Windhoek, Namibia — Dr. Libertine Amathila, Namibia's Minister of Health and Social Services, has been a leader in the fight against HIV/Aids in Africa. Trained as a medical doctor, she has postgraduate qualifications in nutrition, public health and epidemiology. Long before Namibia was independent she was playing a key role in the liberation movement, Swapo, during the long years of exile, as both a leader and a health professional. After independence in 1990, she first took the role of Minister of Local Government and Housing, before taking on the health portfolio in 1996. She was interviewed in Windhoek on World Aids Day by AllAfricas Reed Kramer and Amadou Mahtar Ba.
How serious is the situation you are facing in Namibia with HIV/Aids?
In Namibia, every family has seen a brother or a sister, a close relative or a neighbor dying from Aids. According to the 2002 study we did, 22 percent are positive with the virus, compared to four percent in 1986. We are 1.8 million people here, so that is nearly 400,000.
We are targeting those who are infected but also the 78 percent who are not! We are also working very hard among the youth, with a program called 'My Future is My Choice. Among the youth, we see some positive results. HIV/Aids prevalence among the youth from 2000 2002 was 11 percent, compared with 12 percent [in earlier years], so I think this is working. Ive told them I am so proud of them, so dont disappoint me!
What are the primary aspects of your approach?
To start from the beginning, prevention is the mainstay of what we have been doing and will continue to be doing. Although we have too many people who are infected, there are many more who are not infected and we want to prevent that they get this disease.
We give lots of information; when you are traveling around you see the billboards to warn people on HIV. We use the ABC approach. [The minister points to a poster in her office where ABC is defined as: A - abstain from sex; B - be faithful to a faithful sexual partner, C- use condoms.] You know, by now, 99 percent of our people know what this HIV is and how to prevent it.
In rural areas as well?
In rural areas especially! This is a country that starts things in rural areas.
So why is infection so widespread in Namibia?
Information alone does not prevent the spread of HIV/Aids. We have to convince our people to act. We also have a major problem of violence against women here, and throughout southern Africa. Men use their power to get their way. If the wife says, 'you have been far away for five or seven months, lets use condoms and lets go check,' usually men refuse. [She makes a boxing motion with her hands.]
We have a multi-sectoral approach - education, information distribution, surveillance. We tell people their result and treat the opportunistic diseases. Now we have gone a step further treating people with anti-retroviral medicines.
We treat people when their CD count has gone down to 200. These are one of the cells in the blood, like the white blood cells, and if they are very low, you know somebody has Aids.
This program started two years ago treating mother-to-child transmissions in two hospitals to see what was the impact. We put them on Nevirapine as soon they delivered. Then, five months ago, we started with anti-retroviral treatment, free treatment, for all those infected with HIV/Aids. We thought there might be a hundred to come forward initially, because we still have this stigma. But we were surprised; more than 1,000 came forward. They are coming as a family and there is no more stigma for these people. They want to be treated.
The trouble we have is with manpower. We are training 100 counselors right now, to take over from the nurses the treatment of those on anti-retroviral treatment. Each one of these counselors will follow a group of patients on anti-retrovirals to make sure they are getting their treatments, that they are eating properly and taking care of themselves. These patients need encouragement. Some are stigmatized by their families,
I have wanted to make sure these counselors are trained properly - one month, not just two weeks. The training includes how to recognize women who are living in violent relationships.
We also have decided that, while they are voluntary, that they receive some little money. They need to eat! We have decided that our voluntary workers should get a food ration and some little pocket money as well.
We also have to provide for the patients. Sometimes they dont have any food to eat, so we have to provide food for them as well.
How and where are you making anti-retroviral treatment available in this country?
Our initial goal is to have at least one hospital in each of the 13 regions equipped to provide the treatment. In some regions, two may be needed. We also have the church mission hospitals, which the government is subsidizing 100 percent. One hospital has started the treatment, and another will start soon. This coming Friday, I am going to the mine hospital at Oranjemund to launch anti-retroviral treatments there. So its coming everywhere.
The impact of this treatment is so impressive. Sometimes people come, and they are not able to walk and after a week or so they go back to work. Of course, we want that person to continue to take their pills. It is only three per day - two in the morning and one in the evening, or vice versa.
You have identified 1,000 people now who need the treatment. What is your projection for how many will need anti-retrovirals in the future?
We expect to need to put as many as 25,000 on anti-retroviral treatment by the end of 2005. This may be a little high, we dont know. Probably we will reach that target, but it is not a target I want to reach.
How are you paying for this?
We have budgeted seven million Namibian dollars a year (about US$1.1 million). Donors are coming in also, but we have to budget from our side, so that tomorrow, when the donors are not there, people are not going to lose out on their treatment.
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If we can treat people, we can reduce hospital occupancy, people will be able to go back to work, and they will be able to take care of their children. Right now, they are dying and leaving their children as orphans. And our insurance companies are good for nothing. When people die of Aids, they dont want to pay. They dont tell people when they take out a policy they need to be checked [for Aids], and they dont tell them they can take out an extra cover. Some of them cheat people, telling them 'you dont need to be tested and then when they die, refusing to pay. They must explain to people from the day they come to take out a life policy what are the consequences and how much it will cost them. Then they can make plans for their families.
How do you think we as Africans have dealt with the HIV/Aids crisis?
We may be really poor, but we in Africa have a tendency of looking to the outside. In Africa, money is going to the armies, civil wars are going on. Many African countries have debts. In Namibia, we are lucky that we have seen what is happening in other countries, and we dont have those debts.
My philosophy is if you yourself dont move a little inch, no one will move you. But if you are walking, the likelihood is that someone will give you a lift to move you further. We must make sure we are seen to be doing something for ourselves. The reason that the drugs [for fighting Aids] have become cheaper is that we ministers of health have fought this issue. If we didnt fight, the drugs would still be very, very expensive.
The disease is here, so we must fight it here.
