At least 3 percent of South Sudan’s total population is living with the deadly HIV/Aids virus
31 October 2011-(Juba) -At least 3 percent of the total population of South Sudan is living with the deadly HIV/Aids virus.
That’s according to the non-governmental organization, Family Health International or FHI.
The Senior Program Officer of F-H-I 360, John Bosco Alege said that a survey carried out by the Ministry of Health and its partners came up with 3 percent of the population living with the virus.
Mister Allege said the prevalence rates vary from town to town with the highest rates recorded in Western Equatoria state.
[John
Alege]: “In South Sudan there are huge disparities in terms of prevalence. If you go to major towns like Juba, you go to Yambio, you go to Yei, Wau, Upper Nile and so on there are a lot of disparities in the prevalence. You will realize that currently, Western Equatoria state has the highest prevalence rate, I cannot quote it now because I cannot remember it off head, but it stands far beyond three percent, which means it is higher than the national prevalence that the ministry is working with”.
Alege said that intensive research needs to be conducted in order to establish the exact national prevalence rate.
Courtesey:
Sudan Radio Service, a Project of Education Development Center
The AIDS Pandemic in South Sudan: Death from the bedroom
by Brian Adeba (written in 2001)
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As the AIDS scourge continues to have a devastating toll on Africa, in southern Sudan rampant ignorance about the disease is set to make the situation even worse, so argue AIDS experts.
Largely, thanks to the 18-year-old civil war, the 45 Non-Governmental Organisations (NGOs) working in the war-torn area have mainly concentrated their efforts on relief work and combating other primary health problems, leaving the HIV-AIDS issue literally untouched. The most dominant rebel group in the area, the Sudan Peoples Liberation Army (SPLA) has not done better.
Even after establishing a civil authority and administrative structure in the territory it controls, it has taken the group’s leadership six years to throw its political will behind efforts to fight the scourge. It was only in April this year that the SPLA and the NGOS sat down to formulate a policy guideline to combat the AIDS pandemic. To date, southern Sudan is one of those areas in Africa where no comprehensive statistics on HIV-AIDS prevalence exist.
“We don’t have correct information about the standards of AIDS prevalence in Southern Sudan”, admits Dr. Bellario Ahoi N’gog, Chief Health Officer of the SPLA Health Secretariat. Dr N’gog then cites perhaps the only AIDS survey ever conducted in southern Sudan in 1998 by the United Nations Development Programme (UNDP).
“What was got was that there was AIDS,” he said. The survey found out that the prevalence rates on the virus ranged from one to three percent of the population. The SPLA estimates that there are 12 million people in the territory it controls in the south. Critics have termed the UNDP survey as being not comprehensive. Some areas, especially those where there was fighting, were not accessible to researchers when the survey was being conducted.
The inaccurate and not so comprehensive statistics aside, the situation has been made grimmer by the fact that the rebel authorities lack the means to conduct their own studies on prevalence rates. “We have not had the means to make comprehensive surveys in all the counties of the New Sudan (a term the SPLA uses for the areas it controls in the South) and we think that the problem is bigger than that”, says Dr. N’gog. Dr. I.S. Sindani, a physician who has worked for the relief agency, Norwegian Peoples Aid (NPA), confirms his fears.
For the past three years Dr. Sindani has carried out small-scale studies in two hospitals in southern Sudan. The situation in the main in Yei, which is the main headquarters of the SPLA paints an alarming picture “We collected data from patients dating January 2000 to June 2001 and 24.6 per cent of the patients were positive,” said Dr. Sindani.
For a single hospital to register such an alarming high percentage there is every reason to worry. Dr. Sindani also said samples taken from blood donors within the same period registered a 6.8. percent positivity rate. “These are people living in the community and everybody looks at them as normal people but they are giving it (HIV) to others. So it is quite a high rate,” he says.
Two years ago at the same hospital, Dr. Sindani’s surveys found out that only 18.6 percent of the patients were HIV positive. But Dr. Sindani is quick to emphasise that these are small studies, which are not community based and comprehensive. He believes the prevalence rate could be much higher.
Dr. Sindani is not alone in his fears. Dr. Margaret Itto the Health Co-ordinator of the New Sudan Council of Churches (NSCC), says a hospital the Council operates in the town of Nzara in Western Equatoria Province, has in the last two years been recording an increase in TB cases and resistance to treatment. She says in most cases this is an indication that HIV-AIDS is increasing among the people.
Ms. Judith Roba, a nurse with the NSCC who has worked in many hospitals throughout Southern Sudan, says the situation is getting worse. “In all these hospitals I have worked, I see the signs and symptoms of HIV everywhere”, she said. The main mode of transmission of the virus is through heterosexual sex but of late increased cases of pre-natal transmission are being recorded. This year alone 6.2 percent of HIV patients in Yei Hospital were said to be children below the age of five.
Currently it appears that the number of males living with the virus is more than that of females. But researchers like Dr. Sindani argue that this is because most of the women in Southern Sudan are in refuge in neighbouring countries. According to Dr. Itto, this is a main cause of worry.
“All the five countries neighbouring South Sudan have high peaks of HIV AIDS. With people moving in and out, we expect it (HIV) to be high”, she said. The area under SPLA control is a large swathe of land, perhaps larger than Kenya and Uganda combined. Four years ago, the SPLA forced out government forces from most of Equatoria and Bahr-el-Ghazel Provinces.
From the Ugandan town of Koboko, the road is now open up to northern Bahr-el-Ghazel and a whole market for Ugandan goods was created. And with it, an increase in the movement of people across the two borders ensuring the spread of the scourge from Uganda, a country that a few years ago had the highest prevalence rates in Africa. Counties near the border areas are suspected to be having high peaks of the virus. Other factors like wife inheritance, initiation rites, use of unsterilised needles and the movement of soldiers from one front to another encourage the spread of the virus, so says Dr. N’gog.
Perhaps the major obstacle in the fight against the virus is the rampant ignorance about it in Southern Sudan. The NSCC, which was among the first NGOs under the Operation Lifeline Sudan (OLS) umbrella to initiate awareness campaigns, estimates that only 58 percent of the population is aware about the disease. Awareness exists only around the border areas but deep in the interior, it is non-existent.
Even so, in places where one expects some knowledge about HIV-AIDS, it is mainly attributed to witchcraft. In some areas, people feel there are more pressing needs than awareness. An SPLA officer posed this question to this writer: “Which one kills faster- an assault on enemy trenches or AIDS?”
Awareness campaigns started in 1998, but not much has been done in this front. The situation is made worse by the lack of a wide reaching medium like radio, to disseminate awareness messages. Protective measures like the use of condoms is literally unheard of in most areas and in any case, the Catholic church which commands the largest following among churches in the South, is vehemently opposed to the idea.
Dr. Pius Subek, the Executive Director of the Sudan Health Association (SUHA), an indigenous NGO involved in AIDS awareness said his organisation brought condoms to a county called Kajokeji near the Ugandan border but not a single person came to ask for one. It is the same story in towns like Yei, Maridi and Yambio. Condoms are available in the shops and pharmacies, but there are no customers. Anyone seen with a condom is labelled promiscuous.
The fight against the scourge is also hampered by the fact that there is practically little or no co-ordination among the 45 NGOs in the health domain. As a result, individual NGOs carry out ill-planned and isolated campaigns in the areas they operate. No modalities are created to keep sustained awareness campaigns and soon these fizzle out.
However, AIDS campaigners are hailing as a milestone a meeting in April this year between the SPLA and the NGOS to formulate an AIDS policy guideline. During the meeting held in Natinga in Eastern Equatoria Province, SPLA leader, John Garang declared AIDS as the second enemy of the SPLA: the first one being the government of Sudan.
Garang also announced that the disease should be talked about in parades, churches, schools and courts of the “New Sudan”, whenever leaders find the opportunity. It is hoped that with this political backing of the SPLA, the fight against one of the world’s deadliest diseases may have just begun in one of Africa’s unstable regions. But for it to attain any tangible results a Marshall Plan might be required in the form of funds to kick start and sustain awareness campaigns since as Dr N’gog says the war on AIDS begun a bit late.
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Can we STAND TALL to face the Epidemic?
By Regina Akok
Warning! I’m not acting here as an HIV/AIDS expert, I don’t even belong to medical community, but I belong to human community, which allowed me to be inquisitive, not only that but passionate about health issues, and medical mysterious like many of you on this medium. In fact some of my favourite readings or shows have been about the medical field and health issues. I thought it’s important to access information, learning about prevention or cure for any epidemic like other diseases, and are considered essential part of human rights. I will share with you and some already know the basics about HIV/AIDS in terms of its history, what is it? And what are its social impacts on the victims and those surrounded the victims. What are some misconceptions that need to be changed? And how we need to change the way we look at HIV/AIDS as only an stigma attached to moral or ethical questions only, which hinders both prevention and cure, but as a disease that’s debilitating to all of us, physically, mentally, emotionally, socially, culturally, and economically. In fact, its negative impacts extends to the next generations if we are not careful enough as government, professional healthcare givers, educators, communicators, communities, youth, women, men, chiefs, religious leaders, the victims of the endemic and everybody else. What has been done to prevent it globally? What lessons can we learn from those experiences? I acknowledge it’s not an easy challenge that could be dealt with easy and ready made resolutions. So let’s start exploring because how could we deal with unknown? This is just an attempt to understand the issue.
To start off, what is HIV and AIDS?
HIV is a virus that destroys human immune cells. It weakens the immune system, and without appropriate medical care, it leads most infected people to develop AIDS. The term ‘AIDS’ stands for ‘Acquired humane deficiency Syndrome’. AIDS is a medical condition, and a person is diagnosed with AIDS when their immune system is too weak to fight off viruses. The history of AIDS is a short one; it goes back to 1970s, sadly, no one was aware of this deadly disease. In fact it was first identified or recognized in the early 1980s, in which an unprecedented number of people have been affected by the global AIDS epidemic. Since then the global AIDS epidemic has become one of the greatest fear and threats to human health and development. Simultaneously, much has been learnt about the science of AIDS as well as how to prevent and treat the diseases. Sorry to say, through the process our continent, sub-Saharan region of Africa has shared most of the pain and generations of souls have been lost because of HIV/AIDS. It is not a one person disease, when one is affected the whole family or community is hurt, starting with physical illness, psychological trauma, , deterioration of economic, reproducing parentless children as we saw in Uganda, orphanage, plus new sets of problems that are attached to that. In addition to stigmatisation that can extend to the next generation, placing an emotional burden on those left behind. I cannot even go there, that’s needs a whole book.
According to UNAIDS (2010) on the global AIDS epidemic, it is reported that for the end of 2009 about 33.3 million people are living with HIV, and roughly 2.6 million more people become infected every year with HIV, whereas 1.8 million die of AIDS. It is a staggering figure and scary as well, isn’t it?
We have learned that AIDS is passed from person to person through sexual fluids, blood and breast milk (in case of infected mothers). However, it has been reported that the common HIV infections are handed on through sex between men and women, sex workers, injecting drug users, and men who have sex with men.
Yet again, in many people’s psyche or mentality, HIV and AIDS are very much connected with particular group of peoples, which can lead to even a greater stigma and bias against people already thought of as outsiders. Stigma or shame is one of the reasons that delay fighting HIV or accessing the right treatment all over the world and could be the case in our beloved country, if the authorities are not sensible about it. It’s mainly problematic, thinking mistakenly that, well I’m immune to AIDS because I’m not that promiscuous or not a drug addict or not a gay and simply don’t belong to certain group of people or “the other”, its hookers’ problems not mine or it’s certain nationalities not South Sudanese, please give it a break already it has proven not to be true. The disease does not discriminate against anybody; it practises its fairness very well. Trust me; it’s not that far from your backyard. It affects adolescents, Adults men and women, religious people non religious people, wealthy, poor, those with high moral and those considered with low morals, well educated people and non educated, street people and those who live in mansions, blue, grey people as well as green people, young and old, including babies, those who live in rural areas as well as urban centres, those who reside in Juba a s well as those who live in Akouc (my own village in Twic county), South Sudan as well as America.
What is AIDS related stigma and discrimination? It means to prejudice, negative attitude, abuse and maltreatment directed at people with HIV and AIDS. Consequences range from being rejected by family, peers, and the wider community, by being offered poor treatment in healthcare and education settings, being avoided to socialize with. It is an erosion of rights, causing psychological damage, and as adding negative outcomes on the success of HIV testing and treatment. We can fight stigma through informative and helpful laws and setting policies which begins with openness. It takes courage to speak in public, in schools and empower those affected to use their experience as power of educating others. I know it’s not easy, especially in our communities.
That’s being said no policies or laws that will wipe out HIV/AIDS related discrimination. Stigma and discrimination will continue to exist so long as societies as a whole have a poor understanding of HIV/AIDS and the pain and suffering caused by negative attitudes and discrimination practices. Those fear and stigma need to be dealt with at government levels and community levels through simple tools like billboards like the one that I saw in Juba, translated in local languages, using visual aids, through schools, churches, mosques, villages, health centres, by including the already affected with the disease to be part of the solution. I’m sure I have not included every aspect that might help.
Let’s talk about what others have been doing to prevent the disease and what needs to be done in our situation before we regret it. Earlier responses to HIV prevention, which acknowledged that HIV can be passed to another person through sexual intercourse, even before the term ‘ABC’ approach for prevention was considered. It was obvious in the resources provided by the World health organization (WHO), the global program on AIDS, later succeeded by UNAIDS, governments and organizations around the world, that much attention was paid to abstinence principle (which could be discriminatory itself because not everybody knows how to self-discipline), fidelity and condemn use, which could prevent the sexual transmission of HIV, but was that enough, I mean did that control the spread of the disease? Before we reflect on that we may need to understand what is ABC strategy after all?
What is ABC approach of preventing HIV/AIDS spread?
• Abstinence for youth, including the delay of sexual debut and abstinence until marriage
• Being tested for HIV and being faithful in marriage and monogamous relationships
• Correct and consistent use of condoms for those who practice high-risk behaviours
All the above points sound great but neglect other aspects such as cultures, social economic conditions, gender inequality, level of literacy, strength and willingness of the governments involved, stability of the nations and wars, lack of sex education and taboos and sets of problems surrounded the issue of sexuality, multiple partners and more. As early as 2004, UNAIDS called for a move towards a more comprehensive approach to HIV prevention because it appeared ABC approach was not enough, many people were still dying of AIDS. They thought of reviewing and assessing earlier approaches such as the above mentioned ABC approach and in fact to include realities of the inequality between men and women in many of the countries with a high HIV primacy, which explains, more women being infected with the disease. Some organisations have recommended increasing on the ‘ABC‘ slogan to include social and economic aspects, particularly women’s rights. At one point, it was suggested that ‘DEF‘ were also added; representing ‘defending against gender-based violence’, ‘education: improving girls education’ and fix property and inheritance laws please see more on the (Global AIDS Alliance ‘Comprehensive HIV Prevention) and World Council of Churches (January 2005) “Working with People living with HIV/AIDS Organizations”
However, there are those who believe instead of that ‘one size fit all’, which means applying one model to all infected with the disease without looking at other circumstances that are specific to certain people, communities, or nations or regions. Those alternatives have meant shifting the focus from completely relying on ABC measures alone to considering other models that are more inclusive and culturally specific. Some of the debates believe it is important to discard ABC approaches altogether. Some argue, prevention plans must be tailored to the local context; which means to understand key drivers of the local endemic. It also means adopting more of a holistic approach (social economic, culture, beliefs, myths, gender equality, class and others). Each country has its own circumstances. For certain countries it might be that people are not open enough to discuss issues related with sex even among married people. Or because women are taught not to say no to their partners even if it was evident her partner is not committed to her alone. In other circumstances, the drivers might be inadequate and poor medical equipment, or lack of education about the disease or just government is being reluctant to address the issue or just being in denial. That is why there is now general agreement that where the ABC approach is used, it should be balanced and that it should also been seen as part of a wider prevention strategy that, if appropriate, includes circumcision for men, harm reduction for injecting drug users in other countries, and preventing mother to child transmission of HIV (PMTCT) for pregnant women. In the west they talk even about protecting the sex workers. For more information please see (Cates, Willard (2003) “The ABC to Z approach” Network 22(4))
It’s a responsibility of the government, health care system, professionals, nurses, education system, religious institutions, local communities, media and press, discussion forums like this platform, chiefs, women, youth, local NGOs, humanitarian bodies, individuals and mainly the victims of HIV/AIDS themselves. Who knows better and what else can be more effective and powerful than the living testimony. Personal narratives can be empowering and educating as long as they are not exploited; it has to come from them when they are prepared and feel save to talk about their own journeys on their own terms. The point here is not to be voyeuristic about their pain, but to allow them to reclaim their voices and turn the pain and suffering to a powerful tool. It’s healing process and has been used in different communities to give voice and face to their fear and by doing that they help the whole society. This is might not work in some societies or with some individuals.
In addition to that HIV/AIDS in South Sudan should be treated as an emergency situation. Our government needs to be proactive and not that only but aggressive about it. special funds needs to be allocated for epidemic diseases. It’s unfortunate, malaria killed many which is preventable, which makes the case for HIV/AIDS even more challenging. If we can’t face curable diseases as a country how would we deal with the most complex, It’s another issue.
In the end let’s benefit from the theme for World AIDS’ Day 2010 ‘Universal Access and Human Rights’. We know global leaders have pledged to work towards universal access to HIV and AIDS treatment, prevention and care, recognizing these as fundamental human rights. Though valuable progress has been made globally in increasing access to HIV/AIDS services, yet greater commitment is needed around the globe and specifically in our own nation, Good luck with that.
Please check the following references for more information
UNAIDS (2010) UNAIDS report on the Global AIDS epidemic
WHO, UNAIDS & UNICEF (2010), Towards universal access: scaling up priority HIV/AIDS interventions in the health sector
Mutembei MK (2001) ‘Poetry and AIDS in Tanzania: changing metaphors and metonymies in Haya oral traditions: 144 cited in ‘The African AIDS epidemic: A History’ James Currey Oxford: 82
Costa, M in Nolen, S (2007) 28 Stories of AIDS in Africa, Portobello Books: 131
Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report 2005, (Vol. 17
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