HIV/Aids invades Africa's last uninfected outpost in Sudan

HIV/Aids has penetrated southern Sudan, the last untouched pocket of Africa, threatening an isolated and uninformed people with disaster, health experts warned yesterday, the eve of World Aids Day.

Sudan's 22-year civil war displaced more than four million people - the highest number of internally displaced people in the world - but it also guarded the region against the spread of Aids. That isolation is over and the impoverished inhabitants face a new and previously unknown killer. Charles Lumori, programme director with HelpAge International, in the regional capital, Juba, said: "The spread of HIV in southern Sudan has been held back by the war. We know that it hasn't yet reached many areas but this innocence will soon be lost."

Conflict has left southern Sudan particularly vulnerable to HIV - a virus that experts say has infected more than 40 million people in more than 90 countries - including about 25 million people in Africa.

The rapid increase in traffic of military personnel, commercial transporters, sex workers, and influx of international workers is putting the whole of southern Sudan at risk.

According to government figures, HIV/Aids has infected only 2.6 per cent of people in the whole of Sudan. But Dr Patrick Abok from the World Health Programme, said the region was under threat from all sides now that peace had reconnected it to its neighbours.

"Southern Sudan is surrounded by countries with very high prevalence rates. - Kenya, Ethiopia, DRC [Democratic Republic of Congo] and Uganda," he said. "There are thousands of Sudanese refugees living in these countries that are starting to return home and research is proving that there is a very high prevalence rate in the border regions."

In Juba's only HIV testing centre, the Voluntary Counselling and Testing centre, many of the first victims of the coming epidemic are not even aware what they have caught. "I have never heard of Aids - what is it?" asked one of the young soldiers. "I have come to the VCT because I was referred here by the hospital. I came here from the north of Sudan with the government soldiers. People in the army do have sex a lot with local girls and other girls too. But the army has never told us about these things condoms."

Local cultural practices such as tattooing and polygamy are compounding the problem. Access to basic social services in southern Sudan is among the lowest in the world, with adult literacy 24 per cent and one doctor for every 100,000 people. Lack of health care and skilled health workers makes treatment of people living with HIV/Aids virtually impossible.

Regina Wayet, a traditional birth attendant in Merikyo, a town 30 miles west of Juba, said that prior to the arrival of HelpAge this year, no one had heard of Aids. "There are now a lot of new people coming to this town. For nearly 10 years we were cut off from anybody but with people moving around and soldiers coming home I am very worried they will bring this disease with them."

She said local men traditionally had three wives, to whom they were faithful. But new arrivals were eroding the custom. "There are no condoms here so we have to teach people to be abstinent or faithful - this is the only protection we have against this disease," she said.

The absence of a comprehensive education system is making educating young people about the dangers of the disease extremely difficult. Just one in eight children currently attends school and normally only up until the age of 11. HelpAge International is one of the few international NGOs working in Juba and the surrounding areas. Continuing insecurity, despite the peace agreement and logistical constraints, have limited the arrival of other organisations. Its programmes focus on educating older people about the dangers of HIV and encouraging them to spread the message to their communities, where they hold respect.

The fate of Kusana Sawan, who was in her forties with five children when she fell ill, illustrates the scale of the task facing health workers. After contracting TB - the most common consequence of becoming HIV-positive - she was ostracised from her community.

"Everyone in my community was very suspicious of me because I was very sick and nobody wanted to help me. They thought I maybe had developed this disease called Aids," she said. "My husband just wants me dead because my illness is a shame to him and he has already bought me a coffin for when I die."

Ms Sawan died last week. Left untreated in a filthy ward, she had wanted to be tested for the sake of her family but was forbidden. The stigma attached to terminal illness and suspected HIV infection means that neither hospital staff nor families want to admit the existence of Aids.