Private Albert Joseph Lustiko of the South Sudan Army calls himself an ambassador for HIV testing. When he finishes his morning work as a cleaner at the Juba base he sticks around to talk to other soldiers about HIV and to encourage them to take advantage of the HIV testing and counselling (HTC) services at the nearby military hospital.
“Some of the soldiers know they are sick but they refuse to go for HIV testing, even though they have symptoms,” said Mr Lustiko. He blames their hesitance on poor understanding of the virus and low awareness of the available treatment, but also on the stigma that comes with living with HIV.
Lustiko undertook an HIV test in 2009 after hearing radio campaigns about the importance of HTC. After learning his HIV-positive status, he asked his two wives to go to the hospital with him to get tested. His first wife thought the diagnosis meant he was “the living dead”, and he spent two days explaining to her that with antiretroviral treatment (ART) his diagnosis was not a death sentence. Eventually, she agreed to get tested. Both wives tested negative for HIV and, since his diagnosis, have maintained their status, and each of them have had children born free of HIV.
“I’m now sending a message to everybody,” Lustiko said. “Whether you are a woman or a man, whether you are HIV-positive or HIV-negative, tell your spouse so that all of you can go to the hospital. If one of you is HIV-positive, you have to go to the hospital and follow the regulations. Get advice from there, and you can live longer with your wife. You can have children with your wife.”
However, lack of knowledge about HIV extends beyond Mr Lustiko’s family and the army base. Health officials say there is generally low knowledge about HIV across South Sudan. Only 45% of women between 15 and 49 years old had even heard about the virus, according to an analysis of the country’s epidemic released earlier this year by the government and UNAIDS.
Since its independence in July 2011, South Sudan has been making efforts to overcome the HIV epidemic. However, critical challenges, including stigma, low awareness and knowledge of HIV status, and shortage of community outreach and quality health-care services, continue to hamper the national response to HIV. A household health survey in 2010 revealed that only 23% of the men who participated in the survey had taken an HIV test, and less than half of those had received their results.
According to Moses Mutebi, the World Health Organization’s HIV programme manager for South Sudan, it is critical to spread the message across the country about the importance of knowing one’s status, especially among people at higher risk of contracting HIV.
“The vast majority of people don’t know their HIV status,” said Dr Mutebi. “That’s why we can’t identify who is living with HIV. But whoever has been identified as living with HIV, they have been linked to care and treatment.”
South Sudan is now integrating provider-initiated HTC in health centres to allow patients to avoid the stigma that comes with visiting stand-alone HTC sites and get tested for HIV. “While patients are meeting the surgeon, the dermatologist or the physician, doctors can provide information on HIV and the need to test,” said Emmanuel Lino, Deputy Director at the Ministry of Health in charge of HIV services. “It’s like we are normalizing HIV voluntary counselling and testing.”
Dr Lino noted that his ministry is running training at health centres across the country for doctors, nurses and “even the gatekeepers,” so they have a working knowledge of the virus and where people can go for HIV testing and treatment.
Getting more people on HIV treatment, however, is bound to reveal other gaps in the country’s health system, such as that there are only 22 facilities providing ART across the entire country. South Sudan is also short of the laboratory space required to diagnose patients and the equipment needed to monitor the virus.
Even Mr Lustiko, who is generally satisfied with the services he has received, pointed out that his ART site has run out of medicine more than once, leaving him to go without for several months. An unplanned interruption in ART is extremely dangerous, since it can allow the virus to rebound or cause the patient to develop resistance to the treatment.
The ministry has plans in place to address these problems, including better integration of ART services into existing primary health-care centres and building 100 new centres in the coming years. Dr Lino said there is a standing commitment from the government to address the needs as they arise. But first, he said, people must be made more aware of the virus.
