HIV treatment breakthroughs: Namibia’s success story

Anna Engomba found out she had HIV, the virus that can lead to AIDS, in 2006. Due to the stigma surrounding the infection at the time, she did not want to share this life-changing diagnosis with anyone, not even her mother.
“When you see people are talking there, you will think that maybe they are talking about you. You will think that everyone knows that you are HIV positive,” the 39-year-old Namibian told DW, “I was just alone.”
She told DW that she became pregnant and gave birth in 2009.
“I dropped out of school, and this stopped my education. At that time, it was not even easy to get medication,” she said, fighting back tears.
Engomba is just one of around 40 million people who have HIV, according to the World Health Organization (WHO) — almost 26 million of whom live in the WHO’s Africa region.
In the 1990s, many people considered a HIV diagnosis a death sentence because of the limited available treatment options. 
While the numbers of people with HIV remains high, treatment and preventative medications have made significant gains, especially in Namibia. 
Antiretroviral drugs, for instance, which suppress the virus and prevent it from replicating, are successfully used to treat HIV infection.
“Many HIV-positive women who have become pregnant have opted for getting preventative therapy so that the virus is not transmitted to the unborn babies,” Alfred Besa, an expert on HIV/AIDS and a consultant with the NGO Humana People to People, told DW.
HIV/AIDS is the leading cause of death in Namibia. About 230,000 people have HIV and AIDS in a nation of just around 3 million.
But Namibia’s community-based HIV education and prevention schemes have received credit for slowing down infection rates by 54% between 2010 and 2022 according to UNAIDS, the United Nations’ main agency working on the disease.
“Namibia is on the verge of eliminating the transmission of HIV from mother to child. I mean, what else can you wish for?” he added.
Anna Engomba, for instance, has three children, and due to advancements in preventing mother to child transmission, she said her children are all HIV negative.
At the 2024 International AIDS Conference in Munich, researchers presented promising results from ongoing studies. Germline targeting, for instance, trains the immune system to generate several types of HIV broadly neutralizing antibodies (bNAbs), which are crucial for a preventive vaccine.
But in terms of HIV preventions, there is already another groundbreaking drug called lenacapavir. The anti-HIV compound is already in use, but getting the drug to those who need it most could prove tricky.
“People with economical value to countries have been lost and you have orphans. You have families getting affected because the breadwinner is no more,” said Besa.
This month, US-based biopharmaceutical giant Gilead Sciences said it had signed licensing deals with six drugmakers to produce and sell generic versions of its HIV prevention medicine in 120 lower-income countries.
Gilead also plans to provide its branded version of the drug, lenacapavir, in 18 countries, such as Botswana, Ethiopia and Kenya, until they set up manufacturing capacity and can fully support demand. These countries represent about 70% of HIV cases.
Crucially, researchers estimated that lenacapavir — which costs patients more than $40,000 (around €37,000) per person a year in several countries — could be manufactured for as little as $40.
Another benefit is that the drug only needs to be injected twice a year, making it much easier to administer than current regimens that require daily pills. For Engomba, this particular aspect would be a game changer, and not just for the ease of taking the medication.
“It would take away some of the stigma of the disease,” she told DW.    
Liverpool University researcher Andrew Hill told media that if the drug was given to people at high risk of contracting HIV, it could “basically shut down HIV transmission.” International health agency Unitaid, hosted by the WHO in Geneva, said it was “prepared to invest immediately and collaborate to fast-track access to lenacapavir.”
Licensees include companies in India and Pakistan, according to Gilead. Based on data from its trials, Gilead said it is beginning a series of regulatory filings by the end of 2024.
“The agreements were signed in advance of any global regulatory submissions to enable these countries to quickly introduce generic versions of lenacapavir for HIV prevention, if approved,” it added, refering to the six licensing deals.
The company is also prioritizing registration in 18 high-incidence countries including Ethiopia, Kenya, South Africa, Thailand and Vietnam, to provide Gilead-supplied lenacapavir until generic versions are available.
But girls and young women, sex workers, men who have sex with men and transgender Namibians are among population groups still at high risk for HIV. A recent UNAIDS survey showed the HIV prevalence rate stands at 29.9% for sex workers in eastern and southern Africa.
While there is no comprehensive data on transgender women’s risks in Namibia, globally they are 20 times more at risk than the general population between the ages of 15 and 49, according to figures from UNAIDS. 
Friedel Dausab, a Namibian activist who successefully challenged the criminalization of same-sex sexual activity in Namibia, said stigma is still a major obstacle to life-saving treatment for marginalized people, such as those who identify as LGBTQ+. 
“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 told the Thompson Reuters Foundation.
Eddy Micah Jr contributed reporting
This article has been adapted from an episode of DW’s AfricaLink, a daily podcast packed with news, politics, culture and more.