ARV shortages slow treatment efforts in the south

The unavailability of life-prolonging antiretroviral (ARV) drugs in southern Sudan is threatening thousands of lives and forcing many patients to travel to neighbouring Uganda in search of the medication.

"There are no ARVs here, so once a month we have to travel to Arua [a town in northwestern Uganda] to get drugs," said Joel Baba, who lives in the southern Sudanese town of Yei in Central Equatoria State. "This trip is so expensive; we have to pay border charges, and for accommodation, food and transport - not many people can afford it."

Although peace has returned after 21 years of conflict between the northern and southern parts of Sudan, many areas in the south that were cut off from basic health services during the war still have no access to HIV medication.

Arua is more than 100km from Yei on badly maintained roads that have been damaged by bombs. "In the beginning [of treatment] the Ugandan clinics don't let you take a whole month's supply - you have to keep going for adherence counselling or stay in Uganda for some time, which makes it even more expensive," Baba said. "For patients who are already sick, it is impossible to travel."

There is scant information on the number of people living with the HI virus, which has further hampered provision of HIV services. A 2002-03 study, published in April 2006 in AIDS, the official journal of the International AIDS Society, put the prevalence in Yei at 4.4 percent, significantly higher than the official national prevalence of 2.6 percent.

According to Florianne Gaillardin, area coordinator for the American Refugee Committee, which provides home-based care and other HIV services in Yei, the problem is especially acute for HIV-positive pregnant women.

"Last year, four sites in Yei began providing PMTCT [prevention of mother-to-child transmission] services, using nevirapine provided by UNICEF [United Nations Children's Fund], but since December they stopped providing them - there is a big crisis in PMTCT here," she said.

Two antenatal centres in Yei confirmed that they had not received any nevirapine, an ARV medicine, since December 2006. UNICEF said the drug supply had been interrupted when their consultant in Yei left, making communications difficult.

Sheila Mangan, UNICEF's HIV/AIDS specialist in Juba, the capital of southern Sudan, told IRIN/PlusNews that the organisation was in the process of rectifying the problem.

According to Benjamin Mondi, who runs the Sudan Medical Care antenatal clinic in Yei, "We have the testing kits, but when a woman tests positive for HIV we cannot do anything for her. When the woman goes into labour and needs to get the nevirapine, she cannot get on the bus to Uganda."

Most women could not afford to move to Uganda until they delivered, he added. "Why give the test if we cannot treat the patient?"

Youniter Mutsungah, director of New Start HIV Services, a Kenya-based NGO that recently carried out PMTCT training in Yei for community health workers from five southern Sudan states, said the absence of nevirapine had created a serious hurdle.

"We had to make site visits and do practicals, but because there were no drugs they had to be taught primarily about other aspects of PMTCT, such as safe delivery and breastfeeding options," she told IRIN/PlusNews. "We were very concerned by the lack of nevirapine in Yei."

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See also: SUDAN: New road map to chart course against AIDS in the south