Fears over increase in HIV/AIDS as calm returns to Southern Sudan

NAIROBI, Oct 28, 2004 (IRIN) — 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:
http://www.plusnews.org/webspecials/PNsudan/default.asp