War and poverty driving up HIV cases in Sudan

August 10, 2008 (KHARTOUM) — Poverty and the movement of war-displaced populations have driven the number of HIV/AIDS infections higher in Sudan, though a lack of data is preventing health officials from getting a full picture of the virus’ spread, experts said Sunday.

Sudanese and United Nations AIDS experts told reporters in the capital, Khartoum, that an estimated 1.6 percent of Sudan’s 37 million people were infected. But they cautioned that the real number was certainly higher and that better tracking would reveal that.

The increase in Sudan is contrary to a steady or declining trend among its African neighbors, such as Kenya.

In particular, the movement of large populations — those fleeing fighting in Darfur and those returning after the separate north-south conflict from areas with higher infection rates — were contributing to the spread. A peace deal in 2005 ended the 21-year conflict with rebels in the south but the war in the western region of Darfur continues and has claimed the lives of up to 300,000 people and displaced 2.5 million.

The number of infections based on the available data is thought to be between 350,000 and 600,000, and fewer than 2,000 patients are receiving regular treatment, the experts said.

Doctors and Sudanese officials speaking at a news conference said the 1.6 percent prevalence rate was surely underestimated because the data is outdated and based on surveys in a limited number of clinics, rather than a nationwide survey.

Abdel Kareem Gibreel Algoni, a Sudanese public health consultant who works in South Africa, said the spread of HIV is affected by poverty and illiteracy, both prevalent in Sudan.

“For Sudan practically now we are like in South Africa in the ’90s,” he said. “The virus is not that clever. We can overcome but it works on our ignorance, both political ignorance, economic ignorance and personal ignorance.”

Algoni was among those who attended a U.N.-sponsored workshop in Khartoum for some 60 Sudanese physicians on the clinical management of HIV over the last three weeks.

According to the latest U.N. survey, selected regions in Sudan had between 1 percent and 3 percent infection rates. But Algoni said in his hometown of Abyei, south of Khartoum, some 18 percent of the population was seeking treatment for sexually transmitted infections at mobile clinics he privately set up. “Most probably, they will also have HIV.”

Another physician at the workshop said doctors in hospitals in Khartoum and around it are reporting an average of three to five newly diagnosed HIV patients every day.

“We need to do something about it,” said Zahir Babikr, who works as a specialist in infectious diseases in Manchester, England.

A nationwide survey has yet to be carried out, and conducting one without a reliable, updated census would be difficult, they said. A national survey expected this year has been delayed until next year because of a lack of funds.

A serious response to HIV/AIDS began only two years ago in Sudan and only recently did the country’s religious leaders deem the use of condoms permissible, said Musa Bungudu, the head of UNAIDS Sudan. The use of contraceptives is not a universally accepted practice among Islamic scholars, most of whom oppose birth control.

Neighboring countries, such as Kenya and Uganda, have much higher rates of infection — 5 and 7 percent, respectively — but are showing signs of a decrease.

Sudan has the highest prevalence rate in the Middle East and North Africa and is the country where the virus is growing more widespread, beyond urban areas.

The U.N. AIDS program said the virus in Sudan is spread mainly through sex, not drug abuse. Stigma continues to make prevention and advocacy a challenge. Sudan has no national condom campaign, and HIV centers remain primarily in large hospitals in cities, inaccessible for most of the population.

Mohamed Abdel Hafeez, the manager for the National AIDS program, said that southern and eastern Sudan, as well as the capital, are believed to have the highest number of cases because of the return of large numbers of refugees from countries were HIV is more prevalent.

He said training for physicians and combatting the stigma associated with the disease, particularly among doctors, as well as resources to remote areas are all still lacking.

(AP)