Thomas Athian Lual SJ

I’ve wanted to do a placement at AJAN for years. After working in hospitals in Tanzania and Ethiopia as a Jesuit novice, I yearned to deepen my knowledge about HIV and AIDS. Since I came to AJAN, I’ve been learning a lot. Being here helps me to reflect on what is happening in my country, South Sudan: HIV and AIDS is a challenge for us, people are dying, and I was not too aware of this before.

The epidemic in South Sudan

The Republic of South Sudan borders countries with significant HIV profiles, such as Ethiopia, Kenya, Uganda and Democratic Republic of Congo (DRC), but apparently was not itself too badly affected during the civil conflict with North Sudan that lasted more than 20 years.

However, after the signing of the peace agreement in 2005 and consequent independence for South Sudan in 2011, HIV became a problem in the world’s newest nation, and was even dubbed by one high-ranking official as the country’s “second war”.

One reason cited for this is the mass return of refugees from neighbouring countries. Another is the opening of the country’s borders and increased economic opportunities, with the busy movement of traders from neighbouring countries. HIV prevalence appears to be higher along the borders with DRC and Uganda and in the capital Juba. In villages along the roads and in military garrisons, the activity of sex workers has fuelled the spread of HIV.

Treatment

The government is committed to implementing its national strategic plan to fight AIDS. There has been some success: the infection rate in South Sudan dropped from 2.6% in 2012 to 2.3% in 2013 among the adult age bracket (15 – 49). However, this progress could be undone by low levels of testing and treatment.

Only 6% of people living with HIV in South Sudan are on anti-retroviral therapy and 13,000 people died of AIDS-related illnesses in 2013. The country’s poorly developed health services, a lack of funding for treatment, and prevalent stigma are all big challenges. “We have 16,000 new infections yearly so we have to really do something,” said UNAIDS country coordinator Medhin Tsehaiu.

Transmission

In South Sudan, statistics indicate that the clients of female sex workers – among them motorcycle-taxi (boda-boda) drivers and uniformed men – account for the largest group of new HIV infections that are transmitted sexually. Other prominent modes of transmission are polygamous unions and casual sex.

Mother-to-child transmission is the second most significant mode of infection of HIV in South Sudan and the main source of infection of children aged less than five. The country still has a long way to go in preventing new infections in children: very few mothers get tested for HIV during their pregnancy and even fewer access antenatal care, thus increasing the chances of infecting their newborns. Only 21% of HIV-positive pregnant mothers had access to prevention of mother-to-child transmission (PMTCT) in 2013.

Prevention

The low literacy levels in South Sudan are an obstacle to prevention: only 27% of the population aged 15 years and above can read and write. Literacy levels are much higher among men and in urban areas. To be effective, any prevention strategy needs to take this reality into account. Possible strategies include the creation of more knowledge and awareness of HIV and AIDS through effective communication channels such as radio, television, internet and cell-phones.

More prevention, more testing and more treatment are urgently needed to prevent the epidemic in South Sudan from getting out of hand. It is clear that AIDS is still a rapacious killer in Sub-Saharan Africa and the annual number of new HIV infections is alarming. The time to establish a proper public health response to the epidemic in South Sudan is now.

Thomas Athian Lual SJ is currently doing a placement at AJAN House in Kangemi, Nairobi.