Date: Fri, 14 Nov 2014 14:00:23 +0100
War-ravaged South Sudan Struggles to Contain AIDS
By <http://www.ipsnews.net/author/charlton-doki/> Charlton Doki
Fast Facts About AIDS in South Sudan
150,000 people live with HIV
20,000 children under 15 live with HIV
12.500 AIDS-related deaths in 2013
15,400 new infections in 2013
72,000 people need ART
1 in 10 people needing ART is on ART
1 in 10 HIV positive pregnant women is on PMTCT
27 percent of people over 15 years are literate
1.9m internally displaced people in 2014
JUBA, Nov 14 2014 (IPS) - Dressed in a flowered African print kitenge and a
blue head scarf, Sabur Samson, 27, sits pensively at the HIV centre at
Maridi Civil Hospital in South Sudan's Western Equatoria state.
Today she paid 20 South Sudanese pounds (about six dollars) for a bodaboda
(motorbike taxi) ride to the centre and will have to skimp on food in the
next days.
South Sudan at a quick glance
After four decades of on-off war, South Sudan gained independence from north
Sudan in July 2011. But stability did not last long.
Violence rooted in political and ethnical power struggles erupted in
December 2013, shattering the dreams of peace for the world's newest country
(pop 11.3m).
After independence, South Sudan improved services for its estimated 150,000
people living with HIV. The new conflict reversed these gains, disrupting
not only health services but water and sanitation, roads and bridges, food
security and community networks.
The United Nations estimates that 1.9 million people are newly displaced.
Some fled to neighbouring countries, while 1.4 million huddle in 130 camps
in South Sudan. Of these, 70 are so remote they are inaccessible to relief
agencies, says a study by the HIV/AIDS Alliance.
South Sudan has limited human resources, organisational and technical
capacity to respond to HIV, says the study.
Key drivers of the HIV epidemic in South Sudan include early age at first
sex, low level of knowledge about HIV and of condom use, rape and
gender-based sexual violence, high rate of sexually transmitted diseases and
stigma.
The highest HIV prevalence is found in the three southern Greater Equatoria
states bordering Uganda and the Democratic Republic of Congo. In Western
Equatoria, where Samson and Mongo live, HIV prevalence is seven percent,
more than double the national rate.
She will be hungry and few will help her in the village, although she is
blind and a single mother of two children.
"Many people fear to come close because they fear they will contract HIV,"
she told IPS.
Seated next to her, Khamis Mongo, 32, has lived with HIV for five years now
and has suffered similar rejection. "Some people don't want to eat from the
same plate with me," he says.
Mongo and Samson are among nearly 1,000 HIV positive people receiving care
at the centre, of whom 250 are in antiretroviral therapy (ART). They are
lucky: in South Sudan, just one out of 10 people needing ART gets it.
The clinic sees patients coming from as far as 100 kilometres.
"So many patients are dying because they can't afford transport to collect
their medicine here," clinical officer Suzie Luka told IPS.
A one-way, 80 km bodaboda trip from Ibba to Maridi costs 150 South Sudanese
pounds (47 dollars).
The challenges in Maridi are a microcosm of those that the world's newest
country, South Sudan, faces in containing the HIV epidemic.
Newly independent from north Sudan in 2011, and emerging from Africa's
longest civil war over 21 years with one of the world's lowest human
development statistics, South Sudan plunged again into fighting in December
2013.
The national HIV prevalence rate is under three percent and rising steadily,
according to the
<http://www.unaids.org/en/regionscountries/countries/southsudan> Joint
United Nations Programme for HIV/AIDS (UNAIDS).
This translates into 150,000 people living with HIV in a country whose
social fabric and physical infrastructure was destroyed by successive wars.
"Moving corpses"
Evelyn Letio, from the South Sudan Network of People Living with HIV,
describes poor access, quality and continuity of health services,
underpinned by denial of the disease and high stigma and discrimination,
especially against women.
"Community leaders will hurriedly accept a divorce if it's the woman who is
positive and force her to leave the man's house," says Letio."If it's the
man who is positive, they won't allow the woman to leave the house so she
can take care of him."
Despite denial by government officials, discrimination is rampant within the
civil service, she adds: "People who have disclosed to be HIV positive are
laid off and called 'moving corpses'."
Inadequate financial, infrastructural and human resources limit efforts to
expand HIV services. The national HIV plan has an 80 percent funding
shortfall.
Mongo and Sanson told IPS that the Maridi clinic often runs out of drugs and
they have to return days later. Other times, staff has not been paid for
months and stays away.
"Treatment has been tricky," acknowledges Habib Daffalla Awongo, director
general for programme coordination at South Sudan AIDS Commission.
According to
<http://www.unaids.org/sites/default/files/country/documents/SSD_narrative_r
eport_2014.pdf> UNAIDS, just 22 centres provided ART before the new outbreak
of violence.
Last December, the ART centres in Bor, Malakal and Bentiu, capitals of the
states worst hit by fighting, had to close. The whereabouts of 1,140
patients are unknown. Most likely they have interrupted ART, endangering
their lives.
War and AIDS
Forty thousand people living with HIV have been directly affected by the
recent violence, according to the United Nations. The new fighting reversed
the gains made in HIV services since independence.
"We have lost many HIV positive people during the conflict, some died in the
fighting and others migrated to peaceful areas," said Awongo.
By <http://www.unocha.org/south-sudan> U.N. counts, the new conflict has
displaced 1.9 million people.
In Juba, the capital, camps with long rows of white tents have sprung up to
shelter some 31,000 displaced people.
Among them is Taban Khamis*, who escaped fighting in the key oil city of
Bentiu, 1,000 kms north of Juba. He has interrupted ART and fears his health
will soon worsen but he will not go to the camp's HV clinic for fear of
stigma.
"The camp is crowded and there is no privacy," he told IPS. "Everyone will
know that I have HIV."
Prevalence of HIV and sexually transmitted infections "dramatically
increases in camps", says a
<http://www.aidsalliance.org/assets/000/000/795/South_Sudan_report_original.
pdf?1407227301> study by the HIV/AIDS Alliance.
Awongo is aware of this problem. "We encourage people to come out of the
camps to facility points where they can access services but this is not
making a difference," he says.
*Name changed to protect his privacy
Edited by: Mercedes Sayagues
Displaced women flee fighting by boat to Mingkaman, Awerial County, Lakes
State, South Sudan.. Only one out of 10 HIV positive mothers can get the
drugs needed to avoid infecting her baby. Credit: Mackenzie
Knowles-Coursin/IPS
Displaced women flee fighting by boat to Mingkaman, Awerial County, Lakes
State, South Sudan.. Only one out of 10 HIV positive mothers can get the
drugs needed to avoid infecting her baby. Credit: Mackenzie
Knowles-Coursin/IPS
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