Crafting prevention messages for the south

In Lokony, a suburb of Juba, capital of South Sudan, educational messages about HIV are plastered on the outer walls of a local school, but passers-by barely glance at the posters. This is not surprising as most people cannot read.

Just 24 percent of southern Sudanese can read and write, according to the United Nations Population Fund. This means traditional methods of spreading the word about HIV – such as posters, billboards and leaflets in health centres – do not reach most of the population.

The region received a US$28.5 million grant from the Global Fund to fight AIDS, Malaria and Tuberculosis in 2007, when a roadmap for containing the epidemic was drawn up, but little progress has been made.

"Every time we meet our partners, every time we meet leaders of government, we are challenged that: 'You people say you are fighting AIDS, but when we travel through southern Sudan, in reality you don't see any messages'," said Dr Angok Kuol, executive director of the Southern Sudan AIDS Commission (SSAC).

"We must come up with standard messages," he told a recent meeting of HIV stakeholders in Juba. "We have to stop using messages which are not very clear, which do not conform to our cultures."

For much of the past half century, southern Sudan has been embroiled in various conflicts, the most recent of which ended with the signing of a north-south comprehensive peace agreement in 2005. Since then, public health workers have discovered that the HIV prevention messages that seem to have worked so well in neighbouring countries like Kenya and Uganda are unlikely to have the same success in this region. 

Be faithful to your partner - in a polygamous setting, are you going to tell people to throw away the other wife?

Many health workers question whether the 'ABC' strategy – Abstain, Be faithful, and Condomise – can work in southern Sudan. Public health communicators spent part of the meeting brainstorming about how to modify the approach.

"Be faithful to your partner - in a polygamous setting, are you going to tell people to throw away the other wife?" Fredrick Musoke, a consultant to the UN Children's Fund (UNICEF) and SSAC, hired to draft a behaviour change communication policy for the region, asked the meeting.

Polygamy is just one of several practices standing in the way of public health workers' efforts to combat AIDS. Wife inheritance is also widespread. A wife's dowry is sometimes as large as a herd of cattle, so even if her husband dies, it is in the interests of her in-laws to keep her and her assets in the family.

"Use a condom to protect the one you love," suggested one group, but this was quickly shot down by Deng Mathiang, of the SSAC. "Does it mean that if you have sex with someone you don't love, you should not use condoms?" he asked. "Some people have sex just because they want to."

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In the wake of the LRA: HIV in Uganda and Sudan

"No condom no sex," recommended another group, while the SSAC's Kuol thought the use of detailed educational drawings was the best way to reach a largely illiterate population.

The meeting in Juba had no easy answers, but for health officials in the region there is relief that a meaningful effort to tackle HIV prevention is finally underway.

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