By Angela Stephens
U.N. Wire

NAIROBI – Isolated for two decades by war, southern Sudan is one of the few places in Africa today where HIV/AIDS statistics are hard to come by. The prevalence of HIV is believed to be low overall in Sudan – the Joint U.N. Program on HIV/AIDS put the figure last year at 2.6 percent among adults age 15 to 49 – but with the government and rebels making significant progress toward a peace agreement and with a health infrastructure in the south and other neglected areas that is insufficient to support even the most basic of health needs, health experts fear a disaster is on the horizon.

In the central Nuba Mountains, an area the size of Austria that was particularly isolated from surrounding areas and countries during wartime, a report issued in June summarizing the first HIV/AIDS awareness program held in the area said "HIV/AIDS awareness in the region is nonexistent."

A consortium of aid organizations applied for, and last Thursday was approved for, $7.8 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria over two years to fight HIV/AIDS in Sudan – pending board confirmation in January – although a grant agreement must be signed with the government before disbursement can begin. The 28 million beneficiaries of this funding would be those in northern Sudan, including displaced persons, and those in the south under areas of government control – which excludes most of the southern population.

According to the Global Fund, "General denial and misconceptions have characterized the efforts to respond to the HIV/AIDS epidemic in Sudan."

Not only do lack of knowledge and misconceptions pose challenges in Sudan, but some medical experts worry about how stigma of HIV/AIDS will be played out.

According to Richard Oleko, a physician from the southern town of Juba who now works in the Nuba Mountains for Norwegian Church Aid and took part in the Nuba awareness program, "The moment someone is tested positive, it's a breakdown here. You will be isolated. No one will want to touch you."

"I've talked to people and I know what's in the back of their minds," he said. "At the workshop, everyone wanted to be tested, but if they were tested positive, everyone would turn their back or would even think of killing that person," he added.

"AIDS is definitely taboo here," said Hans Rietkerk, program manager with ZOA Refugee Care, a Dutch nongovernmental organization that has European Union funding for a two-year HIV/AIDS project in Sudan's Western Equatoria region.

Oleko warned against introducing widespread testing for HIV in Sudan without first informing the public more about HIV/AIDS. "If you go around asking people, 'how do you get HIV?' they don't know," he said.

Experts say some Sudanese wrongly believe they can be infected by sharing food or being in the same room with an infected person, and as is the case elsewhere in Africa, some believe they can protect themselves from AIDS by having sex with a virgin.

"There are communities that still believe that in their community grouping, there is no HIV/AIDS," said Raphael Nyabala, reproductive health field officer with the National Council of Churches of Kenya at the Kakuma refugee camp in northern Kenya, home to 85,000 refugees, more than 60,000 of them Sudanese.

According to Esther Mwanyika, HIV counselor with the International Rescue Committee at the Kakuma camp, "The stigma is there because this is a new thing for them. Sudanese don't think it's their problem," she said. "They're very secretive about it – they don't want to declare [their status]."

The IRC has established two voluntary counseling and testing centers in the Kakuma camp since April of last year. Mwanyika said some of the refugees ask to be tested for HIV, but rarely women, due to cultural beliefs and traditional practices. "Men do not allow their women to be seen going for a test," she said. "Their perception is that if a woman is tested, she is promiscuous. Men take it that once they know their status, that will automatically be their wife's status."

"People do not want to accept that their sister died of HIV/AIDS because it is shameful," said James Severino, chairman of the Equatoria United Youth Development Association in Yambio, a county in the southwest bordering the Democratic Republic of the Congo, which is also a crossroads of people coming from Central African Republic and Uganda.

The prevalence rate of HIV/AIDS and knowledge about the disease among refugees is important because observers believe that if a peace agreement is reached, as many as 500,000 Sudanese refugees will return home, some of them likely infected with HIV and unaware of it. Some refugees have already returned this year from countries including D.R.C. and Central African Republic, after years outside Sudan. Peace in Sudan is also expected to open the country to increased traffic from the nine countries it borders, multiplying Sudan's HIV/AIDS risk.

"This will be more dangerous than the Arabs," said Mary Biba Philip, county secretary of Yambio, comparing the HIV/AIDS threat to the government in the Muslim-dominated north of the country. "The first enemy now is HIV, because it kills more than the bullets kill," she said.

"If the traffic starts to increase, truck drivers and so on, it will start to change," said Detta Gleeson, head nurse at the International Committee of the Red Cross hospital in Lokichokio, northern Kenya, which was established in 1987 to treat Sudan's war wounded. "Also, most of them [southern Sudanese men] have got more than one wife, so my best guess would be, it will start to take off," she said of the infection rate.

She believes there is not much willingness among the Sudanese to be tested, however. "Sudanese generally don't want to know," she said.

Yet there are some positive signs. Compared to Nuba Mountains, knowledge of HIV/AIDS is high in Equatoria. Rietkerk said he surveyed 900 people in rural areas of Yambio and neighboring Maridi counties to determine their knowledge of the disease and modes of transmission.

"Ninety-nine percent know about AIDS of the people we interviewed," he said. "More than half could mention two ways or more to prevent AIDS. That was much higher than I expected." He also said men were better informed about AIDS than women.

It is not uncommon in some southern Sudanese towns to see people wearing T-shirts with AIDS awareness messages, such as "AIDS Kills/Protect Your Family," and "Fight for Life, Fight HIV/AIDS."

A local pastor in Yambio last month declared publicly in church, through a letter written by his son, that he has AIDS. He was too ill to deliver the message himself, and has since left Sudan to Uganda for treatment. The announcement was seen as significant because no one had publicly declared his status in the town before.

Yambio's UNICEF-supported Information Center, which offers Internet and email services for a modest fee and has a meager library, also shows HIV/AIDS information videos. When U.N. Wire visited the center earlier this month, UNICEF's Operation Lifeline Sudan spokesman Ben Parker said 50 young people were watching the video at one showing that week. More than 3,000 people watched HIV/AIDS awareness videos at various facilities in town in August, UNICEF said.

Performing arts groups are also reaching the public with HIV/AIDS awareness messages in Yambio and around the south. A folklore group in Rumbek, one of the south's main towns, reached 700 people with these educational messages, UNICEF said in its monthly report for southern Sudan for September.

Young people U.N. Wire interviewed at two youth groups in Yambio talked openly about HIV/AIDS and their fear about the impact the disease will have on their generation in Sudan. The young men said they are willing to use condoms but in an economy where most are subsistence farmers, the price of 25 cents for a package of three sold in the market is prohibitive for most young people. They said there is no free condom distribution in their area.

"We are really in a risky situation, we need help," said Daniel Owudada, administrative secretary of EUYDA.

Dr. Brigitte Toure, who heads the UNICEF/Operation Lifeline Sudan health program, said the expected peace in Sudan presents risks regarding the spread of HIV/AIDS, "but it's also an opportunity. We should treat it as an opportunity," she said.

Source: UN Wire (external link, opens new window).