By Moses Magadza
WINDHOEK – The Country Director for the joint United Nations Programme on HIV and AIDS (UNAIDS) in Namibia has encouraged nurses working in Namibian Correctional Services (NCS) facilities all over the country to encourage inmates to voluntarily undergo HIV testing and to initiate those that need treatment early.
Alti Zwandor made the call at the start of a Provider Initiated Testing and Counseling (PITC) training for nurses working in correctional facilities that took place over five days in Windhoek and ended on Friday. UNAIDS partnered with the United Nations Office on Drugs and Crime (UNODC) – which served as technical lead –, the Ministry of Health and Social Services (MoHSS), the Centre for Disease Control (CDC), the International Training and Education Center for Health (I- TECH) and the Namibia Institute of Pathology (NIP) to organize the training that drew 34 participants.
The training followed another one that UNAIDS supported a fortnight ago to train NCS nurses to initiate inmates living with HIV on antiretroviral therapy (ART). The just-ended training sought to build the capacity of participants to, among other things, initiate PITC, perform HIV rapid testing, perform HIV re-testing before ART initiation, ensure quality assurance and link clients to prevention, care and treatment services effectively and timeously.
Zwandor said PITC was a prerequisite for successful prevention and management of HIV infection.
“PITC is an entry point for treatment and prevention,” she said.
The world had set ambitious targets to ensure that by the year 2020 90% of all people living with HIV will know their status, 90% of all people diagnosed with HIV will receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have viral suppression. Namibia is one of the few countries that have reached these targets ahead of schedule. Zwandor said while this was commendable, there was need to avoid complacency because the evidence on the ground shows that there is still more to be done.
“The achievement on 90-90-90 is neither universal nor uniform. Some regions are way ahead of others and certain population groups are way ahead of others,” she said.
The recent Namibia Population-based HIV Impact Assessment (NAMPHIA) report shows that despite progress made in responding to the global HIV epidemic, there are still approximately 4500 cases of HIV infection annually among adults aged 15 to 64 years in Namibia.
The report also states that although more people are now accessing treatment, that acess is not uniform. It cites Kunene as one of the regions with low access to treatment and with very for viral load suppression.
“We know that when patients are not virally suppressed, there is a high risk of transmission of the virus. Initiating people on treatment is important but it is even more important that we keep people on treatment. High enrollment into treatment, low retention and low viral load suppression equals catastrophe,” she warned.
Zwandor said it was laudable that Namibia, through the NCS, was building the capacity of human resources for health to better manage the health of people in incarceration given the unique challenges that people in such settings face across the world.
“Globally HIV prevalence among people in correctional facilities is much higher than the general population with incarcerated people on average five times more likely to be living with HIV compared with those outside.”
She cited risky behaviors such as sharing needles and syringes, unprotected sex, sexual violence and lack of access to comprehensive HIV prevention and harm reduction services among factors that put people in correctional facilities at a heightened risk of HIV and other infections.
Despite the relative ease of reaching people within correctional services, she said HIV services were not provided in correctional facilities in many countries due to various factors that include the absence of facilities and a limited capacity of health professionals to provide these services with the requisite confidence and assiduity.
Zwandor said the shortage of up to date and disaggregated data on HIV services provided in correctional facilities made it difficult for anyone to appropriately respond to the challenges and needs of people in incarceration.
“A recent review of country reports submitted to UNAIDS in the last three years shows gaps in comprehensive programming in correctional facilities in most countries. The report found that while 183 countries reported HIV testing in correctional facilities, only 74 countries reported programme data on antiretroviral therapy coverage. Much fewer countries reported programme data on comprehensive programmes that include services such as the provision of condoms, opioid substitution therapy and sterile injecting equipment in correctional facilities,” she said.
Zwandor told participants that a meeting of Ministers from the 28 Global HIV Prevention Coalition (GPC) countries with the highest HIV burdens that met in Nairobi, Kenya on November 11, 2019 was scathing in its assessment of progress towards achieving the 2016 Political Declaration on prevention target of 75% reduction in new HIV infections in all countries by the year 2020.
“The reference point or baseline was the new infections recorded in 2010. The GPC Ministerial Review Meeting’s conclusion was summarized in two words – off track,” she said.
She expressed optimism that the training would equip participants with the necessary skills and tools to provide comprehensive quality HIV services at all correctional facilities in the country.
“It is important that we scale up HIV testing services within correctional facilities and strengthen the integration of Sexual Reproductive Health and Rights and HIV services at all facilities,” she said.
Commissioner Ottilie Kovalola, the Head of the Health Care Directorate in the NCS, also welcomed the competency-based training.
“We cannot treat HIV if we have not diagnosed people. We cannot diagnose properly if we do not have appropriate knowledge and skills.
We cannot test anyone if we do not have knowledge on counseling before and after testing. This training will enable us to assist those of our offenders who need treatment to access treatment and be properly managed before being linked to outside health facilities,” she said in remarks made on her behalf by Deputy Commissioner Tony Lubindi, aSenior Medical Officer in NCS.
-Moses Magadza is the Communications Officer for the Pretoria-basedUNODC Regional Office for Southern Africa.