Namibian paradox: diamonds, disparity, and HIV. The unique drivers fueling the HIV epidemic in a wealthy southern African country

Cristina de la Torre, Macro International Inc.
Shane Khan, Macro International Inc.
Erin Eckert, ORC Macro

The HIV epidemic in Namibia presents a paradox: a small population, a high GDP, but, also, an HIV prevalence rate of 20%. What are the unique behavioral and contextual factors driving the epidemic in Namibia? An analysis of available literature and data from Namibia indicates that the epidemic is sustained by a complex interweaving of shifting values around marriage and sexual partnerships, migration, extreme wealth disparities, and gender inequality. Marriage rates are among the lowest worldwide with 25% of adults aged 35-49 having never been married. Transactional sex is replacing traditional economic arrangements as women’s marital independence is not matched with new income generating opportunities. Meanwhile, 16% percent of men report more than one partner in a year. Seven percent of single women aged 15-24 have a partner 10+ years older. Age-mixing, transactional sex, concurrent partnerships and migration ensure that HIV cuts across generations, across class, and across the country.