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November 28, 2011

South Sudan Fights New War Against HIV/AIDS

by Hannah McNeish

South Sudan gained independence from the north after decades of civil war that killed an estimated two million people. Now there is peace and business is booming. But as the borders open for trade and commerce, health experts say the country now is fighting a new war against the spread of HIV/AIDS.

Hidden at the back of one of Juba’s most sprawling markets are row upon row of tin warehouses, hosting some of the estimated 10,000 sex workers that have followed transport routes from neighboring countries to look for work.

Many like Josephine -- not her real name -- came from Uganda in search of a waitressing job in the burgeoning restaurant trade that caters to aid workers and businessmen. Instead of finding streets paved with gold, though, she and countless others ended up surrounded by potholed dirt tracks full of trash, and trapped in prostitution.

HIV rates are thought to be shooting up in brothels where women face violence from men in a post-conflict country with very low awareness of the risk of disease. The virus is brought in by prostitutes, traders and returnees coming from bordering countries with high prevalence rates.

“They just tell you that they want you, then they take you to the room... so from there he’s putting me at gunpoint as he wants to play sex without condom. Sometimes they have Bennett -- it’s a knife. Beat you, slapping you, 'saying why do you say you want to use condom?'” said Josephine.

Testing for HIV

She said most of the 40 or so women in this brothel are HIV positive, and she is three months overdue for a test to see if she is still negative.

The last survey was done in 2009 by the Ministry of Health. Among pregnant women, the HIV rate was then about 3 percent. Various other surveys put the general rate of HIV in South Sudan at just over one percent. Health experts expect it to climb higher, however, now that the borders are open.

Dr. Esterina Novello Nyliok, head of the South Sudan AIDS Commission, said that since signing a peace agreement with Sudan in 2005, the South's population has doubled and the risk of the epidemic spreading has increased.

"Being a post-conflict country, HIV, the prevalence could even go higher than this, as the coming of the peace and independence in South Sudan has opened the movement of people coming in and out," said Nyliok. "Before the peace, we believe that the war was containing the spread of HIV, whereby during the war some areas of southern Sudan were not accessible, and now people are moving in and out of the country.”

Funding gets cut


Nyliok said just as so many people flock to newly independent South Sudan to resettle or to make a quick buck, funding for HIV/AIDS has been slashed in the global economic crisis.

Many governors of South Sudan’s 10 states are trying to round up sex workers and deport them. Women in Jebel market say the mayor of Juba has promised to tear down these brothels and evict them soon.

But charities working on the ground say this will only make one of the highest risk groups - already hiding from the authorities - even harder to reach.

FIH educates, trains

Family Health International [FHI], an American aid agency funded by the U.S. Agency for International Development, is distributing condoms and training peer educators who work with up to 6,000 female and male sex workers in the capital.

FHI’s interim head Phyllis Jones-Changa says many of these women are foreign and have a much higher awareness of the risks of HIV/AIDS than their equally high-risk clients of truckers and motorbike taxi drivers.

“We’re finding that the knowledge levels are higher. We’re finding that the sex workers are actually asking us to provide them more condoms. You do find cases where men don’t want to use condoms, but I think increasingly we’re finding that the sex workers, when they become more aware, they use condoms more frequently,” said Jones-Changa.

FHI found an 8 percent HIV prevalence rate from testing 17,000 people in four border states considered high risk since January.

Jones-Changa said that awareness and prevention of AIDS, and the protection of women, must increase dramatically or the spread of the disease could be what she called “explosive” in a nation that is desperately looking to progress.

HIV/AIDS Worldwide