In 2005, after decades of conflict, a peace agreement between north and south Sudan brought an end to Africa’s longest civil war and made
Southern Sudan an autonomous region. Its future lies in a January 2011 referendum in which southern Sudanese, including 400,000 recent returnees, will vote on whether to permanently secede from the north. Pictured: A child stands near her new home inside the Juba army barracks; as people return, many settle near military bases for the security and services therein.
Since the peace deal six years ago, IntraHealth has worked with the government and the Sudan People’s Liberation Army (SPLA)—once a rebel force but now the recognized military of Southern Sudan—to help rebuild the country's health care infrastructure, which was destroyed during the war, and to raise awareness about HIV/AIDS within the military and among people returning from other countries.
Compared with neighboring countries, the current HIV prevalence here is relatively low at 3.1 percent, but as troops demobilize, displaced residents return home, and commercial traffic from areas with higher HIV rates increases, concerns about a surge in HIV are growing. According to a report released by the AIDS Security and Conflict Initiative (ASCI) in 2009, "post-conflict transitions are both a period of heightened vulnerability to HIV transmission and a neglected element in HIV and AIDS policy and programming.”
The SPLA preemptively established its own HIV/AIDS Secretariat to manage prevention and treatment interventions in the military. IntraHealth has trained the Secretariat in organizational development, established partnerships with military programs in Kenya and Uganda to learn from their efforts to combat the epidemic, and trained military personnel as HIV/AIDS educators.
IntraHealth Deputy Director Dr. John Mondi reviews voluntary counseling and testing (VCT) guidelines with student soldiers. The month-long training prepares them as VCT counselors to counsel and test fellow soldiers for HIV at SPLA barracks in Southern Sudan.
Trained HIV/AIDS educators conduct outreach among the troops and beyond. Their responsibilities include educating communities on aspects of HIV and referring people to counseling, testing, and treatment services.
Military-supported hospitals and health centers established in and around barracks provide key services not only to soldiers and their families, but also to the general population. With greater outreach and a growing range of services, Captain Harriet Fouzia, VCT counselor at the Juba Military Hospital, sees more non-soldiers coming in for clinical treatment and support services.
At the Saint Bakhita Health Centre in Yei, a nurse counsels women on HIV prevention and family planning methods. Pregnant women who come for prenatal checkups are encouraged to seek onsite voluntary counseling and testing to prevent mother-to-child transmission (PMTCT) of HIV.
As of September 2010, 15,264 pregnant women have been counseled and tested in PMTCT settings, with 398 HIV-positive women receiving prophylaxis for PMTCT.
Twins born to a mother who tested positive and received prophylaxis to prevent mother-to-child transmission. Full antiretroviral therapy begins when a woman either has low CD4 count (below 350) or more severe signs of AIDS (clinical stages three or four).
Despite many obstacles associated with the post-conflict environment—from lack of infrastructure to shortages of qualified health workers—IntraHealth and the SPLA have reached several milestones: The project has established 14 counseling and testing centers in six Southern Sudan states, an HIV/AIDS treatment center in Juba, and four centers for prevention of mother-to-child transmission of HIV.
As of September 2010, the project had counseled and tested 54,594 people for HIV and enrolled 529 HIV-positive individuals for antiretroviral treatment and care.
The Reducing the Impact of HIV Project is led by IntraHealth International and funded by the US Centers for Disease Control and Prevention; partners include Merlin, St. Bakhita Health Center in Yei, and the International Medical Corps. Photos by Trevor Snapp.
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