Magazine article Forced Migration Review

Ex-Combatants as Entry Points for HIV Education in Southern Sudan

Magazine article Forced Migration Review

Ex-Combatants as Entry Points for HIV Education in Southern Sudan

Article excerpt

Disarmament, demobilisation and reintegration (DDR) interventions provide potential avenues to help reach those who are most vulnerable to HIV transmission.

Southern Sudan has been affected by conflict since the 1950s. The Comprehensive Peace Agreement (CPA), signed on 1 January 2005, brought an end to the second civil war, and the process of development and recovery is underway. Efforts to develop coherent HIV policies, however, are in their infancy. In a vast area devoid of almost all infrastructure, the challenges are enormous. The limited data available reveal that HIV is prevalent across southern Sudan, but the exact extent is unknown.

This article presents the findings of research focusing on the Sudan People's Liberation Army (SPLA) as a high-risk group which, with its close community links, is a potentially effective entry point for responsive HIV policy development during the disarmament, demobilisation and reintegration (DDR) process.

The post-conflict context

The post-conflict environment in southern Sudan is unstable and constantly changing. People are returning to the region after decades of forced displacement both internally and across borders, and many of them come from urban areas or displacement camps with better service provision. Widespread gender-based violence in both rural and urban areas has both been the cause of increased HIV infection and has posed challenges for HIV interventions. Severe gender inequalities exist, and concurrent sexual relationships exist as a result of transactional sex, inheritance of multiple wives and the encouragement of early marriage and polygamy. Scarification with non-sterile tools and the view of circumcision as taboo also increase HIV risk. Most people lack access to basic services, and infrastructure for managing HIV policies is largely absent. Interventions for HIV prevention need to be innovative and applicable without reliance on basic health services. Many southern Sudanese have never heard of HIV, or do not know how it is transmitted or prevented. Additionally, protection through behaviour change is a choice many do not have.

Accurate data on HIV/AIDS prevalence in southern Sudan is almost non-existent, though a few studies have been conducted to try to determine the extent of the epidemic in the region. One study showed that HIV prevalence is between 2 and 4% of the population, while a 1996 study at antenatal clinics suggested HIV prevalence was 5%. Amongst different tribes various names are given to HIV/AIDS, making data collection more difficult. Despite the lack of precise data, the high-risk post-conflict environment, combined with the lack of infrastructure, has presented both the necessity to establish and implement HIV prevention and mitigation policies - and the difficulties in doing so.

The SPLA - the army of the Government of South Sudan (GoSS), previously the armed wing of the main southern Sudanese rebel movement (the SPLM) - is in the process of transforming from a guerrilla army to a professional military force. Challenges during the transition include ambiguity surrounding command structures, and increased cultural variation among soldiers (as all other armed groups, based on mainly tribal identity, had to be absorbed into the SPLA). The SPLA plans to downsize through the DDR process, which presents an opportunity for HIV interventions as soldiers make the transition to civilians.

During the years of conflict, SPLA soldiers were constantly told they were the instruments for repopulating southern Sudan. Unsurprisingly, therefore, soldiers forgo protection with commercial sex workers. For their part, vulnerable and lacking a normal community life, women seek refuge with soldiers, and often engage in transactional survival sex. HIV interventions must address these realities if communities are to be able to move away from environments where HIV can thrive.

The DDR process provides a valuable opportunity to screen a high-risk group while still in DDR sites, creating a unique entry point where people who will soon be part of a civilian community can be addressed. …

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