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SUDAN: Battling HIV in a post-conflict army

Photo: Edgar Mwakaba/IRIN
Research shows that post-conflict transitions are periods of heightened vulnerability to HIV
JUBA, 29 January 2010 (PlusNews) - The evidence of five years of peace is everywhere in Juba, regional capital of Southern Sudan - in the brisk trade in the city's markets, its packed bars and nightclubs, and in the relaxed gait of the soldiers of the former rebel Sudan People's Liberation Army (SPLA).

For the soldiers, the contrast with life in the bush could not be greater - they wear new uniforms, receive a monthly salary and are revered as freedom fighters by the local population. But behind the good times lurks the threat, senior officials of the SPLA warn, of HIV/AIDS.

"After peace was achieved, our soldiers began to receive regular payment, and with money comes the ability to buy alcohol, to buy sex," said Lt Col John Woja Elinana, head of the SPLA's HIV secretariat. "With the increase in cross-border movement of people from high-prevalence countries like Uganda and Kenya, sex with women whose HIV status is not known is putting them [soldiers] at high risk.”

According to Woja, during the war years, knowledge of HIV prevention was very low among the troops, and the army's leadership embarked on an aggressive campaign to equip soldiers with the knowledge and skills to avoid infection.

A 2009 report, HIV/AIDS, Security and Conflict:
New Realities, New Responses, by The Netherlands-based research group, the AIDS, Security and Conflict Initiative (ASCI), warns that "post-conflict transitions are both a period of heightened vulnerability to HIV transmission and a neglected element in HIV and AIDS policy and programming".

With input from the neighbouring Uganda People's Defence Forces and support from two NGOs, Intrahealth and Population Services International (PSI), the secretariat - created in 2006 - has designed a prevention programme specifically targeting troops.

Army-specific prevention

"PSI has conducted a peer education training programme... the peer educators have reached more than 100,000 soldiers, including spouses, with the HIV message," said Simon Yango Taban, SPLA programme manager for PSI.

''After peace was achieved, our soldiers began to receive regular payment, and with money comes the ability to buy alcohol, to buy sex''
So far, the programme has reached Central, Eastern and Western Equatoria, and Lakes states.

"Working within an army has the distinct advantage that it has its own organized structures so getting soldiers together to pass on the message is relatively easy," he added.

The information targeting the army uses military language to enable soldiers to easily identify with the message; for instance, HIV is referred to as "the enemy", while advice on condom use reads, "using a condom is entering an unknown territory with an armoured car".

PSI has also collaborated with UN-run radio station Miraya FM to hold weekly talk shows on HIV, including Q&A sessions with members of the military.

"We have also been able to distribute about 1.5 million condoms every year to soldiers," said Carol Karutu, programme manager of Intrahealth in Southern Sudan.

Messages encourage soldiers to seek voluntary counselling and testing, and through Intrahealth, the secretariat has set up 10 voluntary counselling and testing centres - either in barracks or in SPLA health facilities manned by soldiers.

Soldiers who test positive are referred to the health facility at the SPLA headquarters in Bilfam, Juba, where an anti-retroviral (ART) clinic and fully equipped laboratory have been built. Once on ART, HIV-positive soldiers continue to be deployed and are referred to hospitals near them or sent back to Juba to refill their prescriptions; so far, about 300 soldiers are enrolled in the army's ART programme.

"We do not discriminate when soldiers are HIV-positive; we continue to train them and deploy them as long as they remain fit," Woja said.

As the army's HIV programme continues to roll out to the rest of Southern Sudan's 10 states, the secretariat intends to mainstream HIV into other SPLA sectors.

Strong leadership

"We plan to train instructors at the SPLA's training schools to incorporate HIV lessons into their curricula at all levels, from commander training to the lower cadres," Intrahealth's Karutu said.

More on the military:
 Military gets new HIV policy
 Military to lead the way in male circumcision
 Armies grapple with HIV among troops
Crucial to the success of the programme and to its expansion, she noted, would be the continued commitment from the highest levels of the army. "We have the commanders talking about HIV at every military parade, the army holds big marches every World AIDS Day, and President Salva Kiir - who is also the SPLA's Commander-in-Chief - has even taken a public HIV test," she said.

"Command-centred approaches to HIV prevention are likely to be more effective in reducing HIV risk among the rank and file than solely relying upon education and training based on individual behavioural, medical, or human rights approaches," the ASCI's report found.

Challenges remain for the SPLA's HIV programmes - demand for information continues to outstrip its supply, which is hampered by severe infrastructural handicaps such as poor road networks and limited health services, while delivering information remains a challenge because, according to Karutu, a large percentage of the SPLA is illiterate and therefore only able to take advantage of oral messages.

"The SPLA recognises HIV as a threat that can disrupt our ability to defend our nation," Woja said. "We must continue to push the message of HIV prevention among our troops."

kr/mw

Theme (s): Conflict, Education, Governance, HIV/AIDS (PlusNews), Prevention - PlusNews, Urban Risk,

[This report does not necessarily reflect the views of the United Nations]

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Pupils at a school in Layibi in northern Uganda stand next to a sign promoting abstinence
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