Environmental Influences

Amy Gregowski is an ICRW public health specialist who directs the Namibia project.

In the fight against HIV, the environment in which women and men live influences their risk of becoming infected. That’s part of the reality in Kabila, a small community on the outskirts of Katutura, Namibia.

ICRW is launching a project here to reduce people’s vulnerability to HIV by addressing risky sexual behavior associated with drinking alcohol. Bars serving alcohol are ubiquitous in the hilly, informal settlement of Kabila.

During our formative research with local partner organization Society for Family Health and social workers from the Ministry of Health and Social Services (MoHSS), Kabila residents told us they were frustrated with the poor infrastructure, crime and inadequate or non-existent utilities, including water. Mostly, people spoke about the hardships of unemployment or underemployment. While some men have found jobs in Namibia’s capital city of Windhoek, women often lack the skills, time or access to find work in the formal labor market. We found that alcohol has become a cornerstone of social activity and the informal economy.

Such an environment only increases women’s vulnerability to HIV. For many women, it’s challenging – if not impossible – to refuse sex or suggest that their partner use a condom. Add alcohol to this mix, and things get worse: Many studies have shown that women are vulnerable to HIV if they are drunk before having sex as well if they’re not intoxicated – but their partners are. Our surveys found that 60 percent of bar patrons are men, and heavy drinking is common among both men and women.

Findings from our formative research highlighted the importance of mobilizing the community in Kabila, an important component of any HIV intervention. However, in Kabila, this activity will be central in building community members' ability to advocate for their collective interests so the project can begin to address the context in which hazardous drinking occurs.

Our goal is to work closely with the women – and men of Kabila – so they may become empowered to change an environment that presents numerous health-related risks, including HIV.