The conflict raging in parts of the country since late 2013, prevents many people being treated for HIV and from accessing vital medicine. Meanwhile, the UN has said that displacement and atrocities related to the violent conflict, including rape, will have a long term impact on the population.
Evelyne Latio the head of the local NGO National Empowerment of Positive Women United, which fights for the rights of women living with HIV, says many HIV positive people are stigmatised within their communities.
She explained that some people don’t even want to be tested for HIV because they are more afraid of the prejudices against the disease than the effects of not being treated.
“Discrimination starts at family level. We have had these incidences where those family members that are positive can be rejected by family members,” Evelyne says. “We have heard of so many cases where their own mothers or their own brothers would not eat from the same plate.”
She says whenever a person living with HIV uses a cup or a plate family members throw it in the latrine. “They fear they would also catch HIV,” she explains.
“We also had incidences where a girl whose mother died, she was three years and she was positive; the father died and mother died and when the mother was being buried, the uncles wanted to bury her alive,” she recalls.
According to UNAIDS and the National Ministry of Health, South Sudan has an HIV prevalence among adults aged 15-49 years of 2.7 percent, meaning three in 100 adults are living with HIV.
That means that a total of around 190,000 people out of a population of around 12 million people live with HIV.
Mumtaz Mia the UNAIDS Programme Advisor on HIV/AIDS says the numbers could even be higher in some geographic sites such as across the Equatoria region. For example, Ezo recorded the highest prevalence of 14%, while Yambio recorded 8.4% and Juba recorded 4.7%, according to a 2012 UNAIDS study.
In 2013, UNAIDS estimated that 35 million people worldwide were living with HIV. The organisation said that 2.1 million people became newly infected with the virus and one and a half million people died from AIDS-related illnesses that year.
Juba resident Angelina tested positive for HIV 16 years ago. Angelina, a single mother of three, says life can be challenging for people living with HIV. But she stresses she can cope after having admitted her HIV status.
“I take them (the children) to school, to the church, during Christmas we go together, we celebrate their birthday together-we are living a happy life together,” Angelina says.
Habib Daffalla Awongo is Director General for Program Coordination at South Sudan’s HIV and AIDS Commission. He says stigma and discrimination is derailing their efforts to fight the disease.
“The impression people have is that once you are HIV positive you are like an outcast and at the same time you are like you are somebody who is dying any time soon,” says Awongo.
Daffalla Awongo says people do not know that they can extend their lives with anti-retroviral drugs.
A 2015 stigma index and vulnerability study conducted by networks of people living with HIV and the South Sudan HIV/AIDS Commission, revealed some shocking results:
52% experienced judgmental attitudes and shaming;
23% were excluded from social events, including family, religious or community gatherings;
30% experienced physical abuse;
18% experienced loss of job or source of income;
15% had to change jobs or were refused promotion;
14% were prevented from attending education institutions.
Feelings of shame for acquiring HIV was also reported by 57% of the respondents.
Meanwhile, the survey showed widespread institutional discrimination, including more than one in five who felt coerced into medical procedures, while 16 percent were denied health/life insurance. Meanwhile, 12 percent were detained, quarantined, isolated or separated because of their HIV status and another nine percent were arrested or taken to court on charges related to their HIV status.
In January this year, The Global Fund approved USD 40 million to fight HIV/Aids in the country through the The United Nations Development Program (UNDP).
Daffala Awongo says the funds will help create awareness and prevent the spread of HIV as well as provide much-needed medicine to people living with the disease.
But the current conflict is impeding the fight against HIV/AIDS, meaning that people with HIV who were already on treatment are missing their treatment due to displacement and insecurity.
There are at least 200,000 South Sudanese seeking protection from the ongoing conflict in Protection of Civilian sites, known as POCs.
The UN says it is concerned about the trend, especially with the recent crisis in Western Equatoria, which has the highest number of people living with HIV on treatment. When treatment is disrupted, people may fall sick and eventually die.
According to the UN it is impossible to have figures in the north of the country worrying about the impact of rapes during the more than two-year conflict.
According to the International Organization for Migration (IOM) TB and HIV/AIDS were the second leading causes of death in the PoC sites in 2015.
And IOM says it remains committed to providing lifesaving health services to vulnerable populations in South Sudan for example by treating curable diseases like TB and preventing the spread of diseases in crowded displacement sites, e.g. in Bentiu.
“We have had people crossing borders to neighbouring countries to access services, countries like Uganda and Kenya. If you look at our treatment services in the country, they are not evenly distributed and, of course, we have areas where people travel for very many kilometres to access a health facility where they can access treatment,” says Daffala Awongo.
Awongo also says his commission will use The Global Fund money to prevent mother-to-child transmission of HIV, a population group he describes as critical.
“It is now policy that all pregnant women should be attending antennal care services. This is where they try to give you health education on how to care for yourself and also monitor you consistently. This is one thing that is taking place in all facilities that all women who go for antenatal services are tested for HIV,” Daffala Awongo adds.
The United Nations Population Fund (UNFPA) and the South Sudan AIDS Commission are providing free condoms in South Sudan, through the Ministry of Health, health facilities such as clinics and hospitals and other NGOs.
However Evelyne Latio blames the societal problem that some men in South Sudan are reluctant to use condoms for the high prevalence.
Arine Quentier, United Nation Mission in South Sudan (UNMISS) spokesperson says HIV is a ticking time bomb, especially because of the ongoing conflict. She says this will be a major issue in 10 years and it could become a huge epidemic if not addressed now.