Thursday, April 21, 2011

HIV and AIDS in South Sudan

     Sudan lies on the boundary between sub-Saharan Africa, where HIV/AIDS is rampant, and North Africa where it is relatively rare. The civil war, which lasted more than two decades and only ended in 2005, effectively isolated the country and shielded it from the AIDS epidemic which affects neighboring countries to the south. Hence the HIV infection rate is comparatively low in Sudan. It’s estimated to be about 1.6% nationwide; however it is higher in the south, where it is estimated to be about 3.1%, and in some areas – particularly crowded towns located near the border with Uganda – it is much higher, possibly as high as 10%. Ironically, the coming of peace seems to have also brought changes that have increased the frequency of HIV: refugees and internally displaced people have returned to their homelands, and trade across the borders with neighboring countries has increased.

     Besides refugees and internally displaced people, the populations most at risk for HIV infection include sex workers, soldiers, truck drivers, and women and girls generally. Commercial sex work is common in many parts of South Sudan, especially in urban areas. Many of the prostitutes are from neighboring countries, but the ones who are Sudanese are mostly very young girls who have little knowledge of HIV and are unlikely to use condoms. Condoms are not available in many parts of the country in any case, and are often unaffordable.

     Knowledge and awareness of HIV is very low in South Sudan generally, with many people never having heard of the disease and most unaware of steps that can be taken to prevent the spread of it. In Sudanese culture, contracting a disease is often blamed on witchcraft or superstition. The spread of HIV is also aided by the practices of polygamy and widow inheritance: if a polygamous man contracts HIV, infects his wives and subsequently passes away, his widows will then be inherited by other polygamous men who will in turn contract the virus and spread it to their other wives.

     HIV is also passed from mothers to their babies. Without intervention, an infected mother will pass the virus to her baby 24-45% of the time. Many women in South Sudan don’t know that HIV can be passed from mother to child, and few of them are able to give birth in a facility equipped to do HIV testing.  

     A particularly deadly obstacle to the treatment and prevention of HIV is the characteristic of the disease that once infected, individuals generally appear to be healthy for some time afterward. They may remain apparently well for 8 or 10 years, and during this time infect many other people. Because of this, many healthcare facilities in Sudan have begun testing all incoming patients for HIV, regardless of the reason they come in for treatment. Early detection of the disease is key to preventing its spread.

     Pictured below is a patient at the Mary Immaculate Hospital in Mapuordit, who is dying of AIDS. This is one institution that tests all patients for HIV, and about 5% currently test positive. Many of the affected individuals identified refuse treatment however, presumably because they don’t understand what the consequences of this choice are. 

Friday, April 8, 2011

Mapuordit, South Sudan

     Mapuordit (Mah-poor-deet’) is a small town located in central South Sudan. Twenty years ago, no one was living in Mapuordit. But in 1993, during the civil war, government soldiers bombed the town of Yirol, 80 kilometers away. People fled Yirol and went west, and eventually found a forested area safely off the main road, where they settled. The trees in the area obscured their huts from planes passing overhead and provided some security and peace during the war. After choosing the place where they would stay, the people sacrificed a grey and brown bull. The name of a large bull with this coloring in the Dinka language is “Mapuordit”, and the people named their town after the sacrificed bull.

     Today more than 30,000 people live in Mapuordit. They live clustered together in small  “compounds”, or groups of tukuls (huts), which are connected by a network of dirt footpaths. The tukuls are constructed by packing mud around a framework of sticks and adding a grass roof, and are sometimes raised six feet or so off the ground. Often a family will construct a small platform outside their tukul for preparing food, and store their pots and cooking equipment on a shelf made of sticks above the platform.

     While in Mapuordit, we visited a family living in a small, square tukul. Inside there were two twin-sized beds outfitted with mosquito netting along the side walls, a narrow space in between the beds with the door at one end of the space and a small table at the other; a radio/CD player sat on top of the table. Several suitcases were neatly piled up behind the heads of the beds; presumably the family’s possessions were stored inside. The family did their cooking outside, over a wood fire. Washed clothes were spread out on the roof to dry in the sun. There was no running water, no electricity, no toilet facility inside their tukul.  

     The small neighborhood-like compounds always seem to be full of people: older adults sitting under trees in the shade, women and children carrying water or loads of firewood home on their heads, individuals busy with household chores, and invariably lots of folks holding small children and babies. The photo below shows women and children gathered in a typical compound scene: