Preventing HIV/AIDS in the south - a cash-strapped mission

In southern Sudan, slowly recovering from a 21-year civil conflict, the fight against HIV/AIDS has to compete with other priorities, such as securing food and safe drinking water, combating other deadly diseases and the lingering threat of landmines and small arms. When signing the Comprehensive Peace Agreement in 2005, the late leader of the former southern Sudanese rebels, John Garang, remarked that after the war AIDS would be southern Sudan's biggest enemy. According to UNAIDS, the adult HIV prevalence in Sudan as a whole in 2003 was 1.6 percent, around 320,000 people aged 15-49 living were with HIV/AIDS, and there were an estimated 34,000 AIDS-related deaths. About 2.6 percent of the adult population in southern Sudan, one of the world's poorest regions, is thought to be HIV positive. "These numbers are based on estimates when the war was still going on and, based on anecdotal evidence, we expect that the number is higher than that," said Sheila Mangan, HIV/AIDS programme officer for the United Nations Children's Fund in southern Sudan. "The current post-war situation provides the perfect environment for the spread of HIV." Since the peace agreement, growing commercial and population movement between southern Sudan and neighbouring countries with higher prevalence rates, large numbers of returning internally displaced persons, military demobilisation and lack of HIV/AIDS awareness among local communities could spur a rapid rise in infections. "As many people are moving towards the towns, we expect to see higher infection rates there, but it is too early to tell," Mangan said. "In rural areas we see high rates of untreated STIs [sexually transmitted infections], especially syphilis and gonorrhoea. We expect that if we would start testing in these rural areas, we would see higher rates [of HIV] there as well." Condoms are not widely available in many parts of southern Sudan, and are often unaffordable; resources are limited and health services are poor or non-existent - a 2004 survey estimated an average of one doctor per 100,000 people. The southern Sudanese government has established an HIV/AIDS Commission directly under the presidency to develop policy and coordinate the response. According to the commission's chairman, Bellario Ahoy Ngong, this is a reflection of how seriously the pandemic is viewed. "HIV/AIDS is not a sectoral problem and it is not a health problem alone; it is a general socio-economic problem." A CHALLENGING START The commission has limited financial resources and capacity, Ngong told Plusnews. "Not a single penny has been put in the budget. We have three permanent members - that is not enough." Other members only joined the commission occasionally for meetings. "We are going to establish a critical department under the commission that will deal with various aspects of monitoring and evaluation, administration, planning and coordination of projects - but this implementation capacity has yet to be established." Ngong acknowledged that "We need to have a baseline, because we can't do anything unless we know the magnitude of the problem." The health infrastructure would also need considerable improvement. "We need to put in place a surveillance system as well as improve service delivery - ARVs [antiretroviral drugs], HIV test kits - to make sure hospitals have the kind of equipment and medical capacity to respond," Mangan said. A national survey covering both north and south Sudan would provide better insight into people's knowledge of HIV/AIDS, while "information about attitudes and knowledge of the disease will give an indication of how fast the infection might spread and what kind of measures are needed to prevent it". "The survey is going to be a huge undertaking," she said. Poor roads and the remoteness of many areas, training reliable data-collectors and preparing medical personnel for surveillance and blood testing are formidable obstacles to obtaining information. "The problem in southern Sudan is that we are spread a little thinly in terms of logistics and capacity - it isn't difficult to do, but it requires a lot of planning and organisation. But right now, the biggest problem we have in terms of programming is getting the financial resources," Mangan said. "If we don't do anything about HIV/AIDS now, we'll be in a dismal position in five to ten years," she warned. "Southern Sudan has many needs, emerging from so many years of war, but if we don't do anything now, it can end up a high-prevalence country, while it could have been avoided." DS/MW/TM