In-depth: HIV/AIDS in Southern Sudan
The 20 year civil war restricted labour migration, trade and travel, and contained the virus
JOHANNESBURG, 22 October 2003 (IRIN) - With real progress in peace talks [Negotiators discuss contested areas
] offering hope of an end to almost 20 years of conflict in Sudan, an emerging HIV/AIDS epidemic could prove to be even more devastating than the civil war.
"AIDS is [now] more dangerous than the Arabs," said Mary Biba, a senior official of the rebel Sudan People's Liberation Army/Movement (SPLA/M), which has been battling the Arab-dominated government in the north for the right to self-determination for the people of the south. [Interview with Mary Biba, SPLA/M secretary for Yambio County
HIV/AIDS is relatively "new" in the region. The two-decade-long civil war restricted labour migration, trade and travel, and contained the virus. As the country opens up with the end of the war, aid workers are predicting a surge in HIV infection, particularly in the chronically underdeveloped south.
All the ingredients for the rapid spread of HIV/AIDS are there: up to four million displaced people returning home, poverty, very low school enrolment, a rudimentary health system, and the powerlessness of women and girls, combined with cultural practices such as female genital mutilation, polygamy and widow inheritance.
Throwing HIV/AIDS into this mix would be "a disaster - like an atomic bomb", said Dr Richard Oleko, a medical doctor working with the NGO Norwegian Church AID in the remote Nuba Mountains of Southern Kordofan Province, in south-central Sudan. [Picture Gallery
Batol Ramadan is a young married mother who works in the fields, cultivating her crops of groundnuts, simsim (sesame) and sorghum in Chawre, a village in the Nuba Mountains. She has never heard of HIV/AIDS, let alone seen a condom.
There are many more people like Ramadan, who lack even basic knowledge about the disease. Geography and Sudan's long-running civil war have closed them off from the rest of the country and the rest of the world.
HIV/AIDS INTERVENTIONS SLOW TO START
The prevalence of HIV/AIDS in southern Sudan is said to be much lower than in neighbouring countries, but experts warn this is false comfort.
According to the UN Children's Fund (UNICEF), who recently published an "Overview of the Health Situation in Southern Sudan", exact data on HIV/AIDS is limited and little sentinel surveillance has been done on the disease.
In terms of creating public awareness, NGOs and UN agencies still have a long way to go in southern Sudan, where myths, denial and prejudice abound.
The UN Development Programme in the Sudanese capital, Khartoum, funded a survey covering knowledge, attitude and practice in HIV/AIDS and sexually transmitted infections, carried out in December 1997 and January 1998. The study found that knowledge of HIV/AIDS prevention methods in southern Sudan was 58.9 percent, condom use was low, unsafe sexual practices high, STIs occurred frequently but were treated sporadically, and HIV infection was highest in females.
As the articles in this PlusNews web special on HIV/AIDS in southern Sudan illustrate, campaigns targeting the disease - particularly in hard-to-reach areas like the Nuba Mountains - have been slow to get off the ground and are limited in scope.
With an estimated HIV prevalence of 7.2 percent, Yambio County in the Western Equatoria region, bordering Uganda in the southwest of the country, is one of UNICEF's focus areas. In February 2002, UNICEF funded a Polio/HIV/AIDS Awareness Campaign, which reached up to 7,000 people in the area.
UNICEF activities in the county have focused on awareness workshops, developing training modules and capacity building among local NGOs.
Although acknowledging the success of UNICEF's campaign in raising awareness levels in Yambio, youth activist Daniel Owudada feels more can be done.
"NGOs are touching but not fully dealing with it. Not enough is being done - we are still far behind, and nowhere in line with the rest of the world," he said during a meeting with PlusNews. [HIV/AIDS not as easy as ABC
Dr Brigitte Toure, the health programme officer for UNICEF’s Operation LifeLine Sudan, is only too aware of this. She admits that with the region's relatively high knowledge about HIV/AIDS, the challenge for humanitarian agencies is to act.
NO CONDOMS, NO TESTING, NO COUNSELLING, NO TREATMENT
"If I've heard all the messages, and if I want to find out [my HIV status], where will I go?" James Severino, chairman of a youth group in Yambio, asked.
If Severino wanted to be tested for HIV, he would have to travel to neighbouring Uganda or Kenya, as there are no testing facilities in Yambio.
Dutch NGO Zuid Oost Azie Refugee Care (ZOA) is about to embark on a programme of voluntary testing and counselling, and is in the process of training counsellors.
Condoms are not freely available and at the price of 500 Ugandan shillings (25 cents) for a packet of three, they are a luxury many cannot afford.
"People can spend that money on condoms or food ... they are not going to spend their food money on a piece of rubber," remarked Bill Colford, an HIV/AIDS counselling trainer.
The situation in the Nuba region is worse. A shopkeeper in Kauda, a town in the southern part of the mountains, had no condoms available and had never heard of them. The buzzing market in Chawre, an even more remote village, displayed all kinds of wares – razor blades, plastic sandals and an array of fruit and vegetables – but no condoms.
The German Emergency Doctors (GED), an NGO operating in the Nuba Mountains, runs a bush hospital in Lwere, the main base of the SPLA/M in the area, and gives out condoms when patients ask for them, but not many people do.
Inevitably, the provision of treatment is still a distant reality. Telling people about antiretroviral treatment now, Dr Richard Oleko said, would be like "talking about some rare medical term only I would understand".
SEEING IS BELIEVING
Youth activists, NGOs and SPLA/M officials all agree that until more people come forward to disclose their status, very little behaviour change will take place.
The story of Pastor Henry Wandu, and how his family is coping after his recent public disclosure, highlights the need for more HIV-positive role models in southern Sudan. [Stephen's story
"Pastor Henry is a son of this land. When we see our own brother suffering and dying, then we can be touched," a youth activist commented.
But the message that people living with HIV/AIDS can lead healthy, productive lives is missing from the many awareness campaigns conducted in Yambio. Wandu is only the second HIV-positive person to come forward and tell people about his status.
OPPORTUNITY TO ACT
Funding is another issue. A proposal to support HIV/AIDS activities was submitted to the Global Fund for HIV/AIDS, Tuberculosis and Malaria in 2002, but was rejected. Another application for the HIV/AIDS component, made in May 2003 by the southern sector of the Country Coordinating Mechanism (CCM), a consortium of agencies working in southern Sudan, also proved unsuccessful.
But the opportunity to prevent HIV/AIDS from reaching epidemic proportions in southern Sudan exists now. According to a 2002 UN-commissioned report by Mary Anne Fitzgerald on the impact of war on southern Sudanese women, once peace arrives, HIV will spread rapidly through the population as there are no checks in place to stop it.
"Southern Sudan cannot afford the luxury of delay. HIV infection and AIDS awareness must be taken very, very seriously today - not tomorrow," the report warned.