1. HIV/AIDS in Sudan
Geneva Foundation for Medical Education
and Research
GFMER Sudan 2012
Forum No: (2)

2. Name of presenter
Name Position Institution
Mishkat Shehata Junior Doctor Ministry of Health
Name of contributors
Name Position Institution
Osman Abass Head of STIs Unit Ministry of Health

3. Content of the presentation
• Overview
• Social and behavioural impact
• Overview of National Response
• SNAP
• Mother-to-Child Transmission
• Prevention through skin piercing & surgical instruments
• Prevention through blood transfusions
• Access to Treatment
• HIV Testing
• Surveillance
• Challenges & Gaps
• Conclusion
• References

4. Overview
• First case of HIV/AIDS in Sudan was reported in 1986
• Sudan has the highest HIV/AIDS prevalence of any
country in the Middle East
• The number of people living with HIV/AIDS (PLWHA) is
estimated in 600,000
• 16 of every 1000 Sudanese people are PLWHA
• In 2002, an estimated 2.6 percent of the adult
population had HIV/AIDS
• High rates have been reported amongst most-at-risk
and vulnerable groups such as sex workers (5%), Tea
sellers (2.5%), refugees (4%) and street children (2.5%)
(1) (National Policy on HIV/AIDS in Sudan. Office of Minister of Health. Khartoum,
2004)

7. Social and behavioural impact
• In a study conducted in 2007, it was found that
the mean age of patients affected with HIV/AIDS
was 34 years
• Male to female ratio was 1:1
• The quality of life in 89% of people diagnosed with
HIV/AIDS was affected
• 59% failed to function at the community level
• 13% expressed negative behaviour by having
unprotected sexual intercourse after diagnosis
• The spouses of 25% of patients were not informed
• 44% of partners wanted a divorce after diagnosis
(2)
(W Ibrahim et al, 2009)

8. Overview of National Response
• The National AIDS Council (NAC) is the
highest level of policy and is headed by the
governor
• The National Executive Council on HIV/AIDS
(NECHA) is chaired by the Undersecretary of
the Federal Ministry of Health. It is
responsible for execution, coordination and
overall management of the national response
(NR) (1)

9. SNAP
• The Sudan National AIDS Control Programme (SNAP) was established since
1987 and is a program within the Communicable Disease Control in the
Federal Ministry of Health (FMOH) (1)
• It is the technical department responsible for policy, planning and
coordination at a national level. It liaises with different sectors such as the
ministries of defense, interior, education, higher education, information and
communication, labour, culture, youth and sports, social welfare and women
and child affairs (3) (UNGASS Report, 2010)
• SNAP acts within the framework of NAC and NECHA and is mandated to
develop the health sector plan to ensure the availability and accessibility to
quality standards of HIV/AIDS services (1)

10. General Objectives
• The main objective of Sudan National Strategy for Reproductive Health was aimed at
keeping HIV/AIDS prevalence less than 2% by 2010
• In addition, it aimed to limit the transmission of HIV/AIDS infection through appropriate
strategies and proper interventions
• It also aimed to reduce morbidity and mortality due to HIV/AIDS and to improve the
quality of live of People Living with HIV/AIDS (PLWHA)
• It identified the need to build the competence of the different partners involved in the
prevention and control of HIV/AIDS
• It aimed to organise national & international resources for the prevention and control
of HIV/AIDS (1)

11. Budget
• The cost of the initiative was 200 million USD;
only one million out of the 200 that is needed
to implement the National Strategic Plan of
2003-2004 was available at that time (1)
• For 2004-2009, the budget set for
achievement of objectives was 19, 119, 391,
10 USD (4) (Sudan National Strategic Plan and Sectoral Plans on HIV/AIDS. Sudan
National AIDS Council. 2004-2009)

12. Prevention
• Over 95% of HIV cases in Sudan are due to heterosexual intercourse (1)
• The coverage of prevention programme is still not sufficient to make a significant impact o
n the overall HIV situation (3)
• There are plans of introducing health education on HIV/AIDS in schools in collaboration
with SNAP, NAC and NGOs.
• In the workplace, there should be a healthy environment, non-discrimination, social
dialogue, care and support, continuation of professional relationship and confidentiality.
Employees should not be screened for purposes of exclusion from employment.
• Data is lacking in special risk groups (sex workers and homosexuals) due to obstacles of
stigma and the informal setting in which they exist.
• Condoms were advocated at an earlier stage as a safe method of population control under
the Family Planning Programme (1)
• In 2009, more than 1 million condoms were distributed through health outlets (3)

13. • Religious leaders and faith-based institutions may
have a good impact on prevention by leadership,
spiritual care, counseling and prevention such as
marriage embrace.
• The community should be involved by receiving ample
information on HIV/AIDS.
• SNAP should develop clear plans to ensure the
availability of good quality condoms as well as needs
assessment, cost and supply, distribution and
monitoring & evaluation
• There is a great need to ensure the availability of
condoms at places and times they are needed (eg.
hospitals, STDs clinics, PHC units, health and
counselling centres)
• Condom distribution should not affect the promotion
of sexual behaviour, bearing in mind the deeply
rooted values of the Sudanese society (1)

14. Mother-To-Child Transmission (MTCT)
• Preventing HIV infection among women of
childbearing age can be achieved by
preventing unwanted pregnancies among HIV-
positive women as well as during pregnancy,
labour, delivery and breastfeeding.
• Improved availability, quality, and use of
maternal and child health services
• HIV voluntary counselling and testing (VCT)
• Antiretroviral therapy (1)

15. Prevention through skin-piercing &
surgical instruments
• Usage of disposable equipment/sterilization
should be encouraged
• With regards to skin-piercing outside the surgical
setting, traditional practices of circumcision,
ritual scarification, tattooing, native healers and
traditional injectors represent a potential
important source of HIV transmission in Sudan.
These procedures are conducted outside the
health care system and are aimed to be the
subject of targeted public education (1)

16. Prevention through blood transfusions
• Mandatory screening for blood and blood
products before transfusion should be
introduced in all hospitals/blood banks in
private and public sectors at a national level
• Decisions on tests to be adopted and kits to
be used are taken by the National Health
Laboratory (NHL) and SNAP (1)

17. Access to Treatment
• Treatment consists of anti-retroviral therapy
(ART) and co-management of Tuberculosis (1)
• There is an urgent need to improve access to
treatment. There is a considerable gap in the
number of patients started on ART and those
currently on treatment. Retention and patient
tracking are issues at hand
• Links between HIV services are weak and need
clear-cut referral systems
• Integration of health services is a priority (3)

18. • Total numbers of ART centers have increased from 21 in 2007 to
32 in 2009
• About 5,710 patients were provided with cotrimoxazole prophylaxis.
• CD4 monitoring coverage was improved by providing
at least one machine per state.
• A nutrition programme targeting PLWHA was initiated
• The TB/HIV services expanded to all states with a minimum of
one centre per state.
• In Sudan, the overall coverage of TV/HIV is estimated at 8 percent.
• VCT centres have increased from 55 in 2007 to 132 in 2009
• The number of MTCT facilities increased from seven in 2007 to 27
in 2009, resulting in an increased number of pregnant women with
access to HIV testing and counselling (3)

19. HIV Testing
• Promotion of early diagnosis of HIV infection
through voluntary testing with pre- and post-
test counselling
• Reassure HIV-negative persons to take
precautionary measures to not get infected
• Counsel and support HIV-positive persons
• Integration of Primary Health Care (PHC) and
Voluntary Counselling and Testing (VCT)
centres is needed (1)

20. • The current reach of HIV testing services remains
poor. The reality is that stigma and discrimination
continue to stop people from having an HIV test
• ‘3 Cs’: Confidentiality, Counselling and Consent
• The standards of HIV testing will be determined
and monitored by the virology department in
liaison with SNAP
• NHL is responsible for quality control for all
institutions running HIV testing and confirmatory
tests
• It should be offered free of charge or at the
lowest possible and affordable price to the general
population (1)

21. Types of HIV Testing
• Voluntary Counselling and Testing (VCT): Test
providers should conform to the UNAIDS/WHO
new guidelines to encourage the use of rapid
tests so that results are provided in a timely
fashion and can be followed up immediately with
a first post-test counselling session for both HIV-
negative and HIV-positive individuals.
• Diagnostic HIV Testing: When there are signs and
symptoms consistent with HIV/AIDS
• Mandatory Testing: Blood and blood product
transfusions

22. Surveillance
• Monitoring and evaluation of the response and
the assessment of outcomes need a reliable
surveillance system
• HIV Sentinel Surveillance
• AIDS Case Surveillance: To assess the incidence of
AIDS cases in the country, data is collected from
hospitals
• Behavioural Surveillance surveys
• Special survey of sero-prevalence: High-risk and
vulnerable groups (1)

23. Challenges & Gaps
• The need to understand the profile and sizes of most-at-risk groups
• More focus is required on community mobilization to access and
utilization of services
• The need to strengthen current health system to achieve Universal
Access targets
• Strengthen current surveillance system to improve knowledge on
trends and extent of epidemic
• Give support to capacity building and leadership of government, NGOs
and people living with HIV groups.
• Re-enforce government coordination and decentralization efforts (5)
(UNAIDS Country Situation. Sudan. 2009)

24. Conclusion
• Strategies and Plans of the NR are sound,
however there is lack of funding from the
government and participating international
bodies to help control the HIV/AIDS situation
in Sudan
• Poor surveillance system
• Access to treatment for high-risk groups and
the community is lagging behind
• Not enough effort is put in prevention
strategies in terms of condom distribution
and health education

25. • Stigma and discrimination are a hindering
factor as they are still major issues
• The new strategic plan for 2010‐2014
has prioritized to address most-at-risk
populations (MARPs) and
vulnerable populations (3)
• There is improvement of TB/HIV services
and nutritional support programmes

26. References
1. National Policy on HIV/AIDS in Sudan. Office of
Minister of Health. Khartoum, 2004
2. W Ibrahim, K Elmusharaf, M Ali. Social and
behavioural impact of HIV/AIDS on Sudanese patients
after the diagnosis. Contraception 01/2009; 80:221
3. United Nations General Assembly Special Session on
HIV/AIDS (UNGASS Report) 2008-2009. Sudan
National AIDS Program. 2010
4. Sudan National Strategic Plan and Sectoral Plans on
HIV/AIDS. Sudan National AIDS Council. 2004-2009
5. UNAIDS Country Situation. Sudan. 2009