Efforts to control the spread of HIV in southern Sudan have been given a shot in the arm by a US $28.5 million grant from the Global Fund to fight AIDS, Malaria and Tuberculosis, as well as a new roadmap for containing the epidemic.
The money comes more than two years after the Comprehensive Peace Agreement ended 21 years of war in the south, which left the region largely dependent on the United Nations (UN) and nongovernmental agencies to provide the few available health services.
According to Patrick Sweeting, head of the UN Development Programme (UNDP) in southern Sudan, work on the roadmap was led by UNDP and the Global Fund, in cooperation with the Southern Sudan AIDS Commission (SSAC); it is expected to lead to a national HIV/AIDS policy and strategic framework by the end of July.
Tekleab Kedamo, a programme coordinator for the Global Fund, said the roadmap was divided into two parts: a planning stage, which has just been completed, and a later coordination stage. The SSAC would play a central role in implementing the plan.
Communication between the various players in the HIV field had been a problem in the past: "There hasn't been much coordination - in three years there have been two stakeholder meetings," Kedamo commented.
The roadmap also plans to bring southern Sudan in line with the UNAIDS-endorsed 'Three Ones' principle of HIV/AIDS management, widely considered to be the best practice, consisting of one coordination mechanism, one strategic framework, and one monitoring and evaluation system.
Not a minute to spare
When the peace agreement was signed in 2005, the late John Garang, leader of the former southern Sudanese rebels, predicted that after the war, AIDS would become the region's biggest enemy.
HIV prevalence is still low compared to neighbouring countries such as Kenya and Uganda. Recent studies suggest this is typical of countries where conflict limits movement, thereby reducing HIV infections. But Amber Kimbro, UNDP regional HIV/AIDS programme manager, commented that the window of opportunity for maintaining low prevalence was rapidly shrinking. She described the situation in southern Sudan's capital, Juba, where a condom is still hard to come by and the only visible evidence of efforts to raise HIV awareness are rusty old signs from the garrison years, as "potentially explosive".
"The signing of the peace agreement opened the door to a massive movement of people: uniformed service personnel, traders, truckers and also the return of internally displaced people and refugees," she said. "It is time to act very fast."
Juba's HIV/AIDS voluntary counselling and testing centre is one of only six recognised by SSAC to cover the vast, sparsely populated region.
A recent survey by the UN refugee agency, UNHCR, reported that 20 percent of people tested in Juba were found to be HIV positive. Although they were self-selected and therefore not representative of the general population, a UN analyst who preferred anonymity said she considered the results "alarming".
UNDP and Global Fund officials agree that levels of HIV awareness and prevalence vary hugely across the region. A 2006 behavioural surveillance survey of populations affected by conflict found that HIV prevalence in people aged between 15 and 49 ranged from 0.4 percent in Rumbek town, in the centre of the south, to 4.4 percent in Yei, near the Ugandan border in the far south.
Serious setbacks
Bellairo Ahoy Ngong, who heads the SSAC, acknowledged that the fight against AIDS in southern Sudan had experienced serious setbacks, partly because donors had failed to honour pledges of financial support.
The underfunded SSAC only came into being in June 2006 after a long delay, and inherited what Kimbro described as a "very broad and basic" policy from its wartime predecessor, the New Sudan AIDS Council.
Its ability to carry out programmes has also been handicapped by a lack of skilled health workers, some of whom have been snapped up by better-paying nongovernmental organisations. Kedamo said a portion of the Global Fund money, which is to last five years, would be used to recruit more staff. New hospitals and health centres will also be built across the region.
Even with the new roadmap and funds, efforts to scale up HIV prevention activities in southern Sudan are vulnerable to further setbacks. Kedamo said security problems had already disrupted work in the southwest, where the Ugandan rebel group, the Lord's Resistance Army, continues to have a presence.
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