$US64m for AIDS, TB and Malaria in war-torn Sudan

10 October 2002

NAIROBI - World Vision is a key player in a ground-breaking $64.8m proposal to fight three killer diseases in southern Sudan for the next five years - a plan that benefits from unique co-operation between the north and south of the war-wracked nation.

The plan will be considered this month by the Global Fund for AIDS, Tuberculosis and Malaria (GFATM). "We are in agreement with Khartoum about submitting two proposals for Sudan, which is quite unusual, and will ask for $64.8m for five years for all three diseases in the south," explains WV Sudan programme officer Steffen Horstmeier, has been working for two months on the plan. His work was only interrupted, as he puts it, ‘by a brief abduction’ - when he was taken captive by a warlord near Waat.

If accepted, the multi-agency plan aims to reduce HIV prevalence by 15% through the provision of comprehensive HIV/AIDS services in Bahr el Ghazal, Equatoria, and the Upper Nile Regions. Activities, in which World Vision would play a major part, will cover education campaigns to prevent mother-to-child transmission and increased access to care for the sick. World Vision’s part of the work would account for a little over $2m a year for five years.

Everyone accepts that bringing a major health campaign to Sudan will be hard. There is a complete absence of infrastructure like roads and meeting places, and a dearth of health centres and trained medics.

"The security situation is very bad in south Sudan and you can’t go everywhere you want, so access to beneficiaries is poor," says WV Sudan health team leader Molly Mwangi. "There’s also a risk that women can be abused and raped by soldiers, which makes the chances of HIV transmission higher."

"When we did an assessment in Tonj last year, we asked 453 people if they know what HIV/AIDS is," recalls Steffen. "Only seven said yes. We are dealing with one of the last countries where people have no knowledge of HIV/AIDS, and it is surrounded by high prevalence countries."

"There is an amazing lack of knowledge about HIV/AIDS in south Sudan, and we need to get peer education working by leaders of every kind.

"It’s an uphill struggle. When we tried to educate people about AIDS in Upper Nile, and said this disease will kill you in a few years time, the people looked at us blankly and asked, why is that any of our concern? We can be killed at any time by guns and bombs, by other diseases and hunger. Why worry about a disease that takes years?

"But we believe this is a critical moment to act. If we do a successful intervention in southern Sudan now, we could actually stop the disease right at the beginning."

Nobody knows the HIV prevalence rate in southern Sudan, but with merchants, soldiers and students regularly crossing borders into Uganda, Kenya, Ethiopia and Central Africa Republic, it is assumed to be significant. If the GFATM proposal succeeds, meaningful measurements of AIDS in Sudan will be taken at laboratories for the first time.

"We know there’s a very high prevalence of Sexually Transmitted Infections (STI's) already, and that’s partly due to the culture," says Molly. "You get status from having as many wives as you can, even up to 30, and if a man dies his brother inherits the wives. The wives have to remarry - no choice.

"While there has been no health system and no drugs, it’s been hard for people to get treatment for STIs, and it’s not something people like to speak about."

One aspect of the culture does offer a ray of hope, though - powerful opinion leaders called Spearmasters and Rainmakers. Some of these have become affiliated to churches, and World Vision has had past success persuading them to encourage people to take part in preventive health campaigns.

To fight TB, the plan is to increase Daily Observed Treatment System (DOTS) coverage to four million people, half the estimated population, by 2005. This would lead to detection and treatment of 4,000 cases a year and leave in place a sustainable TB monitoring and treatment system in 24 health facilities. This part of the proposal would be run by World Vision’s partners.

New interventions to fight malaria have the potential to dramatically reduce death rates in southern Sudan, especially for children. The document proposes that in five years, four out of five vulnerable people will be sleeping under treated bednets, and the same proportion of people with uncomplicated malaria will get early diagnosis and treatment. It wants 70% of pregnant women to get preventive treatment, and 60% of all malaria epidemics to be contained within six weeks. World Vision would be heavily involved in this part of the programme.

By Nigel Marsh, World Vision