Fears over increase in HIV/AIDS as calm returns to the south

Following progress in negotiations between the government of Sudan and the rebel group SPLM/A, the anticipated return to peace in the embattled southern Sudan could lead to a further spread of HIV/AIDS, which already affects 2.6 percent of the adult population in the region, the UN Population Fund (UNFPA) warned in a recent report. Sharing UNFPA's concerns, the regional adviser on HIV/AIDS for the UN Children's Fund in eastern and southern Africa, David Alnwick, said: "In a nut-shell, southern Sudan is a disaster waiting to happen." He added, "Unless something fundamental is done about the situation, HIV prevalence might go up considerably." Alnwick explained that increased mobility as calm returns to the region could raise the threat of HIV infection among rural communities, which had remained isolated during the war and retained low infection rates. He feared this could be exacerbated by the lack of HIV/AIDS awareness among the population, coupled with the already high HIV prevalence in some garrison towns. HIV/AIDS prevention efforts are also likely to be influenced by social bias, attitudes towards condom use, a poor availability of general health services and a lack of trained counsellors. The health workers, UNFPA added, are often unmotivated, lack the necessary knowledge and are ill supplied with blood-testing equipment to protect them from cross infection. The HIV-infection rate in Sudan as a whole is already considered epidemic, according to UNFPA. Ishmael Gulliver of the Sudan Evangelical Mission, which has been running HIV/AIDS awareness-raising programmes in southern Sudan since 2000, told IRIN that the situation in the region was indeed severe. "Sudan is on the verge of an HIV/AIDS epidemic," Prof Ali Biely of Ahsad University in Omdurman, near Khartoum, told IRIN. Little was "being done about it because of the urgency of the humanitarian crisis and the need to respond to those that are immediately dying from curable diseases", he added. "The fact that many Sudanese will return to their homes from countries where HIV/AIDS rates are high might increase the likelihood of a further spread of the epidemic," UNFPA said in its Sudan newsletter for August. It added that while many of the returnees had heard about the disease, access to information on prevention was not universal. The head of the HIV/AIDS programmes for the Office of the UN High Commissioner for Refugees (UNHCR), Paul Spiegel, acknowledged the potential risk of an increase in HIV infections in southern Sudan, but strongly urged not to jump to conclusions with regard to HIV prevalence among returning refugees. "While it is true that conflict-affected populations and refugees are at greater risk for HIV infection - because of sexual violence and disruption of health services - this doesn't necessarily translate into higher infection rates," Spiegel said. "Actual infection rates are highly context specific. "Key factors include the HIV prevalence in the area of origin, infection rates of the population surrounding refugee camps and the time the refugees have spent in the camp." In addition, Spiegel said, the increased risk of HIV infection in a time of conflict can be offset by a decreased risk as refugees’ mobility is reduced and their level of HIV/AIDS awareness is raised through educational programmes in refugee camps. The regional HIV/AIDS adviser for the NGO Save the Children, Rena Geibel, confirmed the mixed picture with regard to HIV rates among conflict-affected populations. "In eastern DRC [Democratic Republic of the Congo], sexual violence is so widespread that the region now has a higher prevalence rate than the country as a whole". In contrast, chronic conflicts in Sierra Leone, Angola and southern Sudan actually kept HIV infections at a lower rate than otherwise would have happened. In Kakuma camp in northwestern Kenya, home to about 60,000 Sudanese refugees and 20,000 refugees from other countries, a UNHCR study found the infection rate in 2002 to be five percent, while in the nearby town of Lodwar, Kenya it was 18 percent. Although significantly lower than the surrounding population in Kenya, the infection rate of refugees in Kakuma seems slightly higher than the infection rate of 2.3 percent among pregnant women in the southern Sudanese towns of Rumbek and Yei, as revealed in a 2003 survey from the US Centre for Disease Control and Prevention. Rather than perceiving the return of Sudanese refugees as a potential risk for increased HIV infections in southern Sudan, both Geibel and Spiegel prefer to see the return of refugees as an opportunity. "Given the lack of information and well-functioning health services in south Sudan, the returning refugee population - who have been educated about the risks of HIV/AIDS and some who have been trained as health-workers or nurses - might actually help to reduce the spread of HIV/AIDS in southern Sudan," Geibel said. The programme manager for south Sudan of Save the Children-UK, Patience Alidri, confirmed the increased level of HIV/AIDS awareness among many returning refugees, but was more sceptical about its effects. "Increased awareness does not necessarily lead to changes in actual behaviour," she said. "Behaviour doesn't change overnight." Conflict in Sudan has displaced millions of people and sent hundreds of thousands fleeing across borders. In the south, a 21-year war between the government and the Sudanese People's Liberation Movement/Army (SPLM/A) has displaced an estimated four million people internally, with over 500,000 Sudanese living in neighbouring states as refugees. The bulk of these refugees live in Uganda, Ethiopia and Kenya, according to UNHCR. The conflict in the western Darfur region, between the Sudanese military - supported by Janjawid militias - and rebels fighting to end alleged marginalisation and discrimination of Darfur residents by the state, has displaced about 1.45 million people and sent another 200,000 fleeing across the border into Chad. However, hope for a peaceful resolution to the southern conflict has grown with ongoing negotiations between the SPLM/A and the government that are going on in Kenya. In May, both sides signed six key protocols covering power-sharing arrangements. They also agreed to the creation of an administration to control three contested areas during a six-year period, at the end of which, a referendum will be held to determine whether the south would remain a part of Sudan. The protocols outlined the arrangement of a decentralised government of national unity and devolution of power to Sudan's individual states. The south would, during the interim period, have its own constitution that would conform with the transitional national constitution. Analysts believe the negotiations in Kenya, which resumed two weeks ago, could be successfully concluded in the near future. The conflict in Darfur, however, could take longer to resolve, analysts noted, delaying the return of the refugees in Chad. On Wednesday, Sudan's Ministry of Health announced that African Union (AU) peacekeepers entering Sudan to monitor the ceasefire in Darfur would be screened for HIV. According to the Sudanese Media Centre, Health Minister Ahmed Bilal Osman said every member of the AU contingent would have to produce a certificate proving they were not HIV-positive. Osman noted that the measure was purely precautionary and aimed at "safeguarding the health of the people of Darfur". The AU is expected to deploy more than 3,000 troops from five countries over the next few weeks in an expanded mission aimed at containing the Darfur conflict. [On the Net: PlusNews special report on HIV/AIDS in Southern Sudan]