‘Blessers’ a threat to Aids fight
There is a need to empower young girls
JB: What is your assessment of Namibia’s progress in terms of eradicating HIV/Aids?
ST: Namibia is one of the countries in the region that is progressing very well in terms of the Aids response. As former minister of health of Botswana we really shared whatever we did with the Namibian former health minister, Richard Kamwi. So the Aids response in Botswana and Namibia have always been on par and that is why we were the first two countries to reach 90% access to anti-retrovirals and 90% reduction of mother-to-child-transmission and the results are being shown.
Right now, Namibia is under 4% and Botswana is almost at 1%.
It was a parallel journey but Botswana started first. The Aids response is really great. The only thing that I think should be done in terms of improving is the maternal health. One of the high-level targets was eliminating new infections amongst children which are now being eliminated to 4%, but also keeping the mothers alive. The maternal mortality rate is still high; therefore there is a need to ensure that we do everything possible to ensure that the women stay alive.
So, ARVs are one of the answers but not the only one because we then need to know the nutrition situation of the women and what caused their death. All the causes that have to do with maternal mortality need to be improved so that we don’t have orphans.
JB: You recently mentioned that of the 2.7 million those aged between 15 and 24 are living with HIV in the region, 70% are female. In your opinion, what is driving this trend?
ST: Really, females still lack that capability to defend themselves and to really ensure they are not HIV infected. For example, in our situation, we teach young girls that they should be obedient to the older people. Except now, you know, the older people are taking advantage of them. You get situations where they say: ‘He said I should go and get water for him.
I did not know that he was going to rape me.’ So, you find that we need to socialise our girls to be assertive to be able to say, I do know you and will not do that.”
Also, a lot of our girls do not know a lot about their bodies let alone about HIV and Aids.
So that’s why at regional level we have what we call comprehensive sexuality education, it includes information which also teaches girls about their rights, how to refuse unsafe sex, how to say they will not get married.
We still have problems with early and forced marriages which are usually to an older adult who is already infected. So, it is a myriad of factors. Poverty is also a factor.
A girl who does not have school fees will succumb to an older guy who says he will pay school fees.
JB: The ‘Sugar Daddy’ phenomenon has been a prominent contributor to HIV infections in southern Africa in particular. Do you think there is a decline in this regard?
ST: It is not on the decline. The only thing that I am seeing that is on the decline is because of education a lot of girls will go into that situation but will say: ‘With me you are going to use a condom.’ In fact now, they are giving it nicer names – blesser.
That is no blesser. We need to really start empowering those girls, whether it is monetary or education. To ensure that at least they have that capability to say no to a blesser but at the same time if they do have a blesser to say sex will be with a condom, because [he] is probably blessing other people elsewhere.
JB: What do you mean when you speak of HIV-specific criminal legislation and why do you regard it as a barrier?
ST: In some countries HIV transmission is punishable and of course it is so hard to prove transmission. How are you going to prove for example that I had sex with you and you infected me when in fact I could have been the one with an infection?
There is no baseline. We are finding that once you do that, we are now criminalising a behaviour that we should be teaching people not to do. That thing goes underground and the response is not quite as good as it should be. I think what we need is just to ensure that people must know that you should not be sleeping with anybody unless you know their HIV status and yours. So far that message is not coming across. We have always said treat every sexual partner as HIV infected until you can prove otherwise.
JB: Namibia has been experiencing a decline in foreign investment for the fight against HIV. In your opinion, how can this impact the gains made by Namibia and how can Namibia close this gap?
ST: It would impact the gains made by Namibia or any country for that matter. Right now, 70% of the country’s Aids response is funded by Namibia itself. But you see, because of shared responsibility and global solidarity we know that the other 30% should be brought in by international partners. Now suddenly if that fell by the wayside Namibia would then say what we give up to find the extra. This is one area where we cannot say Namibia should just use that 70% and not bother about the 30%.
In the Aids response, not doing anything is more detrimental to doing shoddy work. Namibia will have to get money elsewhere. We do not know where.
They will now have to reprogramme. You really have to make real sacrifices. But where there is global solidarity you are able to make those sacrifices but knowing that you are not going to kill yourself. There will be other people to help.
JB: We have seen an increasing number of reports from sexual minorities complaining that they are discriminated against and denied access to health facilities. How can this affect Namibia’s reputation?
ST: The thing is nobody has ever been arrested for being a lesbian or being a man having sex with men. But we need to ensure that services which are already accessible to everybody should be specific enough that we train nurses or doctors to ask a client their sexual orientation. Because if they tell you that they are lesbian then, the kind of care that you are going to give is not the same as what you are going to give to a heterosexual.
If someone says to you I am a man and I have sex with men, you are going to make sure that even the examination will look at the anal area. When you are giving them supplies you will make sure that you give them condoms that have good lubricants but that is not what is happening in our healthcare systems. That is why they say they are left behind.
They sometimes find someone who is so biased whose response to them saying they are a man having sex with men would say ‘you are a what! Abomination, get out of here.’
You can imagine if I am going to a clinic and maybe they are giving a supply of condoms and I say I need 10, I need 20 because I am a sex worker. That is not just in Namibia.
There are other countries where sex work is not recognised. There are some countries in Africa where sex work is recognised and therefore, they have great services and they are able to get their supplies. And, not only that, they are made to teach others who sometimes are HIV negative how to stay negative.
JEMIMA BEUKES
ST: Namibia is one of the countries in the region that is progressing very well in terms of the Aids response. As former minister of health of Botswana we really shared whatever we did with the Namibian former health minister, Richard Kamwi. So the Aids response in Botswana and Namibia have always been on par and that is why we were the first two countries to reach 90% access to anti-retrovirals and 90% reduction of mother-to-child-transmission and the results are being shown.
Right now, Namibia is under 4% and Botswana is almost at 1%.
It was a parallel journey but Botswana started first. The Aids response is really great. The only thing that I think should be done in terms of improving is the maternal health. One of the high-level targets was eliminating new infections amongst children which are now being eliminated to 4%, but also keeping the mothers alive. The maternal mortality rate is still high; therefore there is a need to ensure that we do everything possible to ensure that the women stay alive.
So, ARVs are one of the answers but not the only one because we then need to know the nutrition situation of the women and what caused their death. All the causes that have to do with maternal mortality need to be improved so that we don’t have orphans.
JB: You recently mentioned that of the 2.7 million those aged between 15 and 24 are living with HIV in the region, 70% are female. In your opinion, what is driving this trend?
ST: Really, females still lack that capability to defend themselves and to really ensure they are not HIV infected. For example, in our situation, we teach young girls that they should be obedient to the older people. Except now, you know, the older people are taking advantage of them. You get situations where they say: ‘He said I should go and get water for him.
I did not know that he was going to rape me.’ So, you find that we need to socialise our girls to be assertive to be able to say, I do know you and will not do that.”
Also, a lot of our girls do not know a lot about their bodies let alone about HIV and Aids.
So that’s why at regional level we have what we call comprehensive sexuality education, it includes information which also teaches girls about their rights, how to refuse unsafe sex, how to say they will not get married.
We still have problems with early and forced marriages which are usually to an older adult who is already infected. So, it is a myriad of factors. Poverty is also a factor.
A girl who does not have school fees will succumb to an older guy who says he will pay school fees.
JB: The ‘Sugar Daddy’ phenomenon has been a prominent contributor to HIV infections in southern Africa in particular. Do you think there is a decline in this regard?
ST: It is not on the decline. The only thing that I am seeing that is on the decline is because of education a lot of girls will go into that situation but will say: ‘With me you are going to use a condom.’ In fact now, they are giving it nicer names – blesser.
That is no blesser. We need to really start empowering those girls, whether it is monetary or education. To ensure that at least they have that capability to say no to a blesser but at the same time if they do have a blesser to say sex will be with a condom, because [he] is probably blessing other people elsewhere.
JB: What do you mean when you speak of HIV-specific criminal legislation and why do you regard it as a barrier?
ST: In some countries HIV transmission is punishable and of course it is so hard to prove transmission. How are you going to prove for example that I had sex with you and you infected me when in fact I could have been the one with an infection?
There is no baseline. We are finding that once you do that, we are now criminalising a behaviour that we should be teaching people not to do. That thing goes underground and the response is not quite as good as it should be. I think what we need is just to ensure that people must know that you should not be sleeping with anybody unless you know their HIV status and yours. So far that message is not coming across. We have always said treat every sexual partner as HIV infected until you can prove otherwise.
JB: Namibia has been experiencing a decline in foreign investment for the fight against HIV. In your opinion, how can this impact the gains made by Namibia and how can Namibia close this gap?
ST: It would impact the gains made by Namibia or any country for that matter. Right now, 70% of the country’s Aids response is funded by Namibia itself. But you see, because of shared responsibility and global solidarity we know that the other 30% should be brought in by international partners. Now suddenly if that fell by the wayside Namibia would then say what we give up to find the extra. This is one area where we cannot say Namibia should just use that 70% and not bother about the 30%.
In the Aids response, not doing anything is more detrimental to doing shoddy work. Namibia will have to get money elsewhere. We do not know where.
They will now have to reprogramme. You really have to make real sacrifices. But where there is global solidarity you are able to make those sacrifices but knowing that you are not going to kill yourself. There will be other people to help.
JB: We have seen an increasing number of reports from sexual minorities complaining that they are discriminated against and denied access to health facilities. How can this affect Namibia’s reputation?
ST: The thing is nobody has ever been arrested for being a lesbian or being a man having sex with men. But we need to ensure that services which are already accessible to everybody should be specific enough that we train nurses or doctors to ask a client their sexual orientation. Because if they tell you that they are lesbian then, the kind of care that you are going to give is not the same as what you are going to give to a heterosexual.
If someone says to you I am a man and I have sex with men, you are going to make sure that even the examination will look at the anal area. When you are giving them supplies you will make sure that you give them condoms that have good lubricants but that is not what is happening in our healthcare systems. That is why they say they are left behind.
They sometimes find someone who is so biased whose response to them saying they are a man having sex with men would say ‘you are a what! Abomination, get out of here.’
You can imagine if I am going to a clinic and maybe they are giving a supply of condoms and I say I need 10, I need 20 because I am a sex worker. That is not just in Namibia.
There are other countries where sex work is not recognised. There are some countries in Africa where sex work is recognised and therefore, they have great services and they are able to get their supplies. And, not only that, they are made to teach others who sometimes are HIV negative how to stay negative.
JEMIMA BEUKES
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