Remarks at National AIDS Conference in Swakopmund
Good morning. It is an honor and privilege for me to be present today at the first National AIDS Conference in Namibia. This is yet another milestone, made possible by the Ministry of Health and Social Services staff members, political leaders, partners and U.S. government staff who all contributed their time and expertise to make this conference possible. This milestone follows another achievement worth mentioning, namely the launch by UNAIDS Executive Director Michel Sidibé in Windhoek on November 21st of the World AIDS Day report, Get on the Fast-Track, the Life Cycle Approach to HIV.
UNAIDS could have chosen any country to host the launch of its World AIDS Day report, but it chose Namibia in order to recognize Namibia’s many successes and remarkable achievements in the fight against HIV and AIDS. Let me cite just a few examples:
- More than 70% of Namibians have been tested for HIV and know their status;
- HIV treatment is widely available across the country, and 67% of adults and 90% of children are on HIV treatment; and
- The Namibian government funds 65% of the national HIV response, demonstrating to the world its leadership and commitment to the Namibian people.
2016 has been another successful year for Namibia in its fight against HIV and AIDS. It is amazing to see and note the great strides Namibia has made in ensuring access to HIV treatment for all Namibians.
When the U.S. President’s Emergency Plan for AIDS Relief, better known as PEPFAR, began working with the Namibian government in 2003, this country had one of the highest HIV burdens in the world. More than 15,000 Namibians were getting infected with HIV each year. More than 30% of babies born to HIV-positive mothers were infected with HIV. And nearly 10,000 Namibians were dying from AIDS every year.
Thirteen years later, in 2016, fewer than 8,000 Namibians were newly infected with HIV; less than 5% of babies born to HIV-positive mothers became infected; and fewer than 3,200 patients will die from HIV/AIDS. The United States government is proud to have contributed to this success.
We are encouraged by the results, and we’re committed to continuing our close partnership with the Government of the Republic of Namibia in the fight against HIV and AIDS. The fight against HIV in Namibia has been a major investment for the United States, and it’s one we want to see succeed. Since PEPFAR’s inception in Namibia in 2003, the American people have contributed more than 1.1 billion US dollars for HIV/AIDS activities in this country.
My task today is to give you a brief overview of some of our collective accomplishments and of our planned activities with the Ministry of Health and Social Services. PEPFAR continues to support the Ministry in different areas with the overarching goal of helping Namibia to reach the UNAIDS 90-90-90 targets for HIV epidemic control.
To accelerate progress toward reaching those targets, in the past year we have increased our support of activities intended to promote decentralization of the provision of HIV testing and care services in the parts of Namibia where the burden of the disease is highest. Let me highlight a few of the things PEPFAR has been doing:
- We addressed the health care workforce shortage by hiring more than 400 health care workers in districts and urban areas with high HIV burdens throughout Namibia.
- We have provided pre-service and in-service training for clinical staff to build their capacity and increase the number of trained health personnel
in the regions. One key way we have done this is through Project ECHO, which was formally launched in October this year at the end of a 9-month trial period. ECHO, which stands for Extension for Community healthcare Outcomes, is a unique tele-health platform — the first of its kind in Africa. It provides weekly virtual training sessions to clinicians in high-burden districts across Namibia and creates a unique opportunity for in-service training for those working in remote areas.
- Because of Namibia’s vast distances between towns, remote clinic locations, and rugged terrain, PEPFAR recently provided 17 double-cab 4-by-4’s to the Ministry of Health and Social Services to assist with mobility of healthcare workers. PEPFAR also donated eight pre-fabricated clinics to the Ministry, and we will be donating 24 more in the next few months. Their purpose is to bring HIV services to those who need them, right in their communities. They spring from the vision that PEPFAR shares with the Ministry that, in order to achieve our common goal of epidemic control, patients living with HIV have to be able to receive quality care and quality testing close to their homes.
- PEPFAR Namibia is currently supporting more than 165 ART health facilities through clinical mentoring, supportive supervision, training, and data collection and reporting so that the facilities provide quality HIV services and in order to decentralize these services close to the community. Recently, we supported the deployment of 18 clinical mentors with expertise in HIV to train healthcare workers in HIV clinics on the best practices for HIV management.
- In April, the University of Namibia graduated its first cohort of locally trained medical practitioners. PEPFAR is proud to have supported Namibia as it launched the medical school and pharmacy degree training programs. Both will be critical to enhancing Namibia’s human and institutional capacity in health care.
- Over the past few years, PEPFAR has also supported acquisition by the Namibia Institute of Pathology of 11 high-volume HIV viral-load testing machines, which have been distributed across the country. This decentralized network of testing machines allows clinicians caring for patients with HIV to order the necessary laboratory tests and get the results quickly, which in turn informs their clinical management of patients. We are currently supporting a number of innovative strategies being developed by NIP to improve quick return of lab results to health care providers, which will lead to improved patient management. One of those strategies involved deployment in September at Engela and Onandjokwe of containerized laboratories provided to NIP by PEPFAR. As an indication of the success of PEPFAR’s work with NIP, in 2015 71% of all patients on antiretroviral therapy had access to viral-load testing as indicated in the Namibia national guidelines.
- PEPFAR Namibia has also provided care and support services for more than 9,000 orphans and vulnerable children affected by HIV/AIDS in order to mitigate the impact of HIV
- We provided technical assistance to the Ministry of Health and Social Services to develop and launch electronic health management systems, including the electronic patient management system, or ePMS, and the logistics management information system (or LMIS) dashboard to monitor and assess the essential medicines stock status at the regional and facility level.
- To ensure long term sustainability of our investment in Namibia, we are also supporting the Ministry of Health and Social Services to integrate HIV services into the health extension program and primary health care services.
These are just a few recent examples of what PEPFAR has been doing to contribute to the management and eradication of HIV and AIDS in Namibia. These activities build on our longstanding efforts to identify people living with HIV and ensure they start and remain on treatment; to prevent new HIV infections; and to care for vulnerable children and other people affected by HIV/AIDS. We have done this in close collaboration not only with the Namibian government but also with multilateral partners such as the Global Fund – the second-largest contributor to HIV/AIDS funding in Namibia – and of course, with UNAIDS.
From the beginning of our activities in Namibia, PEPFAR has also viewed civil society as a critical partner in achieving and sustaining epidemic control. I am very happy to see so many representatives from different CSOs participating today. This is not a fight reserved for the privileged few, the well-positioned or the infected. It is our collective responsibility to continue to work tirelessly and together to achieve sustainable epidemic control.
This National AIDS Conference is a clear indication of the abiding commitment of the Namibian government in general, and the Ministry of Health and Social Services in particular, to address HIV and AIDS in this country. The fact that the commitment is backed by strong political support and leadership makes the job easier for all of us involved in the fight. Without the Namibian government’s lead in the fight against the HIV epidemic, Namibia would not be among the very few countries that have a realistic chance of achieving the UNAIDS targets for HIV epidemic control by 2020.
This conference offers all of us an opportunity to make the most of our contributions to epidemic control. I want to urge all of you who are participating in the conference diverse sessions to engage actively in and contribute to the discussions. Share your experiences and best practices.
That is the best way to enlighten everyone participating on how we can collectively continue Namibia’s remarkable progress and do even better.
Some key areas to focus on include:
- Successful implementation of the Treat All approach;
- Improvement of treatment for pediatric and adolescent patients;
- Getting youth, especially adolescent girls and young women, tested and on treatment;
- Treating TB/HIV co-infected patients;
- Reaching key populations—sex workers, men who have sex with men, and LGBTI persons;
- And, reaching targets for VMMC
Those are just a few key areas that need our collective attention.
This conference has a broadly inclusive list of participants, not only researchers, but also program and service delivery professionals, staff from the government, the private sector, and donor community and civil society organizations who represent people living with HIV, and individuals who are HIV-positive.
My basic message to all the participants is simple: we won’t reach our common goal by pursuing business as usual. We need all of your perspectives to figure out what needs to be done in less than 500 days to achieve the UNAIDS target of 90% of all people living with HIV knowing their status, 90% of those diagnosed positive receiving anti-retroviral treatment, and 90% of the people on treatment living healthy lives with a suppressed viral load.
In closing, I want to commend the Ministry of Health and Social Services for convening this conference and providing all of you the opportunity to spend three rich and concentrated days focusing on your passion to end AIDS with compassion. I hope each of you will leave this conference with new ideas and a new commitment about how you can contribute to ending AIDS in Namibia.
Thank you!
