A short cut to prevent spread of HIV?

DW: What is the current situation in Namibia with HIV/Aids?

Dr. Bernard Haufiku: We're getting there. Take the number of people who are on HIV treatment now. It's approximately 80-87 percent. About eight years ago it was far less than that. People are coming in for testing much more now, and people are living healthy lives much more than before. Then take mother-to-child transmission of HIV - 96 percent of babies born to HIV-positive mothers are themselves negative because of medical intervention. But we need to do more on prevention campaigns, especially information dissemination, involving the community, and taking advantage of every opportunity to [reach] people.

You talk about taking a human rights approach to the issue of HIV/Aids, and part of that is reaching young women, girls, and prisoners with your message. Is Namibia taking a leading role on this? Are you a leader for Africa?

Well, as a minister I am a political leader! But I go beyond that. I believe that leadership is about where you lead your people. We try to have initiatives that attract the interest of people. Sport, for instance, is a unifying strategy in the world. People don't go to the soccer field to kick and beat each other, they go there to enjoy the game. So we take advantage of that. When there's a football match, we distribute condoms. We give a message. We also work with musicians on circumcision. I personally have circumcised a musician. And the demand was unbelievable after that.

You circumcised a musician?…

Yes! And I can tell you who, too. We try to circumcise as many people as possible. But don't just cut them and let them go home. We come with a package of information. We tell them that just because you're circumcised now, it doesn't mean you're immune [to HIV] - you still have to use condoms correctly and consistently. So we tell them it just means their risk is lower when they're circumcised. We deliver our message through all of those platforms.

A strategy, not a vaccine

It's been said that male medication circumcision is like vaccination - not that it is a vaccine against HIV, but that we should take a similar approach to circumcision as we do to vaccines. Do you agree?

No, it's not a vaccination - it's a strategy to reduce the risk of your acquiring HIV. But, yes. When Professor Auvert from France carried out his study in South Africa, he found that 60 percent of these young men, who were circumcised, didn't get HIV. Professor Richard Bailey from America did it in Kisumu, Kenya, and came to exactly the same result. Now, in Makandu, we have a tribe that is traditionally circumcised, and when we looked at our figures there, they were the lowest in the country. So, clearly, circumcision prevents HIV transmission in a big way.

So should there be "male medical circumcision" days - just as there are vaccination days to raise awareness?

Yes, to reach our goal in terms of the number of people we want to circumcise, that would be an appropriate approach.

The cost of PrEP

Tell me more about your work in the field. You just called yourself a technocrat and suggested that politics was more a sideline profession…

Well, I didn't go to any campaign or electoral college. I was working in my practice. I've worked in a Catholic hospital in Windhoek for the past 15 years. I've seen a lot of patients with HIV, and I've seen a lot of other diseases. And somehow the president [Hage G. Geingob] heard about my hands-on approach. I think he needed someone with that approach. So he just took me out of my practice! It was quite a big change, but there I am. But I still operate, I still consult together with my doctors.
  
There has been a lot of talk at the World Health Summit about the HIV-prevention drug PrEP [Pre-exposure prophylaxis] and its cost. Even in Europe people are worried about the costs, although that seems absurd as we have comparatively high incomes, especially in view of the situation in some African countries, where access to medicines is a serious problem. What is your take on the cost of PrEP?

PrEP works. There's no doubt about that. I prescribed it to my patients when I was in the private sector. But in bigger programs in the public sector it becomes a problem. We haven't done a large trial modelling, but from what we extrapolate from outside, it's going to be costly. You could probably do better to give it to those who come for it, but don't make it a program and dish it out. We should still concentrate on other preventative measures. And we would mostly make that decision with a cost-benefit analysis.

So how do you feel about this idea of ending the HIV/Aids epidemic by 2030? Is there still a problem that we see it as an isolated issue, rather than include it general public health strategies, and would that hamper efforts?

Well, it is a big challenge. Remember we are now fighting HIV and other diseases within the context of the United Nations Sustainable Development Goals (SDGs). The SDGs have far more goals that the [earlier] Millennium Development Goals. There's a lot of competition from hunger eradication, empowerment… you name it. So we're going to have to be more innovative now to achieve that. It's modelled scientifically. It's known that if we pool our resources in the right way, we can eliminate it. But it'll require much more innovation and prudence.

Bernard Haufiku is Namibia's Minister of Health and Social Services and a practising health professional. He was a workshop speaker at the 2016 World Health Summit in Berlin.