Country situational analysis [1]

The first case of AIDS in Namibia was reported in 1986. The epidemic grew rapidly until 2002 and has since show signs of stabilisation. According to the 2010 UNAIDS Report on the AIDS epidemic, there were 180,000 people living with HIV at the end of 2009, which corresponds to 13.1% prevalence. 

A survey conducted by the Ministry of Health and Social Services in 2008 showed that the median HIV prevalence at ante-natal clinics declined in 15-to-19, 15-to-24 and 25-to-49-year-old women from 2000 to 2008 with the largest rate of decrease between 2006 and 2008.

The prevalence in the younger age groups (15-24 yrs) decreased from 11% to 5.1% among the 15 to 19 years old and from 22% to 14% among the 20 to 24 years old respectively between 2002 and 2008. Among 15 – 24 year olds declines were evident in 11 of the 13 regions from 2004 to 2008 with a 23% decline nationally. The 15-to-24-year-old age group was used as a proxy indicator for HIV incidence data. Among older women aged 25 – 49 years old there was a slight change nationally from 26.5% to 24.7% between 2006 and 2008.

According to UNAIDS estimates, there were 59,376 people on antiretroviral treatment at the end of 2009, which corresonds to 76% coverage of all those in need.

Key elements of the national response

Namibia launched its first HIV/AIDS Medium Term Plan (MTPI) in 1992 under the coordination of the National AIDS Control Programme. This was later replaced by the National AIDS Co-ordination Programme (NACOP) in 1999. Namibia is currently formulating its fourth Medium Term Plan (MTPIV).

Namibia’s Vision 2030 regards HIV as one of the most serious threats facing the country and highlights the need to mainstream HIV programmes to effectively meet the resulting development challenges. Consistent with the goals of Vision 2030, the country's response to the epidemic has intensified considerably in recent years. The Namibian government is fully committed to tackling the epidemic through a multi-sectoral approach. This is reflected in the Medium-Term Plan III (MTP III) for the period 2004-2009 which places particular emphasis on the importance of effective monitoring and evaluation of the epidemic. The overarching goal of the MTP III is to reduce HIV incidence through achieving five key strategic results:

• Enabling Environment -- People living with or affected by HIV enjoy equal rights in a culture of acceptance, openness and compassion
• Prevention -- Reduced new infections of HIV and other sexually transmitted diseases
• Access to treatment, care and Support Services -- Access to cost effective and high quality treatment, care and support services for all people living with or affected by HIV
• Impact Mitigation Services -- Strengthen and expanded capacity for local responses to mitigate socio-economic impacts of HIV
• Integrated and Co-ordinated Programme Management at all levels – Effective management structures and systems, optimal capacity and skills, and high quality programme implementation at national, sectoral, regional and local levels

Key achievements

• A Response Monitoring and Evaluation Unit was established in 2002 with the primary mandate of monitoring and evaluating the implementation of HIV response strategies at national and regional levels. The national M&E plan was developed in line with MTP III and launched in September 2006
• The Third Medium Term Plan (MTPIII) for 2004-2009 was launched in 2003
• The National Policy on HIV/AIDS was launched in 2007
• The Ministry of Defence and the National Defence Forces launched the Military Action and Prevention Programme in 2001
• Provision of antiretroviral treatment began in mid-2003 and reached 32 (94%) of 34 public hospitals by 2005 and has reached all hospitals and some clinics by mid-2007

Key challenges

Emerging challenges to be considered from 2008 include: strengthening national coordination; scaling up HIV prevention; addressing the financial sustainability of the national response; addressing human resources issues; and mitigating the deepening socioeconomic impact of the epidemic.

The NACOP needs to be strengthened in order to guide and manage the national response to HIV. As suggested by the reviewers of the MTPIII, it may be useful to revise the national coordination architecture to strengthen a multisectoral response.

Namibia has made significant progress in the provision of HIV treatment. However, to effectively tackle the pandemic and make treatment sustainable, it is critical to develop and implement a massive HIV prevention programme. Less than 15% of the national budget has been allocated to health and the HIV budget accounts for only a small percentage of it. The Namibian government needs to increase ownership and investment in the response to AIDS.

As Namibia is considered a lower middle income country, many bilateral donors are phasing out, which increases dependence on the Global Fund and PEPFAR. Limited human resources constitute one of the biggest obstacles to scaling up the national response. The Education and Training Sector Improvement Plan is a potential long term solution, as well as submitting short- to medium-term plans to the Global Fund.

The biggest obstacle to increasing access to the provision of antiretroviral treatment, prevention of mother-to-child transmission and voluntary counselling and testing is human capacity. Significant obstacles are also distance, the negative attitude of health professionals and high fees.

There is concern that the country relies heavily on donor funding to finance its national response. In 2007, the HIV/AIDS Partnership Forum engaged the National AIDS Council Chair on this and on the need to step up HIV prevention.

Civil society, including umbrella organisations, needs more financial and technical support in order to strengthen and scale up efforts.

Useful links

National Strategic Plan

• National Strategic Plan
• PMTCT and Paediatric Care and Treatment Fact Sheet
• 2010 UNGASS Report

Contacts

UNAIDS Country Office
Private Bag 13329
Windhoek
Namibia
Tel: +264 61 204 6221
Fax: + 264 61 204 6203

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1. Epidemiological data comes from the country's 2010 UNGASS Report, unless otherwise stated