A shortage of data on the scale of the AIDS pandemic in southern Sudan is hampering prevention, treatment and care initiatives, according to health officials.
Photo: Kate Holt/IRIN
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For more than two decades, civil war and incursions across the southern border by the Ugandan rebel group, the Lord's Resistance Army, prevented any HIV work in the region. Prevalence is believed to be around 3.1 percent - higher than the average of 2.6 percent in Sudan as a whole - but nobody really knows.
"We don't know how to prioritise; which areas to focus on first," said Lul Riek of the Southern Sudan AIDS Commission (SSAC). "It is difficult, with a lack of funds and limited human resources ... you need information."
What seems clear, according to Riek, is that prevalence rates are far from uniform. Figures gleaned from small-scale surveys, antenatal clinics and new voluntary testing and counselling centres across Southern Sudan, vary considerably.
The difference seems especially stark between areas near the Ugandan border - where HIV infection figures from antenatal clinics indicate an infection level as high as 10 percent - and the more central areas of Southern Sudan, where less than one percent of pregnant women visiting the clinics are found to be positive.
Urban areas like the regional capital, Juba, and Wau town, appear to be high-risk hotspots: results from voluntary counselling and testing centres in both towns show HIV prevalence of more than 20 percent; surprised officials had thought of Southern Sudan as a homogeneous low-prevalence area.
Equally worrying, only 3.28 percent of women between the ages of 15 and 24 had a "comprehensive" knowledge of HIV, defined as being able to identify at least two ways of avoiding HIV infection, and reject three common misconceptions about transmission of the disease.
"We want a donor meeting by August; if the funds are there to start a sero-prevalence survey by March , by the end of 2008 we should be able to answer questions," said Riek.
But the data will come many months after the 2007-2011 national strategic framework for HIV/AIDS prevention, launched in June 2007, is put in place.
Neddy Matshalaga, the leading international consultant of the team designing the framework, said this was unfortunate, as experience had shown that evidence-based frameworks were far superior to generalised strategies.
"We have rough guidelines," she said, "but some details will be left hanging ... [which] will be filled as soon as [the data] comes out." Nevertheless, she felt there was enough information available to devise an effective strategy for Southern Sudan.
"The strategy is not just about prevention, but about looking at the enabling environment, the capacity, monitoring and evaluation systems," she said. "Prevention is the only ... [intervention] that needs that kind of evidence."