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[procaare] NAMIBIA: Reaching targets despite great obstacles

  • From: "IRIN PlusNews" <procaare@healthnet.org>
  • Date: Mon, 30 Oct 2006 15:25:35 -0000

NAMIBIA: Reaching targets despite great obstacles
IRIN PlusNews: Oct 30 2006

WINDHOEK, 30 October (PLUSNEWS) - Namibia has become the poster child of
global treatment access efforts because it is one of the few countries to
have exceeded its target in the World Health Organisation's (WHO) campaign
to put three million people on anti-AIDS drugs by the end of 2005.

When WHO launched the '3 by 5' initiative, not much was expected of the
small southern African country, struggling to cope with one of the world's
highest prevalence rates and an overburdened health system.

The treatment programme was launched in 2003 and the government has rapidly
scaled up treatment since then. By April this year all public hospitals were
providing antiretroviral (ARV) drugs. With about 24,000 HIV-positive
Namibians accessing the medication through the state, the country is meeting
50 percent of its treatment needs - according to national figures, 52,000
people require anti-AIDS medicines.

"Namibia is doing very well in rolling out ARVs ... in three years [it] has
reached impressive numbers of people, and this includes their PMTCT
[prevention of mother-to-child transmission] programme," UNAIDS country
coordinator Salvator Niyonzima told IRIN/PlusNews.

But it was now time to take a "cold hard look at financial sustainability",
he said, as financing for the treatment programme has largely rested on
funding from the Global Fund to fight HIV/AIDS, TB and Malaria, and the US
President's Emergency Plan for HIV/AIDS (PEPFAR).

Another growing concern for activists and healthcare workers is keeping all
these people on treatment. Figures for adherence to treatment are still
high - 90 percent - but in a country facing high levels of unemployment and
alcohol abuse, the government could not afford to be complacent, warned
Johan Gamatham, treatment literacy programme officer for Lironga Eparu, an
association of people living with HIV/AIDS.

Beneath the hype

Tucked away in the maze of corridors of Katutura Hospital, in a historically
black township of the capital, Windhoek, is the recently renovated modern
Communicable Disease Clinic. This HIV/AIDS facility treats 8,500 adults and
660 children, and is viewed as the country's "centre of excellence",
according to the hospital's head of internal medicine, Dr Ishmael Katjitae,
who also sits on the country's ARV rollout technical advisory committee.

However, the ARV clinic is not an accurate reflection of what was happening
in the rest of the country. Most of Namibia's health facilities serve rural
areas and are not as well staffed and equipped, said Dr Angelo Madjarov, who
had been working in Oshakati, in the north of the country.

Patients attending the clinic don't consider themselves any better off. A
few kilometres away, in another part of Katutura, a support group run by
AIDS Care Trust, a local nongovernmental organisation (NGO), is holding its
Wednesday meeting. Most of the members access treatment at the hospital.

Inevitably, with 64 percent of people accessing ARVs nationally being women,
the group is largely made up of unemployed women and many have brought their
children. Martha Aluene, 34, who has appointed herself the group's
spokeswoman, says week in and week out the dominant themes of their
discussions are transport and food. "The hospital is too far, and what can
we do but walk - we don't have money for [public] transport and we don't
have income to buy food."

Aluene's seven-year-old daughter is also on treatment. "When you are on this
medication you always want to eat, sometimes she [her daughter] will even go
to the neighbours and ask for food," Aluene laughed sheepishly.

Her daughter does not know she is HIV-positive and used to pester her,
repeatedly asking Aluene when they would stop taking the medicine. "I told
her if we stop, we will die. Now she doesn't ask me any more. I don't know
how I will tell her. Maybe when she is nine, because she will be able to
understand better," Aluene said.

Poverty and alcohol abuse were widespread problems in the township, said Dr
Elenice de Klerk of the hospital. "Our counsellors are making an effort to
keep record of the common reasons for defaulting [on treatment], and we know
this is one of the major causes."

Shebeens (unlicensed bars) in the country's townships and informal
settlements mushroomed when new and more lenient legislation was passed in
1998, replacing the strict liquor laws of the former apartheid era. Small
drinking outlets were legalised, as was the sale of homemade brews like the
popular 'tombo' and 'ashipembe'.

Aletha Kaposambo, a treatment supporter with Lironga Eparu, commented that
with tombo being easily available and cheap, she had encountered many
HIV-positive people "who end up stopping their medication and start drinking
heavily, because it is the only thing they can do".

Any interruption in treatment can lead to the HI-virus becoming resistant to
the medication, hastening progress towards AIDS. "It's clear that we need to
take a closer look at resistance patterns and treatment adherence," said
UNAIDS country coordinator Salvator Niyonzima, who called for government to
strengthen treatment literacy efforts and address food insecurity.

Internal migration also made it difficult to track patients, as many
attending Katutura's AIDS clinic had come to Windhoek from rural areas
seeking work and often return to their rural homes without their medication,
De Klerk said.

Dr Angela Mushavi, a paediatrician at the clinic, believed that a more
pressing problem was the lack of human capacity in the health sector. "We
need to decompress the congestion ... it doesn't bode well for adherence. If
people have to wait in long queues to get treated, they might not be willing
to come back".

Despite these obstacles, a lot had been done. "We reached the '3 by 5'
target through a joint effort between government, development partners and
ordinary HIV-positive Namibians," said Dr Madjarov. "These people budgeted
money for transport and got themselves enrolled on the programmes, even with
other concerns on their minds, such as work and money."

Email: IRIN-SA@irin.org.za