South Sudan: Sex Workers Use Emergency Drugs Instead of Condoms

A leading international aid agency on Wednesday issued a stinging attack on the United Nations mission in South Sudan, accusing it of a "shameful ... ( Resource: MSF Issues Stinging Attack on 'Shameful' UN in South Sudan

South Sudan's AIDS Commission says at least 150,000 people in the country are living with HIV. Despite this, some sex workers are having unprotected sex - and taking antiretroviral drugs afterwards to cut the risk of infection.

"Let me tell you the truth about why many of us don't use condoms," says Jane who has been a sex worker in Yambio since the signing of the comprehensive peace agreement in 2005.

"We don't have money, so when we meet a client who offers more money than we usually get to have sex without protection, then we will do it - even when we don't know his HIV status."

Jane says she and other sex workers do this to earn a living since they have no other way to survive. She also says that sometimes they run to the clinic the next morning to get emergency antiretroviral drugs, which can suppress the virus if taken within 72 hours of infection and, in some cases, stop its progression.

Emergency antiretrovirals

"We use this medicine like condoms, in case of such emergencies," Jane says. "However, there are only a few clinics that have these drugs in town and they are extremely expensive."

The type of antiretroviral in question is known as post-exposure prophylaxis (PEP). It is intended to be used only in emergencies.

For example, it is given to victims of rape if their attacker is thought to be HIV-positive or to medics who have been pricked by a potentially infected needle.

There are no definitive figures to show how well PEP works. Experts say it is far better to prevent exposure to the virus in the first place, by using condoms.

According to Dr Medhin Tsehaiu, UNAIDS country coordinator for South Sudan, the worry is that if all sex workers know about the drugs, they will stop using condoms altogether.

Clinics sell drugs illegally

These drugs are sold illegally in clinics and no one knows where the owners of the clinics get them. This hasn't stopped 24-year-old sex worker Minisare from using PEP for more than ten times in the past two years.

"I had unprotected sex when I was very drunk one night at one of the disco clubs in Yambio," she says.

"The following morning, I told my friend Jane about the incident and she showed me the clinic where I got the first PEP tablets. The first time I went to the clinic, I had to lie that I was forced into unprotected sex."

HIV prevalence in South Sudan

Reverend Samuel Timateo Bandasi, director of HIV/AIDS in Western Equatoria State Ministry of Health, has reiterated the commitment of the state and the national government to work towards a zero HIV infection rate in the country.

Reverend Bandasi stated that a lot has to be done in order to keep HIV prevalence low and awareness needs to be raised, especially among young people. "Most of it is prevention because we have a low prevalence now at 2.6%. If we prevent, then we will remain in 2.6% as no new infections will come in," he says.

However Dr Medhin Tsehaiu said that South Sudan has never had a population-based HIV survey, so the infection rates could be higher than the official figures.

She says: "It could be much higher because South Sudan is surrounded by countries with higher HIV prevalence and, as we know, there are a lot of movements in and out. We have also returnees, displaced people and so many other factors that could cause the spread of HIV."

Additional tools

"We know that despite fairly high rates of condom use in many sex-work communities, we still have very high rates of HIV, so we need additional tools as well as what's already happening," she says. "However, emergency use of PEP is the wrong way to go about it."

Mark Waiwai, Ministry of Health director for Western Equatoria State, said that as well as continuing to use condoms, sex workers should take a type of antiretroviral designed to be taken before exposure to HIV, known as pre-exposure prophylaxis (PrEP).

These are taken daily, and contain fewer drugs than PEP, so there are fewer side effects. They must be used as part of a wider package, including regular HIV testing, to make sure that the patient is on the correct medication.

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