Your daily Selection of IRIN Africa PlusNews reports, 10/15/2004

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CONTENT:

1 - NAMIBIA: New hope for Caprivi with launch of AIDS treatment

1 - NAMIBIA: New hope for Caprivi with launch of AIDS treatment

KATIMA MULILO, 15 October (PLUSNEWS) - Stigma keeps people in denial over

HIV and AIDS. They are silent about their fears, too afraid to change, and

wait far too long before seeking medical help.

Where there is no treatment option, especially in conservative societies

where the stigma surrounding AIDS seems so hard to challenge, there can

appear to be little to gain from coming forward to be tested, and an awful

lot to lose if the result is positive: ostracism, ridicule and

discrimination are powerful disincentives.

The HIV prevalence rate in Namibia's northeastern Caprivi region is

testimony to the impact of denial. In 2002 an estimated 43 percent of the

region's 92,000 people were HIV-positive - 10 points higher than the last

survey in 2000. Analysts fear that new figures, due out in the next few

months, will show a further rise.

Caprivi is a colonial anachronism, a remote strip of land bordering four

countries - Angola, Botswana, Zambia and Zimbabwe - carved out by the

British and ceded to Germany in 1890 in exchange for Zanzibar in the

Indian Ocean.

HIGH-RISK ELEMENTS

Caprivi has all the high-risk elements that are known to drive the

pandemic - poverty, instability and a transport corridor used by

long-distance truckers, as well as a culture that keeps women subservient,

and the open discussion of issues related to sex, taboo.

The Trans-Caprivi highway links landlocked Botswana, Zambia and Zimbabwe -

countries with HIV infection rates that are among the world's highest - to

Namibia's deep-sea port of Walvis Bay. A new bridge across the Zambezi

River, connecting Caprivi with Zambia, was opened this year to capture

trade from as far north as the Democratic Republic of Congo.

Truck drivers are known to play a key role in the spread of the virus.

Relatively well paid, they are at the centre of the commercial sex

industry in a region like Caprivi, with an unemployment rate reportedly as

high as 80 percent.

Glossy posters warning of the risk of AIDS are everywhere in Katima

Mulilo, Caprivi's dusty regional capital. But that has not translated into

behavioural change when tradition and powerful social pressures stymie

orthodox interventions.

" The way the messages are done doesn't take into consideration the context

of local culture ... They are seen as coming from [the capital] Windhoek,

but [many people believe that] AIDS is not a problem here, " explained Dr

Zengani Chirwa, based at the state hospital.

" It's tradition - it's very difficult to talk about sex, it's seen as

something wrong, " said Hilda, one of the very few HIV-positive people in

Caprivi to admit their status.

" Because you get AIDS through sex, it's like you [are promiscuous] that's

why you have HIV. "

DISEMPOWERED WOMEN

In a society where many condone wife beating and polygamy, and women are

often economically dependent on men, admitting to being HIV-positive has

consequences.

" Some women laugh at me, " said Hilda. " They say, 'She's crazy, how can she

say she has AIDS in public? We know we are HIV positive, but we can't do

that because we still need men to support us'. "

The silence surrounding the epidemic means other explanations have to be

found for the deaths that sweep through so many families in the region.

The most common is witchcraft, and the logical response is to visit a

traditional healer.

" People visit traditional healers first - when things don't seem to be

working is when they will come and see me, that's why we see them very

late, when their CD4 count [which measures the strength of the immune

system] is low, " said Chirwa.

" The witchdoctors are lying - they can't cure it, they are only making

money, " said Freddy Kasale, a tour guide. His uncle, whom he suspects was

HIV positive, was taken to a traditional healer. " My family paid Namibian

$1,800 (US $277), but where is he today? He's dead. "

While Caprivians almost uniformily complain of developmental neglect by

the central government, health minister Libertina Amathila says one of her

priorities has been to address the stubborn rise in HIV infections in the

region. " I almost collapsed [when I saw the 2002 sentinel survey] - it was

clear we were not getting into Caprivi minds, " she told PlusNews.

An opportunity to tackle that dilemna came with an offer in 2002 by the

pharmaceutical company Bristol-Myers Squibb (BMS) to fully fund a new

community-based treatment model in an under-developed part of Namibia. " I

said 'Everything to Caprivi!' " Amathila recounted.

A NEW OPPORTUNITY

Last week the Mapilelo ('Place of Survival') project was formally launched

in Katima Malilo. The Cadillac of treatment initiatives, the three-year

programme includes a food and nutrition component, home-based care,

community mobilisation, voluntary counselling and testing (VCT), alongside

highly active antiretroviral therapy (HAART), and prevention of

mother-to-child transmission (PMCT).

" It is a community-based support model that moves away from treating

HIV/AIDS as a clinical problem, to treating it as a social problem; to

mobilise the community to understand the issues of treatment and care, "

explained Jerry Mameja, head of the New Dimensions Consultancy, which

manages the project.

The US $6 million project, which falls under the BMS 'Secure the Future'

initiative, aims to place 750 people on HAART over three years. The

antiretroviral (ARV) element, which began in January, already serves 260

people, has a high adherence rate and complies with the government's drug

guidelines.

Nationally 3,500 people currently receive ARVs through the public health

system with a government target of 5,000 by the end of 2005.

" The time of dying from AIDS is over, " declared Regional Health Director

Likando at the launch of Mapilelo.

The programme has already had an impact beyond the numbers on treatment.

Jane Wachira of Catholic AIDS Action said she had noticed a change in

people's attitudes from last year, when the first two women openly

declared their status and PMCT was made available.

" Speaking to people who say they now want to go for testing - they say if

you are positive, there is competition to be among the 750 who will

qualify for the drugs and free food, as they won't be able to afford it on

their own, " Wachira said.

Chirwa, Mapilelo's principal medical officer, acknowledged that " it's

still the tip of the iceberg, but when we started we wondered if people

would actually come. Now [the clinic] is packed like a market place. "

But a number of challenges remain. People are coming to register with

Mapilelo too late, when their immune system is badly compromised. Thirty

percent of those tested at the New Start VCT centre in town are

HIV-positive, compared with 80 percent at the public hospital, where the

clinic is based.

Women still are a noticeable majority of those attending the clinic. " The

men don't want to be associated, and women take the brunt of the disease -

most are widows who have lost their husbands and are feeling sick, "

explained Chirwa. " Pregnant women want to save their children. "

Likando stressed that men and their attitudes needed to be targeted in the

ARV rollout. " We have heard of incidences of men deserting their spouses

[whom they infected] when they heard they were HIV-positive. This remains

a major challenge. "

Caprivi has proved to be " one of the most difficult sites BMS is funding

at the moment " , said Mameja.

Not only is there an enduring faith in traditional medicine, but the

project found that the more respected healers came from neighbouring

countries, which complicated their cooption into the programme.

" There could be a problem with mixing treatments [a chemical reaction

between the ARVs and the herbal remedies] so we wanted to work together.

But because [the traditional healers] don't have work permits, they are

just not interested in being part of what we're doing, " said Mameja.

BUILDING SUSTAINABILITY

BMS found an active civil society when it came to Caprivi. Mapilelo pulled

together nine NGOs and development agencies to work on the social and

livelihood support aspects of treatment.

The Namibia Red Cross provides 600 volunteers for home-based care, and

delivers food parcels to clients for the first six months of treatment.

Africare helps with agricultural training to enable them to eventually

grow their own food, which includes providing seeds, poultry and goats.

Concern over the possible friction within communities that the

preferential assistance could generate has required preparation.

" We are aware of this possibility and that's why we consult the community

through their leaders very thoroughly before going on, " said Namibia Red

Cross operations manager, Abel Augustinio.

After the three years of BMS funding ends, the ministry of health is

expected to take over the treatment programme. But the food and nutrition

schemes are vital to Mapilelo's overall success, especially in Caprivi

where food insecurity can be a problem.

" We are hoping for the model to be self-sustaining by going into the

community to build capacity to grow their own food, " said Mameja.

In the meantime, Hilda, whose CD4 count is not yet low enough to qualify

for HAART, is cautiously upbeat about the easing of stigma in Caprivi.

" It's changing, it's better, but it's still difficult - people are still

hiding [their condition]. "

[ENDS]

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