AFRICANEWS

Sudan

Death from the bedroom

AIDS

In the past, death in southern Sudan used either to come through war or famine. But now another avenue has been opened through an AIDS pandemic that is sweeping unnoticed in one of Africa's unstable regions.

As the AIDS scourge continues to have a devastating toll on Africa, in southern Sudan rampant ignorance about the disease is set to make the situation even worse, so argue AIDS experts.

Largely, thanks to the 18-year-old civil war, the 45 Non-Governmental Organisations (NGOs) working in the war-torn area have mainly concentrated their efforts on relief work and combating other primary health problems, leaving the HIV-AIDS issue literally untouched. The most dominant rebel group in the area, the Sudan Peoples Liberation Army (SPLA) has not done better. Even after establishing a civil authority and administrative structure in the territory it controls, it has taken the group's leadership six years to throw its political will behind efforts to fight the scourge. It was only in April this year that the SPLA and the NGOS sat down to formulate a policy guideline to combat the AIDS pandemic. To date, southern Sudan is one of those areas in Africa where no comprehensive statistics on HIV-AIDS prevalence exist.

"We don't have correct information about the standards of AIDS prevalence in Southern Sudan", admits Dr. Bellario Ahoi N'gog, Chief Health Officer of the SPLA Health Secretariat. Dr N'gog then cites perhaps the only AIDS survey ever conducted in southern Sudan in 1998 by the United Nations Development Programme (UNDP).

"What was got was that there was AIDS," he said. The survey found out that the prevalence rates on the virus ranged from one to three percent of the population. The SPLA estimates that there are 12 million people in the territory it controls in the south. Critics have termed the UNDP survey as being not comprehensive. Some areas, especially those where there was fighting, were not accessible to researchers when the survey was being conducted.

The inaccurate and not so comprehensive statistics aside, the situation has been made grimmer by the fact that the rebel authorities lack the means to conduct their own studies on prevalence rates. "We have not had the means to make comprehensive surveys in all the counties of the New Sudan (a term the SPLA uses for the areas it controls in the South) and we think that the problem is bigger than that", says Dr. N'gog. Dr. I.S. Sindani, a physician who has worked for the relief agency, Norwegian Peoples Aid (NPA), confirms his fears. For the past three years Dr. Sindani has carried out small-scale studies in two hospitals in southern Sudan. The situation in the main in Yei, which is the main headquarters of the SPLA paints an alarming picture "We collected data from patients dating January 2000 to June 2001 and 24.6 per cent of the patients were positive," said Dr. Sindani.

For a single hospital to register such an alarming high percentage there is every reason to worry. Dr. Sindani also said samples taken from blood donors within the same period registered a 6.8. percent positivity rate. "These are people living in the community and everybody looks at them as normal people but they are giving it (HIV) to others. So it is quite a high rate," he says.

Two years ago at the same hospital, Dr. Sindani's surveys found out that only 18.6 percent of the patients were HIV positive. But Dr. Sindani is quick to emphasise that these are small studies, which are not community based and comprehensive. He believes the prevalence rate could be much higher.

Dr. Sindani is not alone in his fears. Dr. Margaret Itto the Health Co-ordinator of the New Sudan Council of Churches (NSCC), says a hospital the Council operates in the town of Nzara in Western Equatoria Province, has in the last two years been recording an increase in TB cases and resistance to treatment. She says in most cases this is an indication that HIV-AIDS is increasing among the people.

Ms. Judith Roba, a nurse with the NSCC who has worked in many hospitals throughout Southern Sudan, says the situation is getting worse. "In all these hospitals I have worked, I see the signs and symptoms of HIV everywhere", she said. The main mode of transmission of the virus is through heterosexual sex but of late increased cases of pre-natal transmission are being recorded. This year alone 6.2 percent of HIV patients in Yei Hospital were said to be children below the age of five.

Currently it appears that the number of males living with the virus is more than that of females. But researchers like Dr. Sindani argue that this is because most of the women in Southern Sudan are in refuge in neighbouring countries. According to Dr. Itto, this is a main cause of worry.

"All the five countries neighbouring South Sudan have high peaks of HIV AIDS. With people moving in and out, we expect it (HIV) to be high", she said. The area under SPLA control is a large swathe of land, perhaps larger than Kenya and Uganda combined. Four years ago, the SPLA forced out government forces from most of Equatoria and Bahr-el-Ghazel Provinces. From the Ugandan town of Koboko, the road is now open up to northern Bahr-el-Ghazel and a whole market for Ugandan goods was created. And with it, an increase in the movement of people across the two borders ensuring the spread of the scourge from Uganda, a country that a few years ago had the highest prevalence rates in Africa. Counties near the border areas are suspected to be having high peaks of the virus. Other factors like wife inheritance, initiation rites, use of unsterilised needles and the movement of soldiers from one front to another encourage the spread of the virus, so says Dr. N'gog.

Perhaps the major obstacle in the fight against the virus is the rampant ignorance about it in Southern Sudan. The NSCC, which was among the first NGOs under the Operation Lifeline Sudan (OLS) umbrella to initiate awareness campaigns, estimates that only 58 percent of the population is aware about the disease. Awareness exists only around the border areas but deep in the interior, it is non-existent. Even so, in places where one expects some knowledge about HIV-AIDS, it is mainly attributed to witchcraft. In some areas, people feel there are more pressing needs than awareness. An SPLA officer posed this question to this writer: "Which one kills faster- an assault on enemy trenches or AIDS?"

Awareness campaigns started in 1998, but not much has been done in this front. The situation is made worse by the lack of a wide reaching medium like radio, to disseminate awareness messages. Protective measures like the use of condoms is literally unheard of in most areas and in any case, the Catholic church which commands the largest following among churches in the South, is vehemently opposed to the idea.

Dr. Pius Subek, the Executive Director of the Sudan Health Association (SUHA), an indigenous NGO involved in AIDS awareness said his organisation brought condoms to a county called Kajokeji near the Ugandan border but not a single person came to ask for one. It is the same story in towns like Yei, Maridi and Yambio. Condoms are available in the shops and pharmacies, but there are no customers. Anyone seen with a condom is labelled promiscuous.

The fight against the scourge is also hampered by the fact that there is practically little or no co-ordination among the 45 NGOs in the health domain. As a result, individual NGOs carry out ill-planned and isolated campaigns in the areas they operate. No modalities are created to keep sustained awareness campaigns and soon these fizzle out.

However, AIDS campaigners are hailing as a milestone a meeting in April this year between the SPLA and the NGOS to formulate an AIDS policy guideline. During the meeting held in Natinga in Eastern Equatoria Province, SPLA leader, John Garang declared AIDS as the second enemy of the SPLA: the first one being the government of Sudan. Garang also announced that the disease should be talked about in parades, churches, schools and courts of the "New Sudan", whenever leaders find the opportunity. It is hoped that with this political backing of the SPLA, the fight against one of the world's deadliest diseases may have just begun in one of Africa's unstable regions. But for it to attain any tangible results a Marshall Plan might be required in the form of funds to kick start and sustain awareness campaigns since as Dr N'gog says the war on AIDS begun a bit late.

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