Curbing HIV/AIDS along a transport corridor

"That [a condom] is a traveller's companion, just like the passport," said customs officer Joseph Matroos, pointing to a dispenser at the Ngoma border post in the Caprivi region on Namibia's northeastern border with Botswana. Though not an expert, Matroos is aware that the heavy traffic crossing the border has contributed to spreading HIV/AIDS. Ngoma, 40km east of the Caprivian capital, Katima Mulilo, is one of two border posts on the Trans-Caprivi highway linking landlocked Botswana, Zambia and Zimbabwe - where HIV infection rates are among the world's highest - with the deepwater port of Walvis Bay in Namibia. The second border post, Wenela, 5km north of Katima, is at the bridge across the Zambezi River, connecting Caprivi with Zambia. The bridge was opened in 2004 to facilitate trade from as far north as the Democratic Republic of Congo. Matroos said traffic into Namibia was increasing, partly because there was peace in its northern neighbour, Angola. "On a busy day we handle about 500 visitors," he commented, mostly traders from Zimbabwe and day visitors from Botswana, who cross over to see relatives on the Namibian side. The rest are long-haul trucks from either Zimbabwe or South Africa, visitors from Zambia and a few tourists. The increasing traffic has exposed the Caprivi region to countries with high levels of HIV infection and AIDS and, as a result, it has the highest prevalence of the disease in Namibia: 43 percent compared to a nationwide 22.5 percent, according to Dr Zengani Chirwa, chief medical officer at Ngweze State hospital in Katima Mulilo. Officials from the Social Marketing Association, the local affiliate of Population Services International, a global health NGO, regularly distribute condoms at Wengela border post. "We are here every day," said an official who identified herself as Martha. "We have to show the world that we are intent on curbing the spread of HIV." Wengela handles over 800 visitors and up to 15 trucks per day, most of them from Zambia, according to immigration officer Alfred Munalula. The Namibia Red Cross Society has started cross-border HIV/AIDS home-based care and prevention programmes in communities in Zambia's Sesheke district and Botswana's Chobe district, both bordering the Caprivi region. "We cannot rule out mobility as one of the determining factors in spreading HIV/AIDS in the Caprivi," said Caroline Thomas, HIV/AIDS coordinator for the Namibia Red Cross in Katima Mulilo. "The border posts between these three countries are constantly busy." The Red Cross has been targeting communities in Sesheke and Chobe, and since late last year has trained 43 home-based HIV/AIDS care providers from the three communities, who can also lead prevention initiatives and bring about changes in attitude and behaviour because of their links to the community. Although the Caprivi region has the highest HIV/AIDS infection in Namibia, Sesheke and Chobe are not much better off. According to the Red Cross, HIV/AIDS prevalence ranges from 30 percent among the adult population in the Sesheke district to nearly 50 percent in Botswana's Chobe district. The situation is perhaps most serious in Chobe, where the 50 percent HIV infection rate is far beyond the national prevalence of 39 percent, but health authorities report that new HIV cases have reduced in the past year, a tribute to an effective official campaign against the pandemic. The Botswana government opened a voluntary testing and counselling centre in 2004, coupled with a commitment to provide free antiretroviral drugs. Sesheke, on the Zambian side of the Zambezi River, has an estimated HIV prevalence of around 30 percent, but the Red Cross said the reality on the ground may be somewhat different, as there are no testing facilities at any of the district's three hospitals, nor is there any surveillance of lactating mothers, as in other parts of the country. "These people are all one and the same family," said Chief Liswani III, traditional leader of the Subiya people, one of two ethnic groups in the Caprivi region. "There is a lot of interaction and intermarriages in this region." According to Thomas of the Red Cross, more could be done to prevent the disease from affecting high-risk groups like truck drivers and commercial sex workers. Theuns Esterhuysen, safety manager of a Windhoek-based trucking company, commented, "We are governed by the health and safety regulations to ensure that each driver is healthy, [but] living a health lifestyle is one's own responsibility." Each driver was given condoms and HIV/AIDS prevention pamphlets "to read in his spare time". Stigma against commercial sex workers and HIV/AIDS is widespread in Caprivi, where the prevailing culture keeps women subservient and open discussion of sex-related issues is taboo. The Red Cross said it hoped to bring about a change in attitudes with the help of its awareness programmes.