Returning refugees face new challenges in unprepared south

In a crumbling hospital building, pock-marked by bullet holes, Dr Agot Alier Leek admits that he doesn't know the HIV/AIDS prevalence rate in the war-scarred garrison town of Bor in southern Sudan. "We believe the figure is very low, but it is guesswork based on the fact that our out-patient department has recorded no case of HIV/AIDS," said Leek, the Minister of Health for Jonglei State. "This does not mean it is not there, but you know the communities here are traditional, so they try and hide it from the authorities." Compared to the high HIV/AIDS prevalence in the neighbouring Democratic Republic of Congo (DRC), Kenya and Uganda, the infection rate in southern Sudan is estimated at 2.3 percent, according to a report by the UN Population Fund. Despite this relatively low figure, AIDS activists are worried that the ingredients for a jump in the infection rate could be in place. The 21-year civil war between the Sudanese People's Liberation Movement/Army (SPLM/A) and the Arab-dominated Khartoum government displaced around four million people internally, while more than half a million fled across the border into Uganda, Ethiopia and Kenya. Sudan's warring factions signed a peace agreement in January 2005, but some health experts fear the return of the refugees from the so-called 'AIDS belt' to the south could, as one doctor put it, "bring the virus back with them" and drive its spread. However, other specialists differ. According to Dr Patrick Abok, the WHO HIV/AIDS programme officer for southern Sudan, "There are several key factors that will determine the risk: the HIV prevalence in the area of origin; the infection rate of the host population surrounding refugee camps; and the length of time the refugees have spent in the camp." Rather than perceiving the return of displaced persons and refugees as a threat to the region's residents, Abok viewed them a resource that the Government of South Sudan should take advantage of. Many returnees received HIV/AIDS education in the refugee camps. "The people coming back are in fact more aware of HIV/AIDS issues than those who remained in South Sudan during the conflict. They are better informed, with a large wealth of knowledge," he said. HIV is already considered an epidemic in Sudan, with UNAIDS estimating that some 400,000 people are HIV-positive and another 23,000 have died from AIDS-related illnesses. The UN World Health Organization (WHO) said the prevalence rate across south Sudan ranged from less than one percent to seven percent. Leek fears that as calm returns to the region, the increased mobility of people could raise the threat of HIV infection among rural communities that remained isolated during the war, which helped keep infection rates low. "Someone needs to take leadership on this issue," Abok noted. "Ideally, this should be the government, but in southern Sudan it is the NGO community that caters for most health services, so we must look to them to do more."