In South Sudan, tens of thousands of HIV/AIDS patients are eligible to start anti-retroviral therapy to treat the disease. But the country's main source of funding for the drugs - the Global Fund - suspended its latest round of grants at the end of last year. As a result, South Sudan has had to stop enrolling new patients in anti-retroviral programs.
After Patrick Mawa Moigo learned he was HIV-positive in 2008, his medical counselor advised him to start anti-retroviral therapy (ART), right away. The drugs saved his life.
He has started volunteering at Nimule Hospital, where he gets his treatment. The hospital is in the middle of this booming town, just across South Sudan's border from Uganda. Every week, Moigo travels out to the surrounding community, encouraging people to get tested.
"I will be telling them, 'Whenever even you are not enrolled, come for test. Test your blood. When you are found positive, come to ART, whereby you will be counseled. After counseling, then, you will be given medicine.'"
Challenges ahead
Except no new patients can currently be enrolled in ART in South Sudan. The Global Fund to Fight AIDS, Tuberculosis and Malaria was the primary provider of funding for the drugs in the country. But the Global Fund, which draws its financial support largely from donor governments, ran out of money last year. That forced the fund to suspend its latest grant-making round.
South Sudan was hoping the new round would fund its continued rollout of ART. UNAIDS country coordinator Dr. Medhin Tsehaiu says at least 49,000 people qualify for the drugs. But less than 4,000 are currently enrolled. The Global Fund did provide money to keep patients currently on ART, like Moigo, supplied with the drugs. But Tsehaiu said it does not have money to allow the country to enroll new patients.
"That has affected very, very seriously South Sudan," said Tsehaiu. "Because the hope was that we'll have access to that funding. And, of course, the government was not really prepared to fill this gap, because this decision came suddenly. This means we cannot scale up these services, so this is really a big challenge."
South Sudan was already facing difficulties in addressing its AIDS epidemic. There is little knowledge about HIV in the country. The south's decades of war with Sudan and the constant movement of populations made it difficult to raise awareness about how to prevent or control the disease.
Prevalence rate
Despite that, the country's HIV prevalence rate of around three percent is lower than most of its neighbors in sub-Saharan Africa. But that still translates into thousands of people who need treatment now.
There is also concern that the country is about to see a sharp rise in new infections, now that its borders are open and more people are streaming into the country.
Taamba Danmbi-Saa is the project coordinator for Merlin's health interventions in Nimule. Merlin, a British NGO, helps run the Nimule Hospital, along with two other health centers in the area. He says this is especially true in Nimule, which sits on the highway that connects the markets of Uganda to much of South Sudan.
"We are at one of the hotspots in South Sudan. This is the entry point from Uganda, Kenya, by road," said Danmbi-saa. "We have hundreds of trucks that come and station here for a couple of days before they proceed to Juba. These people that are coming - the passengers, the drivers - they are all people that might be potentially infected. And when they come, because of the usual activities, if they get involved in one or two sexual activities, for instance, then they spread on the infection course, because of the low level of people's awareness about infection."
Nimule's prevalence rate is already higher than the national average, at more than five percent. Four years ago, Merlin rolled out a comprehensive HIV service at the hospital, working to get as many people tested and treated as possible. The program runs radio spots and distributes leaflets. And they recruit HIV-positive patients, like Moigo, to go out into the community and talk to people about their services.
Kennedy Ndonja, who runs the ART clinic, says the outreach has worked. In March, 48 new patients were enrolled in the HIV program - more than any previous month. The program includes counseling, food supplements and treatment for the opportunistic infections that can plague HIV patients.
What it does not include, for now, is ART for those new patients. Ndonja's program has not been able to enroll anyone on treatment since November of last year. He is worried about the impact this could have.
"We fear that as this continues, more patients will be able to be turning up with their conditions," said Ndonja. "Now, if we will not be able to initiate them on ARVs, it will be too unfortunate for the patients."
The government and donors are scrambling to find other resources to increase the country's ART availability. For the time being, though, HIV patients who are not already enrolled in the drug treatment program will just have to wait.
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