Namibia marks HIV/AIDS wins but stigma puts LGBTQ+ people at risk

• Namibia nears global HIV/AIDS targets
• Young women, LGBTQ+ people left behind
• Sensitivity training for healthcare workers key

JOHANNESBURG/WINDHOEK - When Friedel Dausab tested positive for HIV in 1999, treatment was both scarce and expensive in his home country of Namibia. He found medical care a decade later, when he was armed with the language, confidence and contacts being an activist brought him.

Many others in Namibia still struggle to get the care they need as shame about the disease persists, even as the country has made major advances in reducing new infections and expanding treatment.

"When I learned I had HIV, I had a choice: to run into a hole and disappear, or stand up and say, ‘This happened, how can I make the best of it and help others do the same?’" Dausab, who lives in the city of Swakopmund, told Context.

A quarter-century later, he is still fighting for equal access to HIV testing, prevention and treatment for others living with the disease in Namibia.

HIV and AIDS remain the leading cause of death in Namibia, where some 230,000 people have the disease. But the southern African country of 3 million people is also seen as one of the most successful in slowing the spread of HIV, with experts crediting community-focused HIV prevention and treatment programs.

New HIV infections in Namibia fell by 54% between 2010 and 2022, according to data from UNAIDS, the United Nations’ main agency working on the epidemic.

But girls and young women, sex workers, men who have sex with men and trans Namibians are among population groups still at high risk for HIV.

Dausab said stigma is still a major obstacle to life-saving treatment for marginalised groups like LGBTQ+ people.

"Even though Namibia has free services and medications, if people can't get them, then it's almost like having a beautiful car without the key to drive it," he said.

'Innovative strategies'

Among the milestones Namibia has reached in the fight against HIV/AIDS is nearly eliminating mother-to-child transmission, the first country in Africa to achieve this.

The country is also close to meeting UNAIDS’ so-called 95-95-95 targets, in which 95% of people living with the virus should know their status, with 95% of those diagnosed receiving antiretroviral treatment. Among them, 95% should show viral suppression.

A long-running campaign to encourage circumcision – which has included enlisting Namibian Kwaito musician The Dogg to popularise the "Smart Cut" - has helped expand a voluntary medical male circumcision program that is covered by the public healthcare system.

Male circumcision reduces the risk of HIV by up to 60%, according to the Centers for Disease Control and Prevention. In the past year, 20,358 Namibians were circumcised, according to the U.N.

A 2023 estimate shows that 64% of boys and men between the ages of 15 to 24 have been circumcised, moving towards the target of 90% by 2028.

"Innovative strategies tailored to local contexts have been vital for our progress," said Rachel Love Gawases, executive director at Namibia's Equal Rights for All Movement, a sex-worker rights organisation.

Barriers to access

A lack of social acceptance towards certain groups and the difficulty of remaining anonymous create barriers to receiving HIV/AIDS care, activists say.

"We are a very small country, (in some towns) every nurse knows everyone. If you are HIV-positive, people are really scared of involuntary disclosure of their status and their sexual orientation," Dausab said.

"It's one thing to remove a barrier, (it’s) another to encourage people who for a long time have been hidden in the closet to come forward and to take up services.”

The HIV prevalence rate stands at 29.9% for sex workers, a recent UNAIDS survey showed. While there is no comprehensive data on transgender women's risk in Namibia, globally they are 20 times more at risk than the general population between the ages of 15 and 49.

The HIV prevalence rate for men who have sex with men (MSM) is 7.8%, below the rate of 9.7% for all Namibian adults aged 15 to 49, but MSM remain at far higher risk for HIV.

Low use of HIV prevention interventions and high rates of sexually transmitted infections are more common among MSM, which in turn increases the risk of acquiring and transmitting HIV.

Namibia decriminalised gay sex in June in response to a legal challenge brought by Dausab, but it has also intensified homophobia in the country, LGBTQ+ activists say.

The government filed an appeal notice in the Supreme Court.

"I think the dust needs to settle since the ruling, because since then it feels like the hate, stigma and violence (towards LGBTQ+ people) has increased," said Amy Maasdorp, a transgender nurse in the capital Windhoek.

Maasdorp, who became a nurse in 2017, said she is determined to be the healthcare provider she wishes her late friend had seen before he forewent treatment due to shame and died from an AIDS-related illness a decade ago.

Maasdorp has faced violence and discrimination, including being spit on and enduring hateful slurs, but continues to advocate for LGBTQ+ access to HIV/AIDS testing and treatment.

"I want everyone, no matter who they are, to feel safe enough to access these services without fear of judgment or harm," said Maasdorp, who has worked for mobile and public clinics, charities and private healthcare.

Government and grassroots funding should prioritise healthcare initiatives in rural communities, where services can be inconsistent, she said.

Local groups are working on sensitivity training for nurses, and the government acknowledges key populations like MSM need particular attention in the fight against HIV/AIDS.

More than 80% of the population accesses services in the public health sector, and the government funds more than 70% of the national HIV response, said Ben Nangombe, executive director at the Ministry of Health and Social Services.

Funding gaps

A decision by the U.S. Congress earlier this year to renew the President's Emergency Plan for AIDS Relief (PEPFAR), a two-decade-old funding initiative for organisations around the world, until 2025, instead of five years, has created new stresses for activists and healthcare workers.

PEPFAR has contributed over $1.1 billion to Namibian organisations fighting HIV/AIDS since 2003.

"Short-term funding can hinder long-term planning," said Gawases.

"This can disrupt essential programs that have been instrumental in reaching our targets," she added.

Continuity of what has been working well so far is key, said Steven Neri, regional director for Africa with the global health charity Project Hopes who is based in Windhoek.

"We can finish this, we are really close, this is our opportunity," he said.

This story is part of a series supported by HIVOS's Free To Be Me programme.

This story was updated on Tuesday September 24, 2024 at 14:29 GMT to include a comment from the Department of Health.

(Reporting by Kim Harrisberg in Johannesburg. Additional reporting by Lisa Ossenbrink in Windhoek. Editing by Sadiya Ansari and Ayla Jean Yackley.)