Namibia

Widespread substance abuse in Namibia, among other factors, contributes to its HIV infection rate

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Background

Located on the southwestern coast of Africa, Namibia borders four countries: Angola and Zambia to the north, Botswana to the east and South Africa to the southeast. Except for Angola, all are designated "focus countries" by PEPFAR, the President's Emergency Plan for AIDS Relief, the five-year, $15 billion U.S. initiative to combat AIDS abroad. Namibia was part of Germany's holdings in Africa until World War I, after which the League of Nations transferred control to South Africa. In 1990, after decades of war and international pressure, South Africa released its claim and Namibia attained independence.

The second most sparsely populated country in the world, Namibia is divided into 13 regions that are further divided into 102 constituencies. Windhoek is the capital.

Namibia's economy is very dependent on mining. Twenty percent of its gross domestic product comes from the extractive industries, including uranium and diamond mining. Subsistence farming accounts for the livelihoods of nearly half of Namibia's population.

While Namibia's gross national income per capita is several times that of sub-Saharan Africa's poorest countries, rampant unemployment means most of the population lives below the poverty level.

Like many southern African countries, Namibia has a diverse population. More than 87 percent is black African, with about half of the nation belonging to the Ovambo tribe. Whites and mixed-race groups each comprise about 6 percent of the population.

Afrikaans is the most widely used common language in Namibia, spoken by nearly all blacks and 60 percent of whites. English, the official language, is widely understood among the younger generation. But both languages are generally second tongues, reserved for the public sphere, while indigenous languages are spoken at home. About half of all Namibians speak Oshiwambo, the Ovambo tribe's language.

The face of HIV

HIV/AIDS has had a severe impact on Namibia. The first case of AIDS was reported in 1986. Since 1996, AIDS has been the leading cause of death among Namibians, including 50 percent of the deaths of those aged 15 to 49. As with most sub-Saharan countries, heterosexual intercourse and mother-to-child transmission remain the most common modes of transmission.

The highest infection rate, which some estimate at 43 percent, is in the six northern regions of the country, where 50 percent of the population is concentrated. As in most of the focus countries, young women and girls are disproportionately affected by HIV. According to Namibia's 2005 Country Progress Report, 9 to 13 percent of men ages 15 to 24 are infected with HIV, while for the same age group among women, the infection rates are 19 to 29 percent.

Orphans and vulnerable children are also severely affected by HIV in Namibia. According to UNAIDS, the Joint United Nations Program on HIV/AIDS, the epidemic has orphaned about 85,000 children, a significant number in a country of 2 million people. About 17,000 children are HIV-positive.

Challenges to fighting the HIV epidemic

Namibia's Third Medium Term Plan on HIV/AIDS attributes the spread of HIV in the nation to, among other factors, cross-border travel; widespread alcohol and substance abuse; gender inequalities; poverty; some cultural practices; intergenerational sex; the disintegration of traditional family structures; and ignorance.

One of the most common challenges to fighting the HIV epidemic in the focus countries is an insufficient number of trained health professionals, and Namibia is no exception. Inadequate human resources, particularly in the sparsely populated rural areas, makes getting vital services to those in need extremely difficult.

Poverty is also a barrier. Namibia has the highest rate of income disparity in the world. Half of the population subsists on just 10 percent of the national income.

Namibian government response

According to the United Nations, the Namibian government is strongly committed to fighting the HIV epidemic, and the country has made great progress in getting services to those who need them.

Shortly after independence, Namibia created the National AIDS Control Program. It was followed by the First Medium Term Plan, which lasted from 1992 to 1998. There have been two more Medium Term Plans, the current one scheduled to end in 2009. Today the government is undertaking its second National Development Plan, which lists as the country's top priorities income disparity reduction and HIV/AIDS prevention and control.

HIV and human rights are addressed in Namibia's constitution, and in 2005 the government adopted a labor act outlawing workplace discrimination against people living with HIV/AIDS.

Health services are entirely subsidized by the Namibian government. Although there are a number of hospitals and clinics throughout the country, many people in the sparsely populated areas must rely on mobile outreach clinics for their health needs.

U.S. government response

Funding from the U.S. government, through PEPFAR, accounts for one-third of all the HIV/AIDS funding available in Namibia. Only the government of Namibia contributes more money.

According to the U.S. State Department's Office of the Global AIDS Coordinator, the U.S. government has been active in supporting Namibia's fight against HIV since 2000, with particular emphasis going to community-based programs.

PEPFAR's fiscal 2005 funding in Namibia for prevention, care and treatment was almost evenly distributed, with care getting a slight edge at 35 percent, or $12 million. Prevention and treatment each received a little over 32 percent of the funding, or $10.9 million apiece.

Repeated requests for an interview with PEPFAR officials in Namibia were unanswered.

Gwen Lister contributed to this report from Namibia.

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