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In South Sudan, Antiretroviral Therapy Gives Man a Second Chance to Live

John shares a light moment with the ART clinician and his treatment supporter during a medication refill at Munuki Primary Health Care Center in June 2023. Photo by Gladys Achan for IntraHealth International.

Thanks to his brother and health workers, John is thriving.

Twenty-five-year-old John thinks he may have lived with HIV for over three years before taking a blood test in December 2021. After several failed over-the-counter malaria treatments, John’s older brother Ojok took him to Munuki Primary Health Center in Juba, where he tested HIV positive.

Although health workers immediately enrolled John on antiretroviral therapy (ART), he refused medication and lived in denial for another year.

John’s health deteriorated and in December 2022, Ojok returned him to Munuki Primary Health Center. After health workers at the center performed another positive HIV test, and provided a radiological tuberculosis (TB) diagnosis, he began receiving HIV and TB treatment.

Munuki is one of 14 health centers supported by the Advancing HIV/AIDS Epidemic Control Activity (AHEC). AHEC is a four-year USAID-funded contract led by IntraHealth International providing comprehensive HIV services—including Pre-Exposure Prophylaxis (PrEP), an HIV prevention method—and free ART to 11,345 people living with HIV in South Sudan. By partnering with local health facilities and organizations, the South Sudanese government, and local communities, AHEC helps train health workers to provide HIV services and adapts evidence-based HIV prevention, care, and treatment interventions for people living with HIV.

This time, AHEC attached John to Agnes, one of 161 community outreach volunteers the activity trained to help HIV clients adhere to treatment. Agnes visits John twice a month to assess and understand the challenges he is facing, suggest appropriate recommendations, provide psychological support, and, when needed, accompany him to the health facility for ART refills or counseling.

Galla Moses, a physician and AHEC’s deputy chief of party, examines John during a visit to the orphanage in December 2022. Photo by Gladys Achan for IntraHealth International

During the first visit, John was wasted, weighing just 35.5 kilograms, and had grade 1 oedema. His eyes sunk, his hair was falling out, and he could barely walk without support. AHEC coordinated with ACROSS to assess and enroll John in the nutritional support program at its service point in Munuki health facility. Because John was bedridden and couldn’t access the services by himself, Agnes collected and delivered food portions to him at the orphanage until March 2023, when John was back on his feet and started visiting the health facility.

John lives in an orphanage founded by his brother, which houses 64 orphans, including adolescent girls and young women. IntraHealth collaborated with Jhpiego to assess and screen children at the orphanage for tuberculosis and HIV, whose results all turned out negative, and enrolled 17 adolescent girls and young women in the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) program. DREAMS, led by Jhpiego in South Sudan, works to reduce HIV infection among adolescent girls and young women through comprehensive HIV services, PrEP, youth-friendly reproductive health care, economic strengthening, post-violence care for survivors of gender-based violence, and psychological support.

Caring community members, health workers, and local organizations are making a difference for people living with, or at risk of, HIV. These partnerships are critical for controlling and ending HIV in the country.

“My brother is my hero,” says John. “He encouraged me to go and get tested for HIV when everyone believed I was bewitched. Now I’m on medication and my life is back to normal. What is more relieving is that I was told at the health facility during adherence counseling that even with my HIV status, I can get married in future and have children who are not HIV positive.”

John poses for a photo with Agnes, his treatment supporter, during a facility visit for ART refill in June 2023. Photo by Achan Gladys for IntraHealth International

Agnes, the AHEC-supported community outreach volunteer, continues visiting John at the orphanage to assess and monitor his health progress and provide coping mechanisms. He now weighs an impressive 50kgs. His viral load is also suppressed and he’s thriving on treatment.

In the 14 AHEC-supported facilities, viral load testing has increased significantly and 87% of HIV clients are virally suppressed.

“I’m grateful to the health workers who have been very supportive and helped me get on treatment,” says John. “Now I sell merchandise at my cousin’s shop. I will use my daily commission to start up my own business soon.”