CORRIDORS OF MOBILITY

Mobility and HIV vulnerability factors in four sites along transport corridors in

International Organization for Migration (IOM) Regional Office for Southern Africa Partnership on HIV and Mobility (PHAMSA)

in partnership with

The Institute for Public Policy Research (IPPR) Namibia Dr Debie LeBeau, Research Consultant

ACKNOWLEDGEMENTS The International Organization for Migration wishes to thank the following people for their contributions to this publication: • Daniel Motinga and Renata from the Institute for Public Policy Research (IPPR) for the overall administrative management • Barbara Rijks (IOM) for overall project management • Christiaan Keulder who was the project coordinator and co-researcher for and analysed and created the maps in Arch-view • Field researchers: Martin Shapi (Field Site Supervisor) and Christine Shilima (), Djaupyu Siteketa (Field Site Supervisor) and Mulemwa Likando (), Simon LIipinge (Field Site Supervisor) and Veronica Naukushu (Oshikango and Walvis Bay) • Geo Business Solutions for creating the base maps, entering the site map data, producing site maps and compiling the map database • Suzanne LaFont from the Legal Assistance Centre (LAC) and Katy Barwise (IOM) for editorial input • Background sections in this document borrow liberally from LeBeau and have been utilised with the author’s full permission. Interview data were transcribed, translated and/or verified by Fransina Ndateelela Kahungu, Renata de Wee, Faroza Eberenz, Djaupyu Siteketa, Veronika Naukushu, Simon Iipinge, Martin Shapi and Vincent Mwange. Grant J. Spence and Gudrun Reimers reviewed the transcriptions for English accuracy and consistency of meaning. • IPPR and IOM would like to thank the informants and stakeholders who participated in the field research upon which this publication is based. The staff at the various Social Marketing association (SMA) offices provided invaluable assistance and opened many doors for further research opportunities.

TABLE OF CONTENTS

Table of Contents ...... ii 1. List of Figures ...... ii List of Abbreviations ...... iv Executive Summary ...... v Part One: Background ...... 8 2. Introduction...... 8 3. Research Methodology ...... 10 4. Migration and HIV in Namibia ...... 19 Part Two: Findings ...... 23 5. Research sites...... 23 6. Sex Workers ...... 36 7. Truck Drivers ...... 41 8. Fishermen ...... 44 9. Informal traders ...... 48 10. Responses to the HIV pandemic in research sites ...... 50 Part Three: Recommendations and References ...... 55 11. Recommendations ...... 55 12. References ...... 57

LIST OF FIGURES

Figure 1 Multi-Level causes of HIV vulnerability ...... 8 Figure 2 Drawing an Informant Map ...... 11 Figure 3 Example of an Informant Map from Katima Mulilo ...... 12 Figure 4 Interviewing a stakeholder in Oshikango ...... 13 Figure 5 Trans Caprivi Corridor (Source: North Star Foundation, Geographical Analysis of potential HIV/AIDS wellness centres, Mark de Blois, Dr Andrew Thow)...... 17 Figure 6 Overall Map of Walvis Bay ...... 23 Figure 7 Walvis bay Harbour ...... 24 Figure 8 The SMA at the entrance to Walvis Bay Harbour ...... 24 Figure 9 The New Bridge at Katima Mulilo ...... 26 Figure 10 Ariel Map of Katima Mulilo ...... 27 Figure 11 Truck Stop and Sex Worker Movements...... 28 Figure 12 Overall Map of Rundu...... 29 Figure 13 The River is Part of Life ...... 30 Figure 14 Map of Shebeens along the Trans-Caprivi Highway...... 31 Figure 15 Rundu Open Market...... 31 Figure 16 Community Member's perception of Rundu ...... 32 Figure 17 Informal Traders in Oshikango ...... 33 Figure 18 Overall Map of Oshikango ...... 34 Figure 19 Truck Loading area, Oshikango...... 34 Figure 20 Sex Worker "Hang outs" in Oshikango ...... 35 Figure 21 Interview with Sex Worker...... 38 Figure 22 Map of Rundo "Hotspots"...... 39 Figure 23 Truck Ports Katima Mulilo and Oshikango...... 42 Figure 24 Oshikango Truck Ports with nearby services ...... 42 Figure 25 Risk Taking Behaviour in Walvis Bay ...... 45 Figure 26 Sex Worker's Cognitive Map of Vulnerability and Help...... 47 Figure 27 Informal Traders in Rundu ...... 48 Figure 28 Sites if Vulnerability and Care and Support ...... 52 Figure 29 "Fishermen are so Far Behind" ...... 54

LIST OF ABBREVIATIONS

ACT AIDS Care Trust AIDS Acquired Immune Deficiency Syndrome ALU AIDS Law Unit (part of the LAC) ARV Anti-Retroviral CAA Catholic AIDS Action CAD Computer Assisted Drawing CBD Central Business District CBO Community Based Organisation CCN Council of Churches in Namibia COH Corridors of Hope EPZ Export Processing Zone FBO Faith-based Organisation HDI Human Development Index HIV Human Immunodeficiency Virus HPI Human Poverty Index IEC Information, Education and Communication IOM International Organization for Migration IPPR Institute for Public Policy Research LAC Legal Assistance Centre MLG&H Ministry of Local Government and Housing MoHSS Ministry of Health and Social Services MPYC Multi-Purpose Youth Centre NACP National AIDS Control Programme NASOMA National Social Marketing Association NDF Namibian Defense Force NGO Non-Governmental Organisation NPC National Planning Commission NZPC New Zealand Prostitutes Collective OVC Orphans and other Vulnerable Children PHAMSA Partnership on HIV and Mobility in Southern Africa PLAN People’s Liberation Army of Namibia SADC Southern African Development Community SADF South African Defence Force SMA Social Marketing Association SRH Sexual and Reproductive Health SWAPO People's Organization (Party) TB Tuberculosis UNTAG UN Transitional Assistance Group VCT Voluntary Counselling and Testing WCPU Women and Child Protection Unit EXECUTIVE SUMMARY

This assessment gathered and analysed qualitative data about factors affecting HIV vulnerability in four cross border sites in Namibia: Walvis Bay, Katima Mulilo, Rundu and Oshikango. The main purpose of this assessment was to assist IOM’s Partnership on HIV and Mobility in Southern Africa (PHAMSA) to identify gaps and develop evidence-based prevention and care programmes in areas of vulnerability along corridors of mobility in Namibia. Through literature review, site-mapping, non-structured interviews with informants and stakeholders and ethnographic observations data was gathered.

FINDINGS BY SITE

Walvis Bay Mobile and related populations in Walvis Bay include fishermen, truck drivers and commercial sex workers. In Walvis Bay truck drivers stay for one or two days while waiting for goods to be loaded onto their trucks. In Walvis Bay there are both foreign fishermen and Namibian fishermen. These fishermen are vulnerable to HIV because they report a high frequency and numbers of sexual partnerships with sex workers. Most foreign fishermen meet sex workers at nightclubs and bars located in and around the harbour area. Local Namibian men also spend long periods of time at sea leaving their partners alone in town. An additional contributing factor to HIV vulnerability in Walvis Bay is the high number of sex workers’ clients who refuse to use condoms. Katima Mulilo In Katima Mulilo, mobile and related populations include truck drivers, sex workers (cross border and internal), uniformed government officials, and informal cross-border traders. The informal movement of people across the River, as well as its proximity to neighbouring countries, make Katima Mulilo (and the entire Caprivi Region) an area of high vulnerability. Truck drivers transit through Katima Mulilo to other destinations and often do not stay in Katima Mulilo for more than a day or two. They usually meet sex workers in the truck parking areas at petrol stations on the outskirts of town. There are also a substantial number of government officials (include police officers, nurses and military personnel) who are not from the area. As is true for other areas, these officials are typically sent without their families thus making them vulnerable to HIV. Rundu In Rundu the primary mobile and related groups are sex workers and informal cross- border traders. Truck drivers are not likely to overnight in Rundu, but use it as a resting point before crossing the . Clients of sex workers include truck drivers, uniformed government officials including military personnel (both Namibian and Angolan) and businessmen who are not permanently in Rundu. The majority of HIV risk-taking occurs in nightclubs and bars in town between sex workers and these temporary residents. A large number of highly mobile informal traders come to Rundu. Some come from other parts of Namibia, while others cross the border from to sell their food and homemade products so they can buy manufactured goods to take back home. One prominent feature in Rundu, identified as a site of HIV risk-taking, is its large open market with about fifty stalls where there are clothes and food stalls as well as small beer stands and pool tables for entertainment. Oshikango In Oshikango, mobile and related populations include truck drivers, informal traders and sex workers. Many informal traders – mainly cross border traders from Angola - come to Oshikango to buy and sell goods. Truck drivers transiting through Oshikango on their way to Angola sometimes wait for up to seven days for their goods to clear customs or for their Angolan counterparts to collect the goods for transport into Angola. While waiting, truck drivers frequent bars and make use of the services of sex workers. The presence of truck drivers adds to increased HIV vulnerability of sex workers in Oshikango. Some adolescent girls drop out of school and come to Oshikango from neighbouring villages to engage in sex work or to look for men to support them.

FINDINGS BY GROUP

Sex Workers Sex workers in the various sites come from a range of Namibia’s ethnic groups, while sex workers in Katima Mulilo (and to a lesser extent Rundu) also come from Namibia’s bordering countries. Most sex workers have children or siblings to support. Informants in most research sites report that there are different types of sex workers – typically described as ‘professionals’ or higher-end, local sex workers and ‘low class’ streetwalkers. However, the criteria for inclusion into one group versus another vary by site. In all research sites, there are women participating in sex work who also have employment in the formal sector. Most of these women are low paid counter clerks, bartenders or traders who supplement their income by doing sex work. Many sex workers have a boyfriend or are married. Sex workers view what they do as temporary. They say they would like to get married and to have a ‘normal’ life one day. Clients of sex workers are often foreign or Namibian fishermen, truck drivers as well as travelling businessmen and uniformed government officials. Fishermen In terms of fishermen, this report specifically examines men who migrate to Walvis Bay or foreigners who take shore leave in Namibia. Foreign fishermen typically go to nightclubs to seek the company of sex workers. Several informants state that foreign fishermen in Walvis Bay have high HIV vulnerability because they are more likely to have unprotected sex with sex workers than Namibian fishermen who accept condom use because they know Namibia has high HIV prevalence rates. Informal traders In the border sites of Oshikango and Katima Mulilo, there are foreign cross-border traders who sell their goods in Namibia or, more often, who come across the border to purchase consumer goods and then return to their home country to sell these goods. Many foreigners cross the borders into Namibia for personal reasons such as to visit friends and family, as well as to make use of services in Namibia that are not readily available in their own country. Female informal cross-border traders face a number of risks, including being sexually harassed by border personnel. Female cross-border traders have far less power and assets with which to negotiate and are thus more likely to be exploited. It is difficult to determine HIV vulnerability among informal cross-border populations because unlike sex workers, who openly discuss their sexual behaviour, cross-border traders (especially women) are typically conservative and do not feel comfortable talking about issues related to sex. Truckers Truckers are found in all four research sites. Approximately 150 trucks pass through Walvis Bay each day where they usually do not stay for more than a day or two while waiting for goods to be loaded of and on to their trucks. Therefore, Walvis Bay is a short transit site for truck drivers who reportedly mostly sleep in their trucks to avoid the expense of a room. With regard to the Caprivi Strip, the new bridge that was finalised in 2004 and crosses the Zambezi River into Zambia, and the reopening of the Trans-Caprivi Highway in 2003 – after it was closed in 1999 due to bad security - has made cross- border trade between Zambia and Namibia easier and cheaper. Currently many of the trucks coming through Katima Mulilo carry goods from Walvis Bay to countries in the interior of southern Africa. Truck drivers transiting through Katima Mulilo usually do not stay for more than a day or two. In Rundu truck drivers are not as likely to stay overnight, but use it as a resting point before crossing the Caprivi Strip. There is only one significant truck stop in town which is located at the intersection of the Trans-Caprivi Highway and the main road through town. Truck drivers transit through Oshikango on their way to Angola and often have to wait a number of days for their goods to clear customs or for their Angolan counterparts to collect the goods for further transport into Angola.

PART ONE: BACKGROUND

1. INTRODUCTION

In Namibia migration is a significant contributing factor to the spread of HIV (Winterfeldt, 2002). The fragmented social and sexual networks apparent in rural and urban social and familial links, in combination with the social and economic environment in which migration takes place in Namibia, puts migrants and their families at risk of HIV infection (LeBeau, 2004). This research is part of a regional IOM HIV prevention programme that focuses on population mobility in southern Africa - the Partnership on HIV and Mobility in Southern Africa (PHAMSA). One of the programme components is to implement research in previously unexplored areas of HIV vulnerability. Through previous research IOM identified three different levels at which HIV vulnerability is evident, and can be addressed (see figure 1). Figure 1 Multi-Level causes of HIV vulnerability • Unbalanced distribution of resources • Unemployment in rural areas Labour Migration • • Gender inequality

Structural Level

Environmental Level

• Low knowledge basic facts HIV transmission Individual Level

• Low levels of consistent condom use • High levels of multiple, concurrent sexual partners • Conditions related to the migration process (‘negotiating’ borders) • Direct living and working conditions • Lack of access to health services and HIV/AIDS programmes,

• Lack of healthy recreational options • High levels of fatalism/low self esteem IOM conducted two information gathering missions in 2004 to Namibia, one focused on the southern part along the Orange River and assessed HIV vulnerability patterns among migrant contract workers on grape farms, the second focused on the northern border between Namibia and Angola, in particular Oshikango. The results of these missions determined that there is very little information available in order to start effective HIV prevention programmes targeting mobile and migrant workers in communities where they live, work and move through. In particular, IOM identified the need for qualitative research on HIV vulnerability in strategic geographical areas of mobility in Namibia. The objectives of this study are to: • Understand and describe HIV vulnerability at all four research sites (Walvis Bay, Katima Mulilo, Rundu and Oshikango); • Develop local site maps of HIV vulnerability factors; • Identify and analyse patterns and relationships and understand causality between mobility and HIV vulnerability; and • Present the findings - with recommendations for programme planning - with local site mapping as the primary focus of analysis.

2. RESEARCH METHODOLOGY

The following qualitative research methods were used: ƒ Literature review ƒ Site-mapping ƒ Non-structured interviews with informants and stakeholders ƒ Ethnographic observations Qualitative data were gathered in order to complement quantitative data that are already available, and establish the evidence base needed to start comprehensive HIV prevention and care programmes in areas if high HIV vulnerability.

Literature review Different literature was reviewed to present the background section on migration in Namibia, HIV dynamics and site-specific information.

Site Mapping Two types of maps were produced as part of this exercise: 1) overall site maps and, 2) informant maps. For each research site one overall site map and at least five informant maps were produced. Overall site maps: Overall site maps were developed in order to have up-to-date reliable information about the geography of each site and to be used as a basis for and comparison with the maps produced by informants. The development of the overall site map was an evolving project and revised through the course of the study as the field researchers learned more about each site. Existing maps of the research sites that could be used for the purposes of this study did not exist. In addition, the use of the Global Positioning System (GPS) to plot points onto existing maps was not accurate as points were recorded in the wrong locations. Therefore, field researchers were given a composite map of an aerial photograph overlaid with the town planning Computer Assisted Drawing (CAD) map. The field researchers walked and drove around the site while numbering relevant features such as truck stops, bars, locations that sex workers frequent, and open fields. They subsequently created a legend for each number. The maps and legends were then given to Geo Business Solutions, a professional mapping service, which entered the legends into the computer and fixed their location on the maps to create a database that could be manipulated to superimpose data points onto the aerial photograph/town planning maps. Points were then plotted in various ways to examine the spatial relationship of the data points to other features. When patterns emerged the maps with relevant data points were produced for analysis and publication. Each field researcher followed the following steps to create overall site maps. . • Step 1: Note industrial, commercial, residential, agricultural and other land use areas. • Step 2: Drive or walk around each sub-division and number buildings, make a legend in a notebook with the meaning of the numbers. • Step 3: Make notes as to prospective areas for research (nightclubs, ports, etc) and points for further investigation. Also note areas where the map differs from what is really there (building torn down, new ones erected, expansion of informal settlements, etc.). • Step 3: Consult with stakeholders in the community as to risk-taking behaviour in the area. • Step 4: Drive or walk back through the sub-divisions with informants and/or stakeholders asking them to identify points to be mapped or revised. • Step 5: Talk to informants in the community about what they believe are areas of sexual risk-taking and where one can get HIV information.

Informant maps Informant maps were developed to gather information about informants’ perceptions of sites of HIV vulnerability. These were created by asking informants to draw a map of the area in which they live or work, then use colouring pencils to draw areas which to them represent areas of HIV vulnerability and risk-taking and also health-seeking locations, such as clinics, VCT centres etc. They were given basic directions and assisted by the researcher when necessary.

Figure 2 Drawing an Informant Map In some sites field researchers drew the major infrastructural features - such as roads - onto paper and asked informants to fill in the map. In other sites informants drew all features on the map. The informants decided what was included on their maps. Some informants drew very detailed maps, while others drew overall maps of their area. The maps were scanned into the computer, digitally enhanced for clarity, and analysed for trends and important data. The following figure shows an informant map of Katima Mulilo – illustrating the movements of sex workers from arriving in taxis, to meeting clients at a local inn and then going with clients to the veld (shown here as grass and trees) to have sex.

Figure 3 Example of an Informant Map from Katima Mulilo

Interviews with informants and stakeholders The selection of informants and stakeholders was flexible and left to the judgement and creativity of the field researchers. However, field researchers were given a list of possible stakeholders and informants who could be targeted within each site. Stakeholders included local branches of the Social Marketing Association (SMA), community and peer educators, NGOs, CBOs working on HIV and AIDS prevention and care programmes, business owners (such as shebeen and nightclub owners or employees), border officials (police, immigration and customs officials), school personnel (school teachers, principles, and learners), military personnel and community or traditional leaders. Usually informants were found using a snowball sampling method whereby once one informant was contacted and interviewed, they were asked to identify other informants. Some of the informants provided entry points for interviews not otherwise easily obtained (such as the SMA assisting in an interview with military personnel and police).

Figure 4 Interviewing a stakeholder in Oshikango The study targeted groups working, living and passing through the research sites, such as truck drivers, fishermen (Namibian and foreign), sex workers, factory workers, informal traders, uniformed government personnel (such as military workers and police officers), and irregular migrants (for business, family or sex work). Community members who frequently have contact with mobile populations passing through the sites include shop and bar owners, bartenders, lodge managers, customs officials and police were also targeted. There was no formal questionnaire or set of specific questions for any target group. Instead, a list of information needs was derived from the literature review and modified for the relevant population groups living in and moving through the four sites (Wilson 2001; Fung 2004). Field researchers were instructed to collect any of the information needed from all relevant sources and to be creative in experimenting with alternative data collection methods. This methodology was used to give informants the ability to address their own areas of concern, free of the confines of a structured questionnaire, and for researchers to follow lines of questioning as topics arose. It was anticipated that this methodology might produce a fresh perspective on issues relating to HIV and AIDS. The only restriction for field researchers was that they had to interview a minimum of five informants from the list of target groups. Between seven or eight informant interviews were completed for each field site.

Topics discussed during the interviews with informants were: ƒ site details such as the location of government and civil society organisations, including NGOs and CBOs providing social services etc; ƒ locations for sexual risk-taking behaviour, groups with increased sexual risk-taking, and socio-economic and cultural factors that are unique to the site; ƒ details about sex workers such as demographics, condom use, bars, streets and hotels where sex workers operate, prices charged by sex workers (such as per session or per night), and type of clients; ƒ details about clients of sex workers such as their demographics, condom use preferences and treatment of sex workers; ƒ information on transactional sex (sex in exchange for goods or favours) such as where it is taking place, the people involved, and what ‘rules’ exist in these exchanges; ƒ location of where migrant and mobile populations such as truck drivers, fishermen, factor workers, informal traders and other irregular migrants stay overnight and venues they frequent; ƒ details about irregular migrants such as where they come from, their purpose for migration (family, sex work, informal trading, etc.), social and economic characteristics and sexual activity with community members; and ƒ attributes relating to orphans and street children (especially girls living in child-led households) such as their socio- economic situation, why are they in vulnerable situations, sources of support, their HIV risks and their suggestions for way to protect them from physical including sexual abuse and HIV infection.

Ethnographic Observations As with the interviews, field researchers were given a list of observation points to guide ethnographic observations. Field researchers were instructed to go to sites of HIV risk-taking, such as bars where sex workers can be found, and observe behaviour and interactions of the target populations. When appropriate, researchers were instructed to photograph sites of sexual risk-taking such as hangouts for sex workers, truck stops/layovers, bars, shebeens (also known as cuca shops), military bases, border routes and informal settlements. The text box below is an example of the types of participant observations conducted.

While in Walvis Bay conducting the preliminary field testing for our research methodology we were informed that a foreign fishing vessel had come into the port and that the fishermen and the sex workers would be found that evening at one of the night clubs. We arrived at Club Energy. After some time a few women drifted into the bar to ask for a cigarette, hung around for a minute and then left. The bar tender told us that these were some of the local sex workers and they were going from bar to bar to see if they could find the men from the ship. I told her that the next time they came in she should give them a beer from me. The girls came back and were given their beers. They thanked me and so I went to sit with them and started talking to them. I explained the purpose of our research and they were comfortable talking with me. After some time, 3-4 fishermen came in and sat at the table at the end of the bar and began drinking. Then the girls said they wanted to dance to “show off their goods”. While I had been talking to the girls they explained that they were from the coloured population group and living in Narraville and lived near to each other. The group represented a support network to help in times of trouble and to lend money when there was no ‘work’. Procedures and Techniques

Prior to the data collection, the project and research coordinator visited Walvis Bay to test and refine the field research methods - mapping techniques, ethnographic observations and stakeholder interviews. A research team of two people (field site coordinator and field researcher) travelled to each research site. The field site coordinator was a senior researcher experienced in qualitative data collection and ethnographic data techniques. The research teams comprised of one male and one female researcher, each with the relevant language skills for the research sites. The procedures employed were based on the following steps: ƒ Collect pre-existing maps of the research sites for use in mapping exercises; ƒ Collect data on infrastructure, migration, social, and economic factors through ethnographic observations; ƒ Conduct informant interviews with mobile and related populations as well as stakeholders to verify and explain patterns that emerged during ethnographic observations; ƒ Document models of perceptions of HIV vulnerability by asking informants to map their own perception of HIV risk in the research site; ƒ Compare the researchers’ maps to informants’ maps to determine external versus local perceptions of HIV vulnerability; and ƒ Write a field site report to document observations and explain unique attributes of the data collected.

Language and recording All informant and stakeholder interviews were conducted in the preferred language of the informant by a local language speaker who was also proficient in English. Most informants chose to be interviewed in their first language, while stakeholders tended to be interviewed in English. All tape-recorded interviews were returned to were they were translated and transcribed primarily by the researcher who had conducted the interview. Transcriptions were then verified by another local language speaker who was unknown to the first translator. The final transcriptions were then reviewed by a native English speaker who corrected language errors. Most interviews were recorded on audio tape for translation into English and transcription for entry into the computer. However, some informants – particularly informal traders, sex workers and truck drivers – refused to be recorded because of the sensitive nature of the topics discussed. For these informants, researchers took extensive notes either during or immediately after the interview.

Sampling Regional site selection was designed to ensure that a diversity of migration sites was covered. To this end data collection sites were selected based on the following rationale: ƒ Katima Mulilo sits on the Trans-Caprivi Corridor which stretches from Walvis Bay in Namibia to Zambia and splits off from the Trans-Kalahari Corridor near Windhoek (see Figure 4). Katima Mulilo has a very high HIV prevalence rate of 42.5% (MoHSS 2005a) and is a transit site for truck drivers and informal traders and also hosts a military base.. ƒ Walvis Bay also represents a high HIV prevalence site at 25.7% (MoHSS 2005a) and is a major internal destination point for migrants employed in the fishing industry. Walvis Bay also has a high level of temporary in- migration due to the frequent utilisation of its port by foreign fishing vessels. ƒ Rundu (see figure 4) represents a moderate to high HIV prevalence site at 20.5% (MoHSS 2005a) and experiences high rates of transit migration (mainly truck drivers) and local cross-border migration (informal traders, uniformed services). In addition, a bridge is to be built over the Okavango River and it is anticipated that high volume cross-border trade with Angola will take place at the planned border crossing. ƒ Oshikango represents a moderate HIV prevalence site at 18.2% (MoHSS 2005a) and is increasingly becoming a destination as well as a transit site. A research study in Oshikango found that the cross-border traffic between Angola and Namibia greatly increased between 1998 and 2003 (Nangulah Selma and Nickanor Ndeyapo, 2005). Cross border movement at Oshikango has distinct gender characteristics. Overall, men dominate cross-border movement from Angola. In the case of Namibian migrants, the pattern is somewhat different: there is little difference between the numbers of male and female border-crossers although women do dominate during some months. . Figure 5 Trans Caprivi Corridor (Source: North Star Foundation, Geographical Analysis of potential HIV/AIDS wellness centres, Mark de Blois, Dr Andrew Thow)

Methodological issues and challenges

Ethical considerations Ethical issues were addressed during the planning and data collection stages of this research project. Informants gave consent prior to them being tape-recorded or being the subject of observations. Researchers were instructed to inform subjects in public spaces (such as sex workers in bars) to the nature of the research questions. Informants who gave interviews were generally given ‘gifts’ as per their request. Informants who assisted in the mapping exercise were also given a cash stipend proportional to the amount of time spent with the research team. Although it was often required that researchers collect data in a nightclub or bar, they were not allowed to consume alcohol or participate in risk-taking behaviour. Researchers were informed and consented to these criteria prior to the commencement of the research. For their own protection, as much data as possible was collected jointly by both team members. Researchers were briefed in advance as to the type of behaviours they might hear or observe. As well as being debriefed once they returned from the field site, researchers were provided with the name of counselling services and spoke frequently and candidly to the Project Coordinator during the field exercise.

Methodological Challenges Due to the innovative nature of the research methodology, some methodological challenges arose during research planning and implementation that required a revision of the research design. • The original research design called for the use of GPS to document points on the site maps. However, preliminary trials determined that maps and hand-held GPS devices were not accurate enough to place points appropriately onto the maps. After consultation with mapping experts and tests utilising various systems, it was decided to use aerial with CAD overlaid base maps onto which locations were numbered and a legend created. The numbers were entered into the computer and their GPS coordinates added based on computer identification. • Given the research methodology and open nature of the data collection tools, the selection of field site researchers was an extensive process. Researchers were required to have a Bachelors or Masters degree, extensive qualitative data collection experience, ideally be from the research site (or have extensive knowledge of the sites), spoke the local language, underwent extensive training and were in daily contact or were visited by the Project Coordinator during the course of the fieldwork.

3. MIGRATION AND HIV IN NAMIBIA

Migration in Namibia

Contemporary Namibia has a highly mobile population – moving both within the country and to other countries in southern Africa. Mobility is a structural factor that influences vulnerability to HIV, similar to poverty and gender inequality, both of which are also prevalent in the country. Prior to independence in 1990, HIV infection rates were relatively low (MoHSS 2005b:12), probably due to internal travel restrictions imposed on Africans under law, as well as restriction on travel to Namibia because of international sanctions against apartheid. With independence these artificial constraints to human movements were lifted and the free flow of people both within Namibia and from outside the country precipitated a sharp increase in HIV infection rates in Namibia. In 1992 Namibia’s overall HIV prevalence rate was 4.2%. It rose rapidly over the following years to 19.7% in 2004 (MoHSS, 2005a). The pre-independence land policy in Namibia was the basis of a colonial economy which hinged on the Contract Labour System and the underdevelopment of manufacturing and family-based ‘subsistence agriculture’ in rural African settlements. The Contract Labour System recruited young men from the rural areas for contract employment to the ‘white areas’. Africans were forced to stay on native reserves called ‘homelands’ unless contracted to work in the ‘white areas’. The pass system prevented women from travelling and living with their husbands (Hishongwa 1992:60). Men were denied the right to permanently dwell in the towns and were forced to return to the reserves or to other labour sites once their contracts were over. While on contract, they were denied the right to visit their rural families. Hishongwa (ibid.:95) states, “the labour system was the most fundamental factor affecting the economic and social lives of most Namibian women”. In the northern rural areas it was estimated that about half of the adult male population were absent from the homestead on contract labour at any given time. Although apartheid has been abolished and people are free to move as they please, many aspects of the Contract Labour System remain evident in contemporary Namibia. As with the rest of the southern African region, unequal development between rural and urban areas has reinforced a complex system of contemporary migration (Hishongwa 1992:49-50; Winterfeldt 2002). Winterfeldt (2002:39-74) argues that Namibia's long history of labour migration has created a ‘collective experience’ for a culture of migration which facilitates human mobility, and with it the spread of HIV. This system has also created the need for cheap labour in primary industries while at the same time creating a demand for cash in the rural areas. In Namibia the two most common forms of migration are cross-borde r cyclical migration and internal cyclical migration – both for the purposes of employment. These populations are highly mobile, using mobility to improve their life’s circumstances. Namibia shares borders with Angola and Zambia to the north, to the east and to the south. Cross-border migration takes place for economic exchanges of goods and services, and also because the borders were artificial constructs of colonialism and most ethnic groups near Namibia’s borders have social and familial networks that extend into neighbouring countries. Although many people from impoverished or war-torn countries (such as Angola) cross into Namibia permanently, most cross-border migrants only come to Namibia for short periods of time to trade, purchase consumer goods, see family members or otherwise take advantage of Namibia’s relatively good infrastructure. The majority of female cross-border traders enter Namibia, purchase small consumer goods such as cool drinks, and return to their country of origin immediately. Male cross-border traders tend to focus on more expensive consumer items and stay in Namibia for longer periods. Within Namibia, many people migrate from the rural northern areas to employment destinations further south such as Walvis Bay (fishing industry), Oranjemund (mining industry) and Windhoek (commerce industry). In addition, there are certain groups of governmental employees (such as military personnel, police and nurses) that are deployed according to regional needs, and leave their partners at the place of origin. Although women have begun to migrate in search of employment to accompany their partners, as government employees (in particular nurses), for short visits to relatives, and to utilise urban infrastructures such as hospitals, migration is still primarily a male domain. (Winterfeldt 2002:64). Migration in Namibia is not simply people moving from one place (usually rural) and relocating permanently elsewhere (usually urban). Most migration is cyclical in nature according to economic need and familial linkages (LeBeau 2005a:20). Migration from rural to urban areas is not a unidirectional phenomenon, but exhibits a high degree of complexity of social relationships that are interwoven between rural and urban loci (Webb 1997:13; Spiegel 1999:9). The fragmentation of the familial unit allows migrants to behave in ways that contradict cultural norms without social sanctions from their rural family members. The further from place of origin a migrant goes (especially for cross- border migration) the more anonymous his or her behaviour becomes. Highly mobile populations take advantage of the anonymous nature of social interaction with related and stable populations, such as sexual behaviours that is culturally unacceptable in their place of origin. Namibia is a country with a rapid urbanisation rate. Windhoek is the largest urban centre housing 39% of the total urban population, followed by Walvis Bay with 7.9%. The urbanisation rate is currently highest in the north with 7.5%. Approximately 67% of the population live in rural areas, a decline from 72% in 1991 (NPC 2003). Namibia is divided into 13 geo-political regions. Social and economic development is not uniform across the country, and varies greatly by region. Namibia has a scattered population which makes provision of infrastructural support such as information, water, sanitation, schools and health care facilities difficult. This dispersed settlement pattern is also a challenge for controlling the spread of HIV and mitigating the impact of AIDS on affected populations. Namibia’s primary industries are overwhelmingly low-paid, unskilled and labour intensive (NPC 2001:5). Because of this the main primary industries all require labour migrants to maintain production levels. Various socio-demographic attributes influence the spread of HIV in Namibia. For example, the sex ratio in Namibia differs considerably by region.1 The (where Walvis Bay is located) has the most skewed sex ratio with 115 males for every 100 females. The northern regions have the lowest male to female sex ratios. Ohangwena (where Oshikango is located) has 83, the Kavango

1 Sex ratio is the number of males per 100 females. (where Rundu is located) has 91 males per 100 females, while the Caprivi (where Katima Mulilo is located) has 96 males for every 100 females (NPC 2001:5).

Migration and HIV

Several regional studies have identified migration as a factor in the progressive spread of HIV throughout southern Africa (LeBeau et. al. 1999:119; Webb 1997:13; Kaundjua 2000:39; Campbell 1997:273; Sinclair 1996:10). Webb (1997:13) found that "movements of the virus follow movements of people, implicating the processes of oscillatory migration (both international and internal)". A study on the sexual networking of HIV positive patients from the northern rural areas of Namibia (where a majority of Windhoek migrants originate from), indicates that, "more than two-thirds had had sexual relationships outside the Owambo region within the three months previous to diagnosis" (Webb and Simon 1993:6 quoted in Winterfeldt 2002). There are various socio-structural factors linking migration to HIV vulnerability (Campbell 1997:273), though mobility alone does not account for sexual risk- taking by migrants (LeBeau et. al. 2001:58). One factor that places migrants in a high-risk group is the fact that they often leave their stable sexual partners at the place of origin, and become part of fragmented social networks at destination, which can lead to risk-taking sexual behaviour at destination (LeBeau et. al. 1999:119). Webb (1997:35) states that any labour migration system that separates household members encourages extramarital sexual contact. Due to the fragmented nature of migrants' social networks, it is less likely that familial relations in one area will know about sexual risk behaviour in another area, thus mobile people are less likely to have social inhibitors causing them to lower sexual risk-taking behaviour (LeBeau et. al. 2001:58; Kaundjua 2000:37). Personal as well as structural factors influence people's sexual risk-taking behaviour. Campbell (1997:273) indicates that a person's identity is shaped and constrained by their living and working conditions, which also influence sexual risk-taking behaviour. Campbell (ibid.:274) argues that sexual behaviour is not an isolated act but is linked to a person's actions, emotions and relationships. Kaundjua (2000:17-18) further explains that individuals' behaviour is not performed in isolation, but is part of a complex set of social and structural factors. The stresses of everyday living and lack of entertainment, also contribute to the need for 'diversionary activities' that often lead migrants to sexual risk- taking (Campbell 1997:276). A sense of powerlessness pervades the migration experience and people feel a lack of control over all aspects of their lives. Disillusioned male migrants working away from home in physically challenging or impoverished situations can develop exaggerated masculine identities that are threatened by the use of condoms (Campbell 1997:275; Webb 1997:91). However, the aforementioned social, structural and personal factors treat migrants as a single sub-group of people who move for work. In reality migrants have different backgrounds, different types of employment, different movement patterns, different perceptions of the migrant experience, and differing HIV vulnerabilities. For example, fishermen are at sea for long periods of time interspersed with short visits on shore, while truck drivers spend long hours on the road with short stays the places of origin, destination and in between.. Although the migrant remittances contribute to the development of the rural areas left behind, this labour migration of husbands, brothers, and fathers has disrupted social and family support mechanisms and structures. It also increases HIV vulnerability both for the migrants as well as their wives who stay behind in the rural areas. Women who stay behind in the rural areas may have unprotected sex with other sexual partners in the absence of their migrant spouse for a host of different reasons, which include sexual pleasure, wanting to bare children, or in return for money or other favours. For women whose migrant spouse might be infected with HIV it is difficult to negotiate condom use as women are frequently in socially and economically weaker positions. Research undertaken in migrant-sending areas in the KwaZulu Natal province of South Africa - comparing migrant couples in which one of the partners migrate for work, to non-migrant couples - showed that it is not always the returning migrant men who are infecting their rural partners (Lurie et al, 2003):

Migrant couples were more likely than non-migrant couples to have one or both partners infected with HIV (35% versus 19%) and to be HIV discordant (27% versus 15%) – meaning that one partner is infected and the other is not. It has long been assumed that it is returning migrant men who are infecting their rural partners. This research found that among HIV discordant couples, 30% of the time it is the woman who is HIV-positive and her migrant partner who is negative. Clearly, an HIV-positive woman whose migrant husband is not infected, must have been infected by someone else.

In a society of social, economic and political inequalities, HIV preventative measures are difficult to implement because immediate, short-term demands of everyday existence take precedence over long-term issues, such as HIV (Webb 1997). People faced with economic and social hardship can have a fatalistic approach to life, which, in some cases, is translated into sexual risk-taking behaviour with an attitude of "we are all going to die some day anyhow" (LeBeau et. al. 1999:127). The inter-relationship between HIV and migration is not a simply model of social mobility leading to sexual risk-taking behaviour, but encompasses social and economic structural inequalities, social identities and personal desires, fragmented social networks and significant rural and urban links. It is this web of complexity that influences HIV vulnerability in mobile and migrant populations and the people that they interact with. PART TWO: FINDINGS

4. RESEARCH SITES

WALVIS BAY

Walvis Bay is the centre of Namibia’s fishing industry. There are several fishery support services in the town such as factories that process fish meal and oils as well as fish canning factories. Several floating fish processing factories in the harbour also provide employment opportunities. Walvis Bay is becoming a gateway for expanding markets in southern Africa with the recent completion of the Trans-Caprivi and Trans-Kalahari road networks as well as a railroad line linking the interior of Namibia to its northern rural areas, including Oshikango. Figure 6 shows the general layout of Walvis Bay including the townships of Kuisebmund and Narraville. This map illustrates the apartheid structure of land use in most towns in Namibia with the previously white areas surrounding the CBD and the other residential areas separated by great distances.

Figure 6 Overall Map of Walvis Bay (Source: Christiaan Keulder based on site data collected) Walvis Bay is the major shipping port for Namibia. Next to the CBD is Namport, port where fishing and cargo vessels dock to offload their products. Surrounding the port are support facilities such as fish processing factories, shipping warehouses and various other commercial enterprises. Among the commercial factories are a variety of ‘human support services’ such as shops, takeaways, nightclubs, gambling houses, some sleeping establishments and a SMA office.

Figure 7 Walvis bay Harbour (Source: Christiaan Keulder based on site data collected) The SMA office is located at the entrance to Namport harbour. As men come from the ships, they pass the office and SMA staff members hand out information pamphlets and condoms. This is also the area where men queue for jobs and SMA staff take the opportunity to provide them with information and condoms as they wait to find work. The photograph below shows people waiting for work in front of the SMA office. Opposite the SMA office is the Seafarers Mission that provides a range of different services to mainly foreign fishermen.

Figure 8 The SMA at the entrance to Walvis Bay Harbour In addition to formal shops that sell consumer goods, numerous informal sellers - most of them women - operate from makeshift stalls along roadsides and walking paths, while living in shacks in Kuisebmund. Usually they make a marginal profit, and some reportedly engage in transactional sex or commercial sex work to supplement their incomes. Walvis Bay has a mixed social structure with white people primarily participating in business ventures in town. Many African and coloured people work in the fishing industry, in informal trade, or own shops. There is a core stable population living in Walvis Bay and a large number of migrants who have come to Walvis Bay for employment. Walvis Bay is an Export Processing Zone (EPZ) which gives tax incentives to foreign companies, therefore some foreigners (primarily Chinese) have settled to open small businesses. The Chinese shops, as in all research sites, sell small consumer items such as bedding, clothes and shoes. There is quite a large group of sex workers in Walvis Bay, estimated by some to be around four hundred. There are also about five hundred informal sellers in the area, most of whom are Owambo women selling food such as apples and cooked meat. Unique to Walvis Bay are stalls that sell cooked fish, which is not as readily available elsewhere in Namibia. Approximately one hundred and fifty trucks pass through Walvis Bay each day. Some of the main trucking companies that have their own truck ports are Namport, Unitrans and Maersk; while other companies, such as Trans Namib and Macs Transport, do not have designated truck ports. Mobile and migrant workers in Walvis Bay are mainly fishermen, truck drivers and sex workers. But Walvis Bay is also a destination site for internal migrants looking for work in the in the construction sector, as informal traders or in the fish processing factories. There are primarily two types of fishermen who in Walvis Bay: foreign and Namibian fishermen. Several informants say that fishermen in Walvis Bay are vulnerable to HIV given their high utilisation of commercial sex workers. Most fishermen meet sex workers at nightclubs and bars located in and around the harbour area. Truck drivers usually do not stay for more than a day or two in Walvis Bay while waiting for goods to be loaded of and on to their trucks. Therefore, Walvis Bay is a short transit site for truck drivers who reportedly mostly sleep in their trucks to avoid the expense of a room. Katima Mulilo

History and Geography The Trans-Caprivi Highway is a stretch of highway completed in 1999, which runs from Rundu in the north of Namibia to Katima Mulilo in the Caprivi region. The Trans-Caprivi Corridor is used intensively by trucks carrying different types of goods. Although truck volume data for Katima Mulilo is unavailable at present, it appears to be a major crossing point and given the local HIV prevalence rate of 42.4%, a place of HIV vulnerability for both mobile and sedentary populations. (MoHSS, 2005a). A recent addition to the infrastructure in the Katima Mulilo area is a bridge that crosses the Zambezi River into Zambia, a crossing that previously had to be done by pontoon or dugout canoe. This has made cross-border trade between Zambia and Namibia easier and cheaper. Currently many of the trucks coming through Katima Mulilo carry goods from Walvis Bay to countries in the interior of southern Africa.

Figure 9 The New Bridge at Katima Mulilo The aerial land use map below shows the Trans-Caprivi Highway in relation to Katima Mulilo, the Zambezi River and Zambia. Although the new bridge is not visible in this map, it has made crossing the river between Zambia and Namibia easier than previously had been the case.

Figure 10 Ariel Map of Katima Mulilo

Source: Christiaan Keulder based on site data collected Since the reopening of the Trans-Caprivi Highway in 2003 – after it was closed in 1999 due to bad security - the town has begun to grow. There are a number of supermarkets, lodges, restaurants, shops, and banks. There are no recreational facilities or market structures and informal sellers operate out of makeshift booths at the local transport stops or along roadsides. The primary business activities in town are the numerous bars and nightclubs. Katima Mulilo has primarily Lozi speaking people, with a number of Africans from surrounding countries such as Zambia and . Katima Mulilo is one of the most ‘African’ towns in Namibia, with few white people and some Chinese. Most foreigners from neighbouring countries come to Katima Mulilo to visit friends and family, to sell their handicrafts and fresh garden produce and to purchase consumer items to take back to their country of origin. Most foreigners do not stay in Katima Mulilo unless they have friends or family there because it is relatively expensive compared to neighbouring countries. As with all rural people in Namibia, young Caprivians are also moving to urban areas such as Windhoek in search of jobs and other amenities of city life. In Katima Mulilo the primary mobile and migrant populations are truck drivers, commercial sex workers, uniformed government officials, informal traders and migrant labourers. There is a lack of recreation other than alcohol outlets. Truck drivers transiting through Katima Mulilo usually do not stay for more than a day or two. The map below, drawn by a sex worker, shows the prominence of the truck parking area at the petrol station and the Mukusi Cabins which is one of the places that sex workers go with their clients. As shown on the map, sex workers not only come from the shanty settlements (Choto, Cowboy and Daily), but also from Zambia across the bridge. Thus, local and cross-border sex workers mix with mobile populations creating a web of HIV vulnerability and transmission. The sex worker who drew the map below also prominently displays the SMA office and the hospital, showing that she knows where to get condoms and HIV information.

Figure 11 Truck Stop and Sex Worker Movements The informal movement of people across the Zambezi River, as well as its proximity to neighbouring countries makes Katima Mulilo (and the entire Caprivi Region) a point of high HIV vulnerability. The rate in Katima Mulilo has continued to climb and in 2004 the prevalence for Katima Mulilo was 42% versus the national average of 19.7%. Evidence of the number of AIDS-related deaths in Katima Mulilo can be seen in the high number of orphans and street children, as well as by examining data from graveyards. The photograph below shows the local custom of marking graves with brightly coloured plastic flowers in an otherwise dry dusty graveyard. The majority of people buried were under 40 years of age, with a large number of children under 5 years old. Iinformants claim that the widespread introduction of ARVs has resulted in fewer funerals, although AIDS related deaths are still an all too common occurrence. A substantial number of uniformed government officials who are not from the Caprivi area are stationed in Katima. These include police officers, nurses and military personnel at the Mpacha army base, 35 kilometres from the town centre. These officials are typically sent without their families; thus making them vulnerable to HIV through their association with sex workers and other partners. Rundu

Rundu is located in the along the Okavango River in the north- central part of Namibia. Across the Okavango River from Rundu is the Angolan town of Calai, which has strong familial and economic links to the Kavango Region. Rundu is about 800 kilometres from in the south and 500 kilometres from Katima Mulilo at the end of the Caprivi Strip in the east. Thus, Rundu is a popular stopping point before one sets off across the Caprivi Strip. The aerial photograph of Rundu below shows the town in relation to the Trans-Caprivi Highway and the Okavango River. Note the lack of development and infrastructure on the Angolan side of the river, causing many Angolans to cross into Namibia for services and supplies.

Figure 12 Overall Map of Rundu (Source: Christiaan Keulder based on site data collected) There are about 44, 413 people (NPC, 2003) in and around the Rundu area. The town has a few banks, supermarkets, a large number of smaller (mostly Chinese) shops in a new shopping centre, and a large Shell filling station that doubles as a truck stop. There are also several lodges nestled along the Okavango River, the most prominent of which is the Omashare Lodge with its adjacent nightclub and gambling house, ‘Back Stage’. In addition to the local Kavango people and the Chinese shop owners, a number of Portuguese speaking people from Angola live in Rundu and own shops, restaurants and nightclubs in and around the town. The Kavango people live along a narrow strip of fertile land approximately three kilometres wide on the banks of the Okavango River. The Okavango River is the border between Angola and Namibia, with many Kavango people having relatives in Angola and conducting business on both sides of the river. The photograph below shows the centrality of the river in everyday life as a means of transport, as a source of water and fish, but also as a location where people meet socially.

Figure 13 The River is Part of Life In addition to the river, the Kavango Region has large stands of dolfwood (Pterocarpus angolensis) and Rhodesian teak (Baikiaea plurijuga) from which people, primarily men, carve masks, drums, stools, sculptures and furniture. The practice of wood-carvings began as a home industry but with the advent of mass tourism in Namibia has become an internationally recognised form of artwork, and a significant source of cash income for the local population. Rundu’s prominence as a transit site on the Trans-Caprivi Highway and its HIV prevalence rate of 21% make it a possible site for increased HIV vulnerability. It was also reported that the town is planning to build a bridge for crossing the Okavango River into Calai. Rundu experienced significant upheaval during the liberation struggle, especially due to the presence of the South African Defence Force (SADF) in the region. Due to and the location and distance, Kavango men did not participate as much in the Contract Labour System as the Owambo men did. However, since independence, people from the Kavango Region have also begun migrating to towns and mines in search of employment. For Rundu the primary mobile and migrant populations are commercial sex workers and informal cross-border traders. Truck drivers are not as likely to stay overnight in Rundu, but use it as a resting point before crossing the Caprivi Strip. The only significant truck stop in town is the Shell service station located at the intersection of the Trans-Caprivi Highway and the main road through the town. The map below shows a proliferation of shebeens set up to cater to travelers coming across the Trans-Caprivi Highway, especially truck drivers who do not usually go into the town of Rundu.

Figure 14 Map of Shebeens along the Trans-Caprivi Highway (Source: Christiaan Keulder based on site data collected) There are also a large number of highly mobile informal traders in Rundu, some of whom come from other parts of Namibia, while others come from across the border to sell their food and homemade products. One of the prominent features of Rundu is its large open market with about 50 stalls selling everything from clothes and food to small beer stands and pool tables for entertainment. In the photograph below, women sell food at the open market, while in the background men can be seen playing pool.

Figure 15 Rundu Open Market (Photo courtesy of Carolyn Nordstrom) Sex workers’ clients include truck drivers, uniformed government officials including military personnel and businessmen who do not permanently reside in Rundu. As can be seen from a community member’s perception of Rundu, the majority of HIV risk-taking occurs in nightclubs and bars in town between local community members and these temporary residents; while along the Trans- Caprivi Highway the majority of HIV risk-taking is between sex workers and truck drivers. Note that this community member identified shops and the police station on the map, as opposed to maps drawn by sex workers who locate SMA offices, hospitals and clinics – showing that local community members have a different cognitive map of their town.

Figure 16 Community Member's perception of Rundu 5.4 Oshikango

Before Independence Oshikango had a large military presence from the South African Defence Force (SANDF) with little development because of the armed conflict in both Namibia and Angola. By the mid to late 90s, Oshikango began to experience greater economic development due to increased trade with Angola, and since the peace in Angola Oshikango has witnessed rapid development as a major trading point. There are about 27,599 people (NPC 2003) in the Oshikango area. Most of the people are Oshiwambo, but there are a number of people from African neighbouring countries such as Angola and the Democratic Republic of the Congo. There are reportedly around one hundred sex workers as well as women doing sex work to supplement their income. There are over 50 informal traders and small market stands lining the Oshikango main road selling everything from fresh fruit to consumer items such as sunglasses. The Owambo live in northern Namibia between the Etosha Pan and Angola in what was formerly known as 'Ovamboland'. The Owambo are divided by the Angolan border, with one-third of their population living in Angola. Due to their participation in the Contract Labour System, the Owambo can be found throughout Namibia (Hishongwa 1992:50-52). Today, many Owambo still migrate to towns and mines in search of employment. Oshikango is located in the northern most part of the and is the main border post between Namibia and Angola. There is no real border in this area with only a wire fence, which does not run the entire length of the Namibian/Angolan border. Just across the border into Angola is the town of Santa Clara. A 2005 study on cross border movements in Oshikango reported that the majority of the people interviewed during the study (55%) were crossing the border on foot, suggesting a local point of origin. A large number of people crossing the border into Namibia at Oshikango are engaged in local, circular movements within the border vicinity. Most people from Angola were going to local destinations such as Oshikango. The majority of respondents were in possession of a border pass, a permit given at the Namibian border for travelers who do not possess any other traveling documentation and are restricted to travel within 30km of Oshikango border post for a fixed period of time (Nangulah and Nickanor, 2005).

Figure 17 Informal Traders in Oshikango The aerial map (Figure 18) below shows Oshikango right next to the Namibia/Angola border, with few services available on the other side of the border.

Figure 18 Overall Map of Oshikango Source: Christiaan Keulder based on site data collected)

Figure 19 Truck Loading area, Oshikango There are several truck ports and a large (off)loading area (see figure 19). It is estimated that about 150 trucks come through Oshikango a day, with most either off-loading their cargo or driving through to Angola. Truck drivers transiting through Oshikango on their way to Angola have to wait a number of days for their goods to clear customs or for their Angolan counterparts to collect the goods for further transport into Angola.

The presence of truck drivers seems to be the driving force behind HIV vulnerability in Oshikango. The map below, drawn by a sex worker, shows that many of the places sex workers go to find clients are businesses and truck ports.

Figure 20 Sex Worker "Hang outs" in Oshikango There are over 100 shops of varying sizes from warehouses to small locally owned stores, and almost as many bars, nightclubs and shebeens. Due to the presence of an EPZ there are also some Chinese shops. The shops and services are a significant draw for people from Angola where there are few shops and services available. Although Oshikango does not have a hospital, the Hospital is only eight kilometres away and provides some of the most modern health care in Namibia. Many people from southern Angola cross the border to make use of the Engela Hospital. The current HIV infection rate in Oshikango is 18.2% (MoHSS 2005a). Oshikango has only been a site of commerce for a few years and it is anticipated that this rate will increase. In Oshikango mobile and migrant populations are mainly truck drivers, commercial sex workers, and informal traders. A number of adolescent girls have dropped out of school and have come to Oshikango from neighbouring Owambo villages to participate in commercial sex work or to look for men to support them. In addition, this research found a number of street children and orphans in child-headed households in and around Oshikango. Orphaned children migrate to Oshikango for food and clothes, where they themselves become vulnerable to HIV infection.

5. SEX WORKERS

In Namibia sexual exchanges for money and other goods take two forms: transactional sex and commercial sex. Transactional sex – or a ‘transactional relationship’ - refers to cases in which one person has sex with another person in exchange for food, clothes and other household support. Commercial sex refers to cases in which a person has sex in exchange for money (UNDP 2001:119). Although there are no statistics about the number of people involved in either transactional or commercial sex, the former appears to be a widespread practice in Namibia and has been reported throughout the country (LeBeau et al. 1999:132). Many women and adolescent girls participate in both forms of sexual exchanges and some, depending on opportunity and life circumstances, float between the two. Earlier research in Namibia has shown that women and adolescent girls often expect their 'boyfriends' to provide money and material support in exchange for sexual favours or else, as has been reported, they will "love someone else" (Webb 1997). In northern Namibia, near Oshikango, young men reported being aware of local girl children having sex with older men for money or gifts (LeBeau et. al. 1999:163-164). Usually these older men are recent migrants to the area or uniformed governmental officials such as military personnel and local government employees. (ibid: 164). This research found many women in an environment of HIV vulnerability through transactional sex, particularly in impoverished communities such as Rundu and Katima Mulilo. Generally mobile and migrant men such as truck drivers and fishermen do not have transactional sexual relationships because of the costs involved in supporting women in several locations and the short time they are at a site. Despite this, in some cases such relationships do occur. In Walvis Bay, for example, some foreign fishermen pay for a rental house and support their girlfriends. However, while the men are at sea the women might have other ‘boyfriends’ and possibly participate in commercial sex. The fishermen, on the other hand, view the women as their girlfriends in an attempt to recreate the impression of a home environment. Women in transactional relationships have less power to negotiate safe sex than sex workers. They cannot demand condom use or monogamy from men who pay the bills and give them ‘gifts’. Informants in all research sites confirm that poverty is a contributing factor to HIV vulnerability for women involved in transactional relationships. In Rundu and Katima Mulilo, the two most impoverished research sites, some women exchange sex for mealie meal or a bar of soap. One truck driver bragged that he can ‘buy’ a woman in for the price of a beer. In general, knowledge and awareness is high among sex workers, but due to social factors this knowledge is not always translated into lowering HIV risk- taking. However, sex workers in specific areas earn enough money to enable them to demand condom use, while in other areas sex workers do not have the economic power to negotiate safe sex practices. Some sex workers encountered in Walvis Bay and Oshikango had mobile boyfriends (fishermen in Walvis Bay and truck drivers in Oshikango) who supported them for a period of time, however, when the relationships ended the women returned to commercial sex until they meet the next ‘boyfriend’. Sex workers are usually women between the ages of 16 and 30 years old. However, in some sites such as Oshikango, girls as young as 13 years old were reportedly engaged in sex work. In some research sites, women from neighbouring countries cross into Namibia to participate in commercial sex. Informants, especially in Katima Mulilo, explain that foreign women come to Namibia so they can operate without worrying that their own community members will learn of their activities. Informants in Katima Mulilo claim a substantial rise in the number of foreign sex workers since the new bridge between Zambia and Namibia opened. In Rundu sex workers have clients who drive trucks along the Trans-Caprivi Highway as well as clients who are uniformed government officials, including military personnel, and businessmen.

Categories of sex workers Informants in most research sites explain that there are different ‘levels’ or types of sex workers – typically described as professionals, ‘locals’, and low-class sex workers or streetwalkers. A professional sex worker is paid the most and is described as someone with vast sexual experience who is contactable for appointments by cellphone. A ‘local’ sex worker is lower paid and could be an adolescent girl who possibly failed school and operates from the bars. A streetwalker is the lowest paid sex worker and is picked up by clients from the streets. However, the criteria for inclusion into one group versus another group vary by research site and the women’s social circumstances. In Walvis Bay and Oshikango a professional sex worker is described as someone who is contactable for appointments by cellphone. Clients of professional women are typically foreign fishing boat captains and businessmen. In addition, some professional sex workers may be given durable goods from their clients such as furniture, cellphones and household items. A sex worker from Walvis Bay reported having primarily white foreign fishermen and businessmen as clients because they pay more and often give her gifts. During the interview, she wore a pair of pants from Italy. She is considered a professional because she charges more for her services, wears expensive clothes and has a cellphone. There are fewer professional sex workers in Rundu and Katima Mulilo, but those that are there are identified as women found in nightclubs who charge more for their services and “keep themselves clean”. A ‘local’ sex worker in most sites is described as an adolescent girl who possibly failed school, is low paid and operates from the bars. Local sex workers’ clients are typically local or Russian fishermen in Walvis Bay; Angolan truck drivers in Oshikango; uniformed government officials and truck drivers in Katima Mulilo; and travelling businessmen and uniformed government officials in Rundu. The photograph below shows a researcher interviewing a local sex worker in a bar.

Figure 21 Interview with Sex Worker The ‘lowest’ level sex workers in Walvis Bay are identified as women who walk the streets and are scantly clad. These women’s clients are typically low paying foreign fishermen (identified as Chinese) and truck drivers. In the other three research sites, low-level sex workers were found in shebeens and at truck stops. They would have sex with clients for small amounts of money or small consumer items such as a beer. Some informants claim you can identify low-level sex workers because “they do not take care of themselves. They do not bath, wear dirty clothes, and their skin is a bad colour”.

In Walvis Bay, one community member claims: The Chinese are having sex with ‘low-end’ prostitutes like you find on the street. An informant from SMA states, “The Chinese do no like condoms and do not want to pay so they have high-risk sex with low-level prostitutes. Other foreigners have high-end sex workers but also do not want to use condoms. The local guys have girlfriends in Kuisebmund so they are not using the prostitutes as much, but they go out and look for other women.

Namibian sex workers rarely cross the border in search of clients, primarily because most of Namibia’s neighbouring countries are poorer than Namibia and therefore there would be less business there. In Rundu, however, Angolan Army personnel cross the border into Namibia to take advantage of the services in Rundu, including the services of sex workers. The map below, drawn by a sex worker, also shows some of the “hotspots” in Rundu, with the open market prominently displayed and marked as a “hotspot”. Note that the primary places identified as “hotspots” are the filling stations and local bars and nightclubs.

Figure 22 Map of Rundo "Hotspots"

Clients of sex workers Clients of sex workers tended to be from highly mobile population groups such as fishermen and truck drivers. However, clients are also travelling businessmen, uniformed government officials and sometimes construction workers temporarily in the region. In Rundu and Katima Mulilo sex workers say their primary clients are local businessmen, military personnel, the police, construction workers and truck drivers. Fishermen and military personnel tend to be in their 20s, while truck drivers and businessmen tend to be in their 30s and 40s. Most sex workers say they have only occasionally had problems with clients or the police. The most common problem reported by sex workers is that clients do not want to use condoms. Sex workers and a bartender in Oshikango discuss the issue. One sex worker explains: Angolan people don’t use condoms. … They believe that AIDS doesn’t exist. So, they just sleep like that [have sex without a condom]. [The bartender adds] Some of the girls, you know these prostitutes, you can hear them talking, Angolans don’t like condoms.

While conducting research in Katima Mulilo, the researcher happened upon a truck driver and a woman. The truck driver introduced the woman as “my wife’s assistant”. When he sent her to buy beer for them, he explained that she was a local sex worker. However, he clarifies this statement by saying, “She helps my wife out while I am on the road, so she is the assistant to my wife”. In one research site a policeman explains that men need to have sex just like they need to eat and thus having extra-marital affairs and going to sex workers is just like having “pad kos”2 while other terms used to describe sex workers include “sex helpers” and “sex work helpers”. Another truck driver in Walvis Bay explains that sex workers do a community service because they take care of men’s needs while on the road. In Oshikango one man explains that sex workers provide “quick service” to truck drivers who are always on the move. A Namibian fisherman in Walvis Bay explains: These girls, are helping the fishermen. … Because, we fishermen do not have enough time to find a girl that is not paid for sex. Sometimes we come in here in the morning and then you will go back the sea in the afternoon of the same day. … You don’t really have time to struggle for a normal girl. [A sex worker] is the only option you have to be able to be with a woman.

Highly mobile men indicate they cannot afford to have steady girlfriends in the towns where they work and wives or girlfriends in their place of origin. They explain that women are expensive to support whereas sex workers are paid only for the services they provide and there are no ‘hidden costs’ or additional problems such as jealousy. Although most sex workers say they always ask for condoms, one fisherman contends that condom use is still a male prerogative. He explains:

We are using condoms, but I met many girls who do not say anything like ‘let’s use a condom’. It comes from you as a man. However, if you did not say anything either, then you will end up having sex without a condom. Although there are those [sex workers] who have their own condoms in their rooms, it is only you who says we must use a condom.

One truck driver in Walvis Bay who uses the services of sex workers in Walvis Bay, Rundu and Oshikango says that he has never used a condom with a sex worker, his girlfriends or his rural wife. He explains, “There are some who say let us use a condom. You gave her money and still you have to use a condom. Will you enjoy anything? No. You cannot enjoy sex with condoms.” Sex workers in Walvis Bay are also vulnerable because many of their clients, particularly foreigners, reportedly refuse to use condoms. SMA in Walvis Bay has held workshops and events to educate sex workers about their rights and to discuss with them how to manage clients who do not want to use condoms. One sex worker explains, “We are informed about HIV and AIDS. We go to meetings, many times. I know that I am at high risk. I have to use condoms because every day I have a new client”. Sex workers are less likely to seek health care due to the discrimination they experience as well as fear that their families will find out about their profession or their health status; leading them to have illnesses (such as STIs) that go untreated (OSI 2006:1). Indeed, in Namibia several sex workers say that when they go for health care they are berated by health care providers who know they are sex workers.

2 Loosely translated, this is an Afrikaans term “food eaten while travelling”. 6. TRUCK DRIVERS

A study on the sexual and reproductive health (SRH) of adolescents found that in the southern areas of Namibia along the South Africa-Angola truck route, adolescent girls participate in sex work with truck drivers passing through. These girls know the truck drivers’ schedules and plan their visits to the truck stops to coincide with these (UNFPA 2004a: 51). Parents claim truck drivers are to blame because they know the impoverished conditions within which local adolescent girls live and they take advantage of the situation. However, some mothers encourage the behaviour for the economic gain of the family (ibid.:viii). Research in shikango confirms that adolescent girls engage in sex work with Angolan truck drivers who they usually meet in local bars and shebeens (UNFPA 2004b: 88). Research conducted by the Legal Assistance Centre (LAC) found that many truck drivers are hesitant to admit that they use the services of sex workers. The study also found that most truck drivers regard sex workers as entertainment and a distraction from the long trips they have to make (LAC 2002:xxii). The demographic attributes of truck drivers going through Namibia vary greatly, however they tend to be in their thirties and forties. Most truck drivers interviewed for this study were married and had children. The length of time truck drivers are at any particular site depends on the reasons for transiting through the site. Truck drivers typically have the longest stays in Oshikango because they must clear Angolan customs, a process that can take up to a week. Sometimes truck drivers have to wait for their Angolan counterparts so the load can be transferred to Angolan-bound trucks. In Walvis Bay trucks are either coming through from South Africa or loading goods to be delivered elsewhere, therefore, they are only at the port for a couple of days to collect and to deliver their goods and move on. In Rundu and Katima Mulilo most truck drivers are not delivering or collecting goods, so their transit times range from a few hours to a night. It is more likely that they will overnight in Katima Mulilo since most drivers coming from Namibia will have driven through the Caprivi Strip the whole day and will stop to wait for the border to open and get a fresh start in the morning. Most of these drivers will have to cross several international borders, which will take several hours, regardless of their country of destination. Andreas, a truck driver interviewed in Oshikango coming from Windhoek with a load of motorcycles, says he usually spends six to seven days in Oshikango waiting for his paperwork and his Angolan counterparts to collect the shipment. Andreas explains that he often drives to different countries in southern Africa, and regardless of where he travels he can sleep in the cab of his truck. However, he says that in some countries he parks his truck at the police station for security purposes. Most towns in Namibia have truck stops within their limits or nearby. All research sites have at least one truck stop. Usually the truck stop is a petrol station with a large parking lot for the trucks. Other services can include a take-away food vendor, a restaurant and a shop with goods required by travellers. The photographs below show two of the different truck ports in Namibia. One is in Katima Mulilo and one at the Piscas Motel and Truck stop in Oshikango. At the Katima Mulilo truck stop there is a petrol station with a shop, and a hangout for sex workers across the road.

Figure 23 Truck Ports Katima Mulilo and Oshikango Local populations are aware that these truck stops are stopping points for travellers and truck drivers, and the location is therefore a focal point for informal sellers who offer a variety of fruits and cooked food, street children and sex workers. The main truck port and petrol stop in Rundu is at the intersection of the Trans-Caprivi Highway and the main road to Rundu. Because Rundu is not a main destination or overnight transit stop for truck drivers, there is no accommodation at these truck ports. Usually there is accommodation close by the truck stops, as is the case in Katima Mulilo and Oshikango. The map below, drawn by an Oshikango community member, shows that truck stops have accommodation and a number of shebeens or other alcohol outlets nearby.

Figure 24 Oshikango Truck Ports with nearby services Because there are few recreational activities and little to do for truck drivers, they usually spend a lot of their time in bars, shebeens, night clubs and cuca shops, where they also meet women (usually sex workers). Max, a truck driver in Walvis Bay who drives to most of the other research sites, has never used a condom – either with a sex worker, with women he meets in bars or with his rural wife. He explains, “this thing of driving, we like to walk around and go to have a drink and enjoy ourselves. I like dancing in the clubs like in Walvis Bay. When I am in town, I like the Nexus Nightclub”. However, Max is worried about HIV and says, “I’m now scared because we’ve come a long time. I realised it sometimes, but I’m scared … you got this girl there and there you are scared maybe you caught the disease.” Andreas says it is difficult to tell if other truck drivers use condoms and, he claims, “Angolans do not like to use condoms. Some will, but the majority do not”. Andreas supports the statements of Oshikango sex workers who contend that Angolan men do not want to use condoms. However, he alleges Namibian truck drivers typically use condoms, which not all sex workers agree with. 7. FISHERMEN

The lucrative fishing industry means that Walvis Bay is frequented by large number of foreign fishermen fishing for international vessels. These foreign fishermen arrive on a regular basis mainly from Europe (Spain, Russia),Asia (China) and even as far as South America. The presence of these foreign fishermen and truck drivers provide additional incentives for commercial sex work, and brings a different dynamic to HIV risk behaviour and the way it relates to highly mobile populations. Under these conditions, the implications and consequences of risk behaviour are truly international, and the effects hereof would be felt thousands of miles away. Foreign fishermen and truck drivers, through their contact with local sex workers, put their regular partners and many others at risk of infection, thereby providing new impetus to the ever increasing pandemic. Two types of fishermen use Walvis Bay as their port of call: foreign fishermen from Europe and Asia and local Namibian fishermen.

FOREIGN FISHERMEN The foreign fishermen do not reside in town other than for short periods of shore leave. Their overall stints of employment in Namibian waters is usually between three and six months, interspersed with short period of shore leave which usually does not last for more than a couple of days depending on the reasons for port calls. Typically these fishermen come from areas with low HIV prevalence, and hence, as low awareness of and knowledge of the disease. They frequent night clubs and discos close to the harbour area for entertainment and have contact with high-end commercial sex workers. Depending on their period of shore leave, sexual relations with the commercial sex workers do not last beyond the night of the initial contact. There are exceptions though. Some European fishermen (usually Spanish) engage in longer term relations with local sex workers. These fishermen rent residential properties in town and take the local sex workers as a live-in girlfriend. These girls remain “faithful” when her partner is on shore-leave and in town, but continues to solicit new clients when he returns to sea. These relationships could last for the duration of the fisherman’s stay in Namibia. At one club an informant explains that he rents to foreign fishermen and their local girlfriends: High-end prostitutes get [Spanish] foreign fishermen to rent houses for them. The fishermen live with the women when in port and when they are at sea the women go to the nightclubs and see other men. They know when the boats come back and clean up for them. The foreigners think all is well and that they have a woman and a place to stay. For the men it is about having a place like home, while for the women it is about security and having a place to stay. Chinese fishermen on the other hand prefer once-off encounters with low-end sex workers and prefer unprotected sex. One SMA staff member explains that they have held training sessions with sex workers who complain that foreign fishermen do not want to use condoms, but they have no trouble with local fishermen because the locals have grown up here and know about HIV and AIDS. They explain: The Chinese do no like condoms and do not want to pay so they have high- risk sex with low-level prostitutes, other foreigners have high-end girls but also do not want to use condoms, while the local guys have girlfriends in Kuisebmund so they are not using the prostitutes as much, but they go out and look for other women. SMA staff members are not able to provide HIV IEC information to foreign fishermen because of language barriers. There is, of course, also the issue of educating foreign fishermen with Namibia’s donor funding and then having that education taken away from Namibian. This begs the question as to who is responsible for funding the education of non-Namibians who participate in sexual risk-taking within Namibian. Many foreign fishermen come from countries that have low HIV infection rates. Therefore, the level of information they have about HIV and AIDS is low. When they come to Namibia they are not aware of Namibia’s high HIV infection rates. However, these men link high risk sexual networks from Walvis Bay to their sexual partners in their countries of origin, sometimes taking with them HIV.

Figure 25 Risk Taking Behaviour in Walvis Bay Therefore, the foreign fishermen’s vulnerability to HIV stems from a number of factors that include: • Not having had any HIV education prior to their arrival in Namibia. • Not receiving any HIV education during their stay in Namibia. • Having low levels of knowledge and awareness due the fact that they come from areas with low prevalence levels. • Frequently engaging in unprotected sex and high risk sexual activities with high risk sexual partners (commercial sex workers). • Engaging in short-term relationships with unfaithful partners (sex workers as girlfriends). • Frequent abuse of alcohol. • Inability to communicate in any of the local languages.

Namibian Fishermen Local fishermen are usually permanent residents of Walvis Bay, and hence, spend more time on-shore than the foreign fishermen. They frequent the numerous shebeens in Kuisebmond and have sexual relations with the low-end sex workers who also frequent these establishments, and with women who engage in transactional sex. A contributing factor to HIV vulnerability in Walvis Bay is the short amount of time fishermen spend on shore. They do not have enough time to form long-term monogamous relationships and thus often see sex workers. Local fishermen do not frequent the same clubs and bars as the foreign fishermen, although some of the sex workers might move between the two sets of locations. It is, therefore, quite possible that local and foreign fishermen could have sexual relations with the same sex worker. Some internal migrants who migrate to fish from Walvis Bay come with their families. The wives of fishermen can be found working in fish processing factories or as informal sellers. However, by far the most common scenario is still that of young men migrating to work in the fishing industry without their wives or girlfriends. In most cases a fishing vessel is out to sea for anywhere from 20 days to over two months, depending on the size of the crew, the supplies on board and if they can process the fish off-shore without having to dock. The fishing vessels usually go for deep-sea fishing and just to get to their fishing spot can take several days. One Namibian fisherman explained that sometimes they work off the coast of South Africa for six months and are then told they are sailing to Argentina; meaning that these fishermen will be away from Namibia for over a year. Given the long months at sea and the relatively short stay in the town, fishermen look for ways to relax and enjoy themselves with as little effort as possible. Namibian fishermen, who understand the local languages can attend sporting events and go to the local township (Kuisebmund) because it is cheaper than the bars in town and they can meet people from their home areas. The map below, drawn by a sex worker, shows many of the same bars that this Namibian fisherman identified, as well as the police station and the Tutaleni self-help project. Although local fishermen have had much greater exposure to HIV education and awareness campaigns some have indicated that existing efforts are not sufficient. Their vulnerabilities stem from the following: • Inadequate HIV education • Distrust in vessel owners and management • Unprotected sex with low-end sex workers and women who engage in transactional sex • Frequent abuse of alcohol • Absent spouses or partners

Figure 26 Sex Worker's Cognitive Map of Vulnerability and Help 8. INFORMAL TRADERS

Informal traders can be local, from other parts of the country or from neighbouring countries. Many of the traders found at the four research sites have migrated from other areas in Namibia, while Rundu and Katima Mulilo have the highest percentage of foreign informal traders who have come from Angola, Zambia or Zimbabwe. It is difficult to measure the HIV vulnerability of cross-border mobile populations because most (especially women) are relatively conservative and uncomfortable talking about sexual issues. Many did not want to participate in this study, and were outspoken about not being audio-taped or photographed. Some traders spoke about their work, but terminated the interviews when sexual issues were raised. Despite these limitations it was possible to gather some data about HIV vulnerability of this mobile group. Many informal traders have dropped out of school, limiting their prospects for formal sector employment. Some informal traders say they sell because they cannot find formal sector employment, while others say they make more money and have greater freedom than in menial jobs such as domestic work or bartending in local nightclubs. The income derived from trading, although small, affords many women a measure of economic freedom not otherwise available to them. The age of informal traders varies significantly. Women traders are typically in their thirties and forties, and many have first tried to work in the formal sector. Male informal traders are usually younger, in their early to late twenties.

Figure 27 Informal Traders in Rundu Women tend to sell items such as clothes or food such as fruit and cooked meat (called kapana), whereas men sell manufactured items such as sunglasses, audiotapes and ‘boom boxes’. Informal traders are poor and typically live in shacks in informal settlements, but may travel great distances to sell in towns, along roadsides or at meeting points where business is quick. In Walvis Bay and Rundu informal sellers also have a market place built by the municipality. However, there is a monthly charge for the stalls and related services (such as communal water taps) and thus many informal sellers choose to operate along the road. In the border sites at Oshikango, Rundu and Katima Mulilo, there are a number of cross border traders who either sell in Namibia or, more often, cross the border to purchase consumer goods to sell in their own country. Informants explain, “girls from across the river come and sell it at the open market” to earn Namibian currency with which to buy manufactured products. In Oshikango there are a large number of informal traders who cross the border only long enough to purchase consumer goods to bring back to Angola. These traders usually do not bring trade items with them but have US Dollars, which is the currency of trade in Angola. Informal cross-border traders face a number of risks, including being caught and deported, being put in jail, having their goods confiscated and being sexually harassed by border personnel. Female cross-border traders have little power and assets to negotiate with border officials and thus are more likely to be sexually exploited. Cross-border sex workers are at risk of having to pay a ‘bribe’ to border control personnel and are also at risk of being abused by clients who know they cannot go to the police. Female cross-border traders are also vulnerable to exploitation by the people with whom they trade in the place of destination. People who want to cross the Rundu border post late at night are subject to ‘fines’. For men this ‘fine’ is money, but for some women this ‘fine’ is often a “sex bribe”. Sex workers say the border police treat women crossing the border badly, while border police claim the women are rude towards them. In Rundu and in particular Katima Mulilo, many women and adolescent girls come from Angola and Zambia to escape poverty in their country of origin and work as domestic workers or bartenders in Namibia. These women are often exploited and work for little or no pay, as well as being at risk of sexual exploitation by their employers. Previous research (LeBeau 2004b) on child labour in Namibia found that some of these workers are only given food and shelter in exchange for their labour, thereby making them indentured servants. 9. RESPONSES TO HIV IN RESEARCH SITES

Knowledge and behaviour of mobile and migrant populations

Most informants taken from the group of mobile and migrant populations have heard of HIV and AIDS and have a good working knowledge of how HIV is transmitted and prevented and know the signs and symptoms of someone who is AIDS symptomatic. Namibian commercial sex workers, in particular, have high and accurate levels of HIV information. There is the greatest lack of knowledge (and thus vulnerability) among foreigners who come from countries where infection rates are lower and where no intensive HIV prevention campaigns are found. These include foreign fishermen (including from Spain, Russia and China); Angolan truck drivers and businessmen; and Chinese business owners. A large percentage of informants have undergone VCT, primarily at the New Start Centres. Several informants say they did not want to go to a hospital or clinic for testing because of the time involved and issues of confidentiality. Many informants explained that they decided to go for VCT because they attended a course or talk that advocates testing, they thought they have been exposed to HIV or thought they were pregnant.

HIV/AIDS Responses

In all research sites there are a number of organisations that work on various aspects of HIV prevention, IEC dissemination and caring for people affected by HIV and AIDS. In some research sites, such as in Katima Mulilo, several NGOs working on HIV prevention and care share office space. One of the only research sites not to have a platitude of organisations working in HIV prevention and AIDS care is Oshikango, although it was reported that SMA opened a New Start VCT centre there in 2006. In addition there is the Oshikango HIV AIDS Information Centre which is understaffed and lacks infrastructural capacity. Most Namibians know that if they test positive for HIV, they can get medication that will prolong their lives. Surprisingly, a large percentage of informants from the mobile and migrant population group have been for VCT, primarily at New Start Centres, with most informants going for testing about once a year. SMA has offices in all four research sites. They encourage condom use by selling condoms such as Maximum Gold at a reduced price, offering government supplied condoms free of charge and educating the public about using condom. Part of SMA are the New Start VCT Centers. New Start offers Voluntary Counselling and Testing (VCT) services. The cost of the service is usually about N$10, but this fee can be waived if the client cannot afford the price and sometimes New Start has promotions whereby they offer free VCT services for a month to all clients. Usually a client is first counselled as to what to expect and what they might do if they are HIV positive or HIV negative. After testing they are informed of the results and again discuss with trained personnel what they should do once they know their HIV status. In Walvis Bay the Multi-Purpose Centres (MPC) is on the same premises as the New Start VCT centre and Catholic AIDS Action (CAA). The CAA programmes primarily target HIV-positive or vulnerable populations with counselling, medication and healthy food through home based care and after school care programmes for OVCs. CAA was visited at all research sites, except Oshikango where there is no CAA office. CAA is supported by a group of Faith Based Organisations (FBOs) and offers a range of services to people infected and affected by HIV. Aside from their educational outreach services, probably one of the most vital services CAA offers is home based care. Although most HIV organisations target stable populations, some organisations such as the SMA and its associated New Start VCT centres target segments of mobile populations including sex workers, the military and occasionally truck drivers. The SMA also holds ‘promotions’ at various events such as sporting events or hold lunchtime events at the workplace. SMA goes to a variety of locations to educate mobile and related populations, including truck stops and truck loading areas, nightclubs, bars and shebeens.

During the pre-field work research visit to Walvis Bay, SMA in association with the New Start VCT Centre held a lunchtime event at one of the local factories. The SMA/New Start staff arrived just prior to lunch. When the lunch bell rang, about 40 employees, mostly men with only two or three women, assembled. The team gave information on Voluntary Counselling and Testing (VCT) such as how to get tested, why someone should go for testing, technical issues such as CD4 count and viral load testing, the different HIV tests used, and the fact that New Start uses the rapid test which gives results within 15 minutes. They also explained how much the test costs, the fact that it was confidential and one does not have to bring identification. After the information was given, the group was asked if there were any questions. There were seven or eight questions that fell into two topical areas: 1) how to be tested; and 2) information about VCT. The questions included: ƒ Where to go for VCT ƒ How much VCT costs ƒ What they need to bring ƒ What happens if they are HIV positive ƒ Information about the ‘window of opportunity’ (false negatives) ƒ How long the results take ƒ If they have to go on ARVs, how long they can live. These questions show that the audience was interested in getting tested and that participants had some knowledge about HIV. Of importance was the fact that these men knew that there is a period of time when they can be HIV positive but the test shows they are negative. After all questions were answered, the SMA/New Start staff then asked the crowd questions and those who answered correctly received gifts that had sexual health messages. The most popular items were decks of playing cards and t-shirts. The SMA/New Start staff explained that they target only one topic at a time so that the audience can have clarity on that specific topic. For example, on this day they did not answer questions about HIV transmission modes, but said they would come back later to discuss this issue. The staff also does follow-ups with each group depending on how busy the company is, the audience’s level of knowledge and if there are peer educators within the company.

Figure 28 Sites if Vulnerability and Care and Support The following map of Katima Mulilo, drawn by a sex worker, shows sites of HIV vulnerability where sex workers come and go from Zambia to meet truck drivers in transit at the Engen truck port (prominently represented in the drawing). The areas identified as places where they take their clients are the bushes and riverbeds as well as the Mukasi Cabins, although truck drivers often use the cabs of their trucks to entertain sex workers. However, of interest in this drawing is the representation of the New Start VCT centre, which is shown as being very close to where sex workers take their clients, indicating that the New Start centre holds prominence in this sex worker’s cognitive view of the world. Oshikango is the only site that does not have a large number of organisations working on HIV prevention and care. There are two HIV prevention programmes in Oshikango who are both understaffed and lack infrastructural capacity. One is USAID’s Corridors of Hope (COH) Programme, implemented by SMA. The SMA/COH office is a small structure of one room with a desk and a large collection of different HIV posters and information. As in other research sites, the SMA staff does outreach promotions and workshops with some of the target mobile populations such as truck drivers and commercial sex workers. The SMA also distributes government provided condoms free of charge and sells Maximum Gold and Cool Ryder. After finalising this assessment a New Start Centre was opened in Oshikango. The other organisation is the Oshikango HIV and AIDS Information Centre which operates out of a caravan. This CBO provides HIV IEC materials and was run by the government in partnership with IBIS-Yelula. However, the volunteer at the caravan explains that this funding ended as of November 2004, but they continue to operate the centre, without funds or remuneration. There are two volunteer staff members, one runs the office and one does home based care in the area. The staff at the centre also works in conjunction with SMA to do community IEC outreach. The photographs below show the billboard for the organisation.

Condom Availability and Use Condoms are readily available through a variety of organisations. The SMA provides government condoms for free and sells Maximum Gold condoms at a reduced rate to shops and liquor outlets. Other more popular brands of condoms, such as Cool Ryder and Sense, are for sale in most shops and retail outlets. In Walvis Bay, Namport makes Cool Ryder available free to its employees. Not only do condoms need to be at the right place at the right time, but people should understand why you should use a condom and be motivated to use them. This motivation can come from fear (use condoms or die), from caring for others (protect your loved ones) or simply for enjoyment (use these condoms and it will feel good). Throughout the research, regardless of the research site, almost every informant identifies Cool Ryder as their preferred condom brand. Local fishermen (as with the rest of Namibian youth) have received HIV information from a variety of IEC sources such as school programmes, MoHSS IEC campaigns and hospitals. Although Namibian fishermen have higher knowledge than foreigners because they have grown up with mass IEC campaigns, they complain that there are few programmes that target them as a group. In the box below, a Namibian fisherman expresses his wish for more information and suggests that it should be made available to them when they come from the fishing ships. However, the SMA office is located directly at the entrance to the port, with SMA staff members noting that when they have approached fishermen coming in for shore leave, most men do not want to stop to listen but only want to “get to the bars as fast as they can”. Overall there has been an unprecedented mobilisation of resources and personnel towards reducing HIV vulnerability in both stable and mobile populations. However, there are still a number of social and cultural factors that continue to maintain mobile and related populations within a high-risk milieu.

Figure 29 "Fishermen are so Far Behind"

One Owambo fisherman complains that he and his colleagues do not get HIV and AIDS information from their fishing companies, while at the same time expressing distrust towards his employer: You know those who are supposed to give us that information are our bosses, the boat operators. They are all foreigners, so they don’t really care about us. Their concern is just work and their fish. Those foreigners wish that we should suffer so that they can come back in our country … The same fisherman says that he and his colleagues have received no information nor attended any workshops when coming for shore leave. He claims: We want to attend, but time is a problem for all fishermen. Our companies should conduct workshops for us upon arrival. They can give this responsibility to people who are willing to assist fishermen. … or to other organisations so that they can come and meet with the fishermen when the boats arrives. Up to now I have never seen such a thing.

PART THREE: RECOMMENDATIONS AND REFERENCES

10. RECOMMENDATIONS

Recommendation 1: More attention should be paid to develop or work with organisations by and for sex workers to empower sex workers by sharing information, develop awareness raising strategies; and work in close collaboration with community level organisations to provide condoms and outreach services to sex workers. Recommendation 2: Develop and implement IEC campaigns for truck drivers at transit and destination points. IEC materials should also be distributed in all relevant languages through transport companies as well as by NGOs at HIV risk- taking sites such as truck stops, bars and shebeens. Especially Angolan truck drivers and businessmen have unprotected sex with sex workers while in transit and at points of destination. Therefore, IEC campaigns, widespread condom distribution and education is needed both on the Angolan side of the border as well as in Namibia. Recommendation 3: IEC information must be provided to all vulnerable groups who come to Namibia – whether foreigners or Namibian. Foreign fishing companies should be required to provide HIV/AIDS IEC materials in their home language and distribute condoms to fishermen before they are allowed to come ashore. Recommendation 4: Use a targeted and individualised approach to IEC provision, which is particularly relevant to mobile and migrant populations who have specific risk factors and information gaps, which differ from other population groups in the stable population. It can be more effective to provide targeted information on a single topic to small groups of the same composition instead of mass information campaigns. These small targeted information sessions should be done regularly, which has more impact on behaviour change. Recommendation 5: Peer educators should be trained and placed on board fishing vessels and all foreign vessels should be required to show proof that their crew has been given information about HIV and AIDS (and given condoms) before being allowed into Namibia for shore leave. Recommendation 6: Integrate HIV prevention messages into existing curricula to train Namibian and foreign fishermen.

Develop and implement comprehensive HIV prevention and care programmes: Comprehensive HIV prevention and care programmes should be developed and implemented targeting mobile and sedentary populations within the four different research sites. These programmes should be implemented by employers, NGOs and government, and could include: ƒ Developing workplace policies and programmes, especially for formal sectors such as government (military, health sector, justice), fishing and trucking industries; ƒ Integrating HIV and AIDS prevention messages into learning modules such as truck drivers learners exams, and curriculum of schools for fishermen, both foreign and local Namibian ƒ Making condoms available for mobile and sedentary populations at all times in place of transit and destination; ƒ Implementing regular outreach and information sessions on different topics with small groups of different mobile and sedentary groups. ƒ There is a need to develop and strategically distribute BCC materials (leaflets, audio tapes, DVDs etc) aimed at mobile and related populations. This includes BCC materials for foreign fishermen, truck drivers from Angola and other neighbouring countries and (cross border) informal traders in places of origin, transit and destination.

11. REFERENCES

Campbell, Catherine. 1997. "Migrancy, Masculine Identities and AIDS: The Psychosocial Context of HIV Transmission on the South African Gold Mines", Soc.Sci.Med. Vol. 45, No. 2, pp 273-281. Fung, Vincent. 2004. “Mapping made easy: a guide to understanding and responding to HIV vulnerability”. UNDP: Bangkok. Hishongwa, Ndeutala. 1992. The Contract Labour System and its Effects on Family and Social Life in Namibia. Gamsberg Macmillan: Windhoek. Iipinge, Eunice and Debie LeBeau. 2005. Beyond Inequalities 2005: Women in Namibia. 2nd ed. SARDC/UNAM: Windhoek. Iipinge, Eunice and Debie LeBeau. 1997. Beyond Inequalities: Women in Namibia. SARDC/UNAM: Windhoek. International Organization of Migration (IOM). 2003. Mobile Populations and HIV/AIDS in the Southern African Region. Desk Review and Bibliography on HIV/AIDS and Mobile Populations. IOM/UNAIDS International Organization of Migration (IOM). 2002. IOM Position Paper on HIV/AIDS and Migration. IOM: Switzerland. Kaundjua, Maria. 2000. 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