UN Integrated Regional Information System - November 20, 2008

In 2007, the SSAC announced a new road map http://www.plusnews.org/Report.aspx?ReportId=71581 to contain the epidemic. The region was also due to receive grants worth US$28.5 million from the Global Fund to fight AIDS, Tuberculosis and Malaria, but Bellario Ahoy Ngong, chairperson of the SSAC, said recently that the bulk of the money had not yet been transferred.

Southern Sudan's strategic framework for fighting HIV is expected to cost around $656.12 million over a period of five years, of which $124.16 million has been secured, leaving a funding gap of about 80 percent.

However, according to the UNAIDS country progress report http://data.unaids.org/pub/Report/2008/south_sudan_2008_country_progress_report_en.pdf only $4.1 million had been spent as of February 2008, and funding delays were largely due to the inability of implementing agencies to absorb and manage the money, as well as persistent security concerns in some states.

"Until now I don't have an office; I am mobile," Paul Juoch, director of the AIDS commission in Unity State, told IRIN/PlusNews. He has worked in a room that also served the drugs store in the state's ministry of Health since he started the job in 2007.

A few months ago his office burnt down and he has temporarily moved to a local hospital, where he refurbished an unused room. The state finally gave his office 2,000 square metres of land, "But we don't have the resources to develop that land for our activities," he said.

More troubling than the lack of office space has been the stubborn refusal by the local population to accept Juoch's HIV message. When he sought help from local officials in the state capital, Bentiu, to educate people about the use of condoms as a way to fight the disease, they turned him down. "If I go to a school and I tell them to use condoms ... it's like you are introducing sex to people," he said.

It is still taboo to talk openly about sexual matters, but high-risk behaviour is not uncommon; according to a 2007 study in the regional capital, Juba, 11.7 percent of men and 5.9 percent of women had sex with a casual partner in the last 12 months. Studies have also shown that fewer than 25 percent of men in southern Sudan report consistent condom use with casual partners.

"Sometimes I feel like quitting," said Juoch, who returned from the US in 2007 to take up the position. "I am always frustrated that people are not responding."

Juoch's experience is repeated in states across the south; when Benjamin Waigo was appointed director of the SSAC in Eastern Equatoria State, he found there were no voluntary counselling and testing centres. "The ministry there had nothing," he told IRIN/PlusNews.

Persistent ignorance

Waigo has also encountered widespread unawareness of HIV and how to prevent it; soldiers, a major target in prevention activities, are reluctant to believe a disease can kill them after they survived a 21-year war with the northern government, while much of the local civilian population believes that HIV is a "foreigners' illness".

"Southern Sudan is arguably at a stage where many countries in sub-Saharan Africa were in the 1990s," said Douglas Graeme Higgins, chief of

programmes in the Southern Sudan Office of UNICEF, the UN children's fund, which is responsible for drafting a behaviour change communication strategy for the region. "Changing attitudes, leave alone behaviour, is not easy."

A 2007 household survey found that more than half the women in southern Sudan had not heard of AIDS, and 70 percent could not name the three main ways that HIV is transmitted.

The region's population of 10 million can be broadly divided into three groups: those who stayed in the south during the war; returnee populations from the capital, Khartoum; and returnees from neighbouring countries such as Ethiopia, Kenya and Uganda.

A 2008 study http://www.bicc.de/sudan/pdf/final_report_aah-i_ipcs_bicc.pdf by the Bonn International Centre for Conversion, a peace and development NGO, found that people who had remained in Sudan during the war, whether in the south or Khartoum, largely blamed returnees from outside Sudan for bringing HIV to the region.

"They often think that AIDS came from the [Democratic Republic of] Congo and East Africa," Waigo said. "The people from Ethiopia [and] East Africa are generally well aware of the pandemic, compared to those who stayed."

Although a conclusive picture of HIV prevalence in Southern Sudan has not yet been established, limited surveillance at antenatal care sites shows prevalence ranging from 0.8 percent at some sites to as high as 11.5 percent in others.

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