways to improve access to condoms for young people. The policy of government is ABC - abstain, be faithful and if you cannot you must condomise - this is the policy of government. Research and experience in other countries have shown that condom provision in schools does not incite young people to have sex. I'm saying, yes indeed condom use must be encouraged in schools, we are simply trying to make sure that girls complete their studies without pregnancies and above all it's a policy of government."

Previously some people were very reluctant to use condoms and they even compared using condoms to a man taking a shower with a raincoat on, or a person eating a sweet in a wrapper. What is the situation like now compared to the time when some men resisted using condoms, saying they preferred skin-to-skin sex?

"This also draws back to the concept of culture, it brings you to awareness. It takes you to why should you use a condom. People must be informed. You find such men, mainly the majority coming from rural areas and they find it very difficult. The resistance (to condom use) was there especially in the beginning of the AIDS response in the nineties and among older men. However, this initial resistance was quickly overtaken once people understood the importance of the use of condoms to protect themselves, especially among young people. People should underline that a condom is there to protect against unwanted pregnancies, against one getting infected by someone who is HIV positive or from someone who has gonorrhea or from someone who has syphilis and other related STI's. Between 2000 and 2006 we have seen a further increase in the use of condoms in at-risk sexual encounters from approximately 50 to 70 percent and we expect that this has further increased."

You said earlier that the Ministry of Health and Social Services procures condoms. How many condoms does the ministry distribute freely in a month and what are the cost implications?

"On average between 1.2 and 2 million condoms were distributed per month over the past two years, so it's a lot of money (involved)."

There were also problems with the female condom with skeptics comparing it to a shopping bag and there were also complaints over the rings. Is anything being done to make the Femidom more user-friendly?

"Indeed the female condom requires some practice in order to use it effectively, therefore the importance of organising good counseling and education, demonstration and practice of course for women by peer educators, is vital if we are to succeed in this area. The Femidom is an important protection tool, because it is controlled by women themselves. Women do not depend on the men to negotiate condom use because it is their own instrument. So the way I see it, it's the women who should take a lead. There is globally only one producer of the Femidom, hence we are dependent on the international market in terms of improving the product and the pricing. The Femidom needs sophisticated expertise, but I encourage our women folks to use it. It's one of the strategies that we cannot afford to go without."

Still on the Femidom, people were saying it was too expensive compared to the male condom. Is the ministry doing something to make the female condom less pricey and more accessible?

"The way we are working is exactly the same as we advocated for low prices in terms of ARV's (antiretroviral drugs) and like I said we only have one company in the whole world that is producing Femidoms, so it is a real challenge. I think that is a real, real challenge."

Madam Graça Machel last week said she believes pediatric AIDS can be completely eradicated even in Namibia, What are your views on this? And are we taking steps in eliminating pediatric AIDS?

"First of all, I want to say it was an honour and privilege for me to have worked with her very closely during those two days. She is such a dynamic woman, certainly a woman of substance. Indeed, I have to say Namibia is on track on virtually eliminating mother-to-child transmission of HIV by 2015/2016. That is something that I speak of with authority. Namibia has rapidly scaled up the prevention of mother-to-child transmission services since 2003 and was already reaching approximately 90 percent of HIV positive pregnant women already in 2011. We are somewhere around 95/97 percent in terms of scaling up prevention of mother-to-child transmission (of HIV). Currently, the transmission rate (of HIV from mother to child) is estimated to have come down to approximately 5 percent, that is from more than 30 percent during 2001. So I am extremely grateful, I'm happy with this type of achievement. So, Graça Machel was correct, she was right."

Donors have withdrawn and they continue to withdraw funds in the HIV/AIDS fight in Namibia. How is Namibia currently coping, in the area of HIV/AIDS with more donors withdrawing funds? Would Namibia be able to cope on its own if donors pulled out completely?

"I want to confirm the fact that since 2008/2009 a number of donors have reduced their funding to Namibia and in particular with HIV/AIDS. Clearly, they too have some challenges back home. Namibia is one of those countries rated to be an upper middle-income country. With that status in itself, it has shifted the priorities. Namibia has anticipated this and has put clear targets on domestic funding on the national AIDS response in our national strategic framework. But I also tend to differ because it's not at all a pullout all together, not at all. In our dialogue with development partners, for example PEPFAR, the United Nations, Global Fund, EU - especially these ones - they indicated to us that they will not pull out completely, no they will not. It is not just about money but also about partnerships, strategic information and capacity building."

Scientists still have not discovered a cure for HIV/AIDS, is there any progress being made towards finding a vaccine for HIV? And are there any new advances in AIDS treatment?

"I want to reiterate that no vaccine has yet and no cure has yet been found. Progress in developing a vaccine is very slow because of the complexity and adaptability of the virus (HIV). No vaccine is expected within the next five to ten years - that we can forget. A vaccine will most likely not be fully effective, say 50 to 70 percent and then you will still have to get it to the population, that will mean resources. So a vaccine will not be the easy and final solution. We already have many tools in the toolbox and we must continue to scale up the provision of the high impact interventions."

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