SUDAN: Trying to stem the spread of HIV/AIDS
[This report does not necessarily reflect the views of the United Nations]
KHARTOUM, 6 September (PLUSNEWS) - Asha Ebrahim, a mother of eight living in the Sudanese capital, Khartoum, vividly remembers the day she first learned she was HIV-positive seven years ago.
"When the doctor told me that I had the disease, I fell down. When I went home, I closed the door and stayed inside for three days," she told IRIN.
One of an estimated 600,000 people in Sudan living with HIV/AIDS, Ebrahim contracted the condition through a blood transfusion following a minor surgery.
"As soon as the man who owns the house I am renting learns that I am positive, I am kicked out," she explained. "Teachers in the school tell my children that there is no place for them."
Asha, determined to educate her community on how to prevent, treat and live with HIV/AIDS, has appeared on numerous television programmes and has become a key speaker in many HIV/AIDS-related workshops throughout Sudan.
"I want people to know that this disease is a killer, but it can be prevented and that it should be so that it does not spread throughout our country," she stressed.
Asha is the information counsellor on the Executive Committee of the Sudanese People Living with HIV/AIDS Care Association (SPLCA).
The SPLCA is one of more than 30 national and international NGOs within Sudan dedicated to fighting the spread of HIV/AIDS.
FEARS OF SPREAD
According to UNAIDS, Sudan has an HIV prevalence rate of 2.6 percent among persons aged 15 to 46 - a relatively low rate compared to neighbouring countries like Kenya, with 6.7 percent, and Chad, which has an HIV/AIDS prevalence of 4.8 percent.
Despite this low prevalence, however, leaders of organisations battling HIV/AIDS in Sudan are worried that the rate could increase.
According to these leaders, large population movements are anticipated following the recent signing of the Comprehensive Peace Agreement (CPA), a trend that could increase the risk of disease spread.
The CPA, signed by the southern Sudan People's Liberation Movement/Army and the government of Sudan in January, brought to an end a civil war that had ravaged southern Sudan for more than 21 years.
Many displaced Sudanese are now anxious to return home - some of whom had found refuge in countries with higher HIV prevalence rates, where they faced a greater risk of contracting HIV.
"Because of the peace agreement there will be tremendous population movement from the south to the north and the north to the south," Musa Bungudu, country coordinator for UNAIDS in Sudan, told IRIN. "Unless these people keep great restraint and control themselves, we could have a big problem."
However, the head of the HIV/AIDS programme for the Office of the UN High Commissioner for Refugees, Paul Spiegel, acknowledged the potential risk of an increase in HIV infections in southern Sudan, but strongly urged people not to jump to conclusions with regard to HIV prevalence among returnees.
"While it is true that conflict-affected populations and refugees are at greater risk of HIV infection - because of sexual violence and disruption of health services - this doesn't necessarily translate into higher infection rates," Spiegel said. "Actual infection rates are highly context specific.
"Key factors include the HIV prevalence in the area of origin, infection rates of the population surrounding refugee camps and the time the refugees have spent in the camp."
In addition, Spiegel noted, the increased risk of HIV infection in a time of conflict could be offset by a decreased risk as refugees' mobility was reduced and their level of HIV/AIDS awareness was raised through educational programmes in refugee camps.
The regional HIV/AIDS adviser for Save the Children, Rena Geibel, said there was a mixed picture with regard to HIV rates among conflict-affected populations.
"In eastern DRC [Democratic Republic of Congo], sexual violence is so widespread that the region now has a higher prevalence rate than the country as a whole," she added. In contrast, chronic conflicts in Sierra Leone, Angola and southern Sudan actually kept HIV infections at a lower rate than otherwise would have happened.
Rather than perceiving the return of Sudanese refugees as a potential risk for increased HIV infections in southern Sudan, both Geibel and Spiegel prefer to see the return of refugees as an opportunity.
"Given the lack of information and well-functioning health services in south Sudan, the returnees - who have been educated about the risks of HIV/AIDS and some who have been trained as health-workers or nurses - might actually help to reduce the spread of HIV/AIDS in southern Sudan," Geibel said.
Bungudu urged leaders, NGOs and governmental organisations to get involved in Sudan's fight against the HIV/AIDS epidemic.
Government institutions throughout Sudan are increasingly aware of the issue and have initiated HIV/AIDS prevention programmes.
"I have seen the military force showing their solders how to use a condom," Bungudu said.
The General and Higher Education Ministries have set up a curriculum in primary and secondary schools, he added, to teach students at an early age of the risks of unprotected sex. The Ministry of Religion, meanwhile, encourages Muslim and Christian communities to discuss preventive measures with their members.
The deputy manager of the Sudan National AIDS Control Programme, Mohammed Siddig Abdelgadir, commended the ministries and organisations for their involvement in trying to stop the spread of HIV/AIDS, but feared it was not enough.
"The problem is that Sudan is so big and the population scattered all over. We do not have accurate surveillance systems, monitoring systems, proper health centres and enough funding," he said.
In response to these concerns, UNAIDS is trying to get more leaders to speak out in public, and to enable more people to access treatment. It is also making a special effort to reach displaced people in camps and rural areas and is attempting to get Sudanese people living with HIV/AIDS involved in informing, educating and counselling others.
"They say that an owner of a house knows where it leaks more than anybody, so they are the best people to educate others," Bungudu noted.
"Sudan has a great opportunity to keep the statistics low, especially with the new peace that will be bringing people from all around into the country," he added. "But it is up to the people of Sudan to take responsibility and stop the spread of this disease."