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A Perspective on World AIDS Day from Namibia: The Bush Institute Talks with Dr. Richard Nchabi Kamwi

Article by George W. Bush Presidential Center December 3, 2014 //   6 minute read

Namibia has one of the highest HIV/AIDS rates in the world. In 2013, the HIV prevalence was 14.3 percent. An estimated 178,000 people are living with HIV in Namibia. Despite these numbers, Namibia is seeing some success in tackling the disease. Between 2005 and 2013, the country experienced an estimated 36-percent reduction in new HIV infections, saw 8,400 fewer AIDS-related deaths, and achieved a mother-to-child transmission rate of less than four percent.

Under the leadership of Dr. Richard Kamwi, M.P. and Minister of Health and Social Services since 2005, the government of Namibia recently launched a three-year strategic action plan to further accelerate nationwide HIV testing and counseling. With the help of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the country has shown that achieving a massive scale-up of HIV services in a short period of time is feasible, given sufficient political commitment, social mobilization, financial investment, and close collaboration with both civil society and development partners.

We asked Dr. Kamwi about this success, and how his approach could affect AIDS-related diseases such as cervical cancer.

Congratulations to Namibia for being so successful in reducing the rates of HIV. What approach did you use to make such an impact?

First, we rapidly scaled up anti-retroviral therapy (ART) services, which has allowed 84 percent of eligible adults, and 82 percent of eligible children, to receive these services. Namibia has also extended ART to HIV-positive children younger than five years of age and to patients with hepatitis B, who are more likely to succumb to HIV infection.

Second, we scaled up prevention of mother-to-child transmission services (PMTCT), which has reduced the rate of the transmission of HIV from mothers to their babies to only four percent. We have also adopted the “Option B+ approach,” which ensures that all HIV-positive pregnant women are placed on ART as soon as they are diagnosed, regardless of their CD4 count or symptoms.

Namibia also continues to implement robust prevention programs, including Social Behavior-Change Communication (SBCC), condom provision, and HIV testing.

In addition, in 2010, the five-year National Strategic Framework for HIV and AIDS was developed, and launched by His Excellency President Hifikepunye Pohamba. This framework defines national priorities and targets, and prioritizes strategies for the disease, by emphasizing high-impact and effective interventions.

What role has funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) played in strengthening Namibia’s health care system to help you achieve this success?

U.S. government investments remain the largest source of external HIV/AIDS funding in Namibia. PEPFAR funds have been invested through partnerships with the government and implementing organizations to treat those living with HIV/AIDS, to prevent new infections and to care for affected individuals in the country. The areas of support include:

*Financing positions and training healthcare personnel to scale up services rapidly;

*Technical assistance to local organizations in the areas of care and treatment, HIV testing, laboratory services, care for orphans and vulnerable children, and

blood safety; and

*The strengthening of health systems, including laboratory infrastructure, national procurement systems and information technology.

In August 2014, Namibia was selected as one of the next countries of engagement for Pink Ribbon Red Ribbon. How do you plan to apply the lessons learned in HIV control to tackle cervical cancer?

Cervical cancer is the second-most-common cancer in Namibia. Annually, 117 women are diagnosed with cervical cancer, and 63 die from the disease. Women with cervical cancer are typically not identified until they are at an advanced stage of the disease, which results in high morbidity and mortality.

In addition, long turn-around times for Pap smear test results delay necessary and timely treatment. We know that cervical cancer is potentially preventable, and effective screening programs can lead to a significant reduction in deaths from the disease.

Through Namibia’s partnership with Pink Ribbon Red Ribbon, we can follow a similar approach as we used to tackle HIV, and accelerate life-saving screening and treatment. In Namibia, this initiative will build on existing health care programs to add interventions to prevent, screen for, and treat cervical cancer.

With Pink Ribbon Red Ribbon’s support we will:

*Develop and execute a National Cervical Cancer Strategy, which will ensure timely access to appropriate diagnosis and treatment services;

*Implement a demonstration program to vaccinate girls against the human papillomavirus, or HPV (which is the primary cause of cervical cancer); and

*Train health workers to perform the single-visit “See-and-Treat” approach for cervical pre-cancer.

Pink Ribbon Red Ribbon has already supported Namibia to train staff, and has donated equipment to the Ministry of Health and Social Services to screen and treat women for pre-cancerous lesions.

We know from our experience with HIV that it’s important to get all sectors of society involved to accelerate the response to the disease, and this will be our approach with cervical cancer as well.

What role can public-partnerships play in these efforts? 

Partnerships are crucial.  They can ensure direct contact with intended beneficiaries, access to additional human and financial resources, and ownership of programs by communities and affected populations. This fully integrated approach is key to making a difference.