Ondiiyala — Sixty-three-year-old Hatsita Uushona lives eight kilometres west of Omuthiya at Ondiiyala village.
Journalists, a representative from the US Embassy and representatives of Project HOPE visited Uushona and her household on Friday at her homestead where she lay hopelessly close to her hut.
Three of her grandchildren, all six years old, were playing but stopped when they observed the presence of visitors. Uushona has difficulty walking and spends most of her days lying outside in the hot northern sun. If she has to do some house chores, she crawls her way through them or asks her grandchildren to assist her.
"We are nine people living here," said Uushona, explaining that some of her children, their children and her husband make up that number. The number does not include Uushona's other children, who left in search of greener pastures outside of Omuthiya.
"I stay here with my grandchildren," she adds. Two of Uushona's children are HIV positive, or at least those are the ones' whose HIV status she knows.
One of them is 29-year-old Justine* (not real name) who had defaulted on her antiretroviral medication last year. With the help of Project HOPE, Justine has successfully re-entered the antiretroviral programme.
In 2013, Project HOPE began the five-year Namibia Adherence and Retention Project (NARP), which is funded by PEPFAR through the United States Agency for International Development (USAID).
The aim is to strengthen adherence and retention to HIV care and treatment, including prevention of mother-to-child transmission of HIV, and to mitigate the impact of HIV on people living with HIV and those affected, such as orphans and vulnerable children, as well as caregivers. The project covers 14 health districts in eight regions.
NARP provides community-based HIV prevention, care and treatment support services in line with UNAIDS' global goals.
Justine, the unemployed mother of three children, was not home when we visited her homestead, despite agreeing to be interviewed. "She left yesterday afternoon and she did not return. She does that often," said Uushona. Penehafo Timoteus, the community health worker for Project HOPE, which stands for Health Opportunity for People Everywhere (HOPE), explained that Justine goes when and as she wants, leaving Uushona and her husband to take care of her children as well as her brother's daughter, who is HIV positive.
"The last three years have been difficult," said Uushona, stressing that the drought has had its toll on them.
"When we get our pension payout we buy big bags of maize meal but that does not last very long because the family is big," she explained.
Often times, the family only eats once or twice a day, despite the fact that HIV medication should not be taken on an empty stomach.
"One of Justine's daughters makes sure her cousin (a HIV-positive child) takes her medicine on time," said Timoteus. She discovered that there was no consistency in the time the child takes her medicine.
"Since Justine is not always here to make sure the child takes her medication, I have tasked her cousin (also six years old) to assist her grandmother with that responsibility," said Timoteus.
So, the two underage children make sure that the HIV-positive child drinks her pills on time.
"I have taught her to maintain good hygiene by washing her hands or at least putting the pill on a piece of paper and use that to put the pill in the mouth when they don't have enough water - that way she maintains good hygiene," said Timoteus.
The other problem is that the HIV-positive child does not have a birth certificate. "But we are working with the family to get her one. At least she would get a social monthly grant because she has to walk 25 kilometres to get her medicine," said Timoteus.
When journalists visited the family, the six-year-old HIV-positive child was not feeling well. Timoteus and the grandmother then explained that the medicine makes the child drowsy.
"She has not been going to school because she is sick," said Uushona.
According to USAID, HIV is a major contributor to maternal and child mortality in Namibia.
Furthermore, statistics from USAID show that five percent of new HIV infections in 2010/2011 were due to mother-to-child transmission, a significant drop from 33 percent in previous years.
From 2005 through 2010, HIV testing among pregnant women increased from 47 percent to 86 percent and maternal antiretroviral therapy coverage increased from 60 percent in 2209 to 85 percent in 2011.
In 2014, HIV prevalence among pregnant women attending antenatal care was 16.9 percent, however this rate varied significantly among sites, ranging from 3.9 percent in Opuwo to 36 percent in Katima Mulilo.
Meanwhile, putting Justine back on ART was difficult because after being traced she was reluctant to go back to the hospital. She is also said to have un-sober habits.
"She cited the long distance as the reason she stopped going back but I have since promised her that I would assist with transport money," added Timoteus.
"We want a clinic nearby. This would improve the lives of people here and the surrounding villages because they will not have to travel long distances to access their ARV services as well as other medical check-ups," said Timoteus.