Juba — Before South Sudan could confirm its first COVID-19, the airwaves had been filled with preventive messages. Many were deeply concerned as they were being urged to stop handshake greetings and observe physical distancing. The life and soul of South Sudanese communities hinge heavily on social interaction.
The first case was detected in April 2020. Then the spread of the virus sparked another anxiety: people not only feared the disease, they also feared the reaction and alienation of close family, relatives and neighbours if they tested positive for COVID-19. Even those conscious of the huge health risk found themselves paralyzed by the idea of being ostracized by their neighbours and community - around whom so much of daily life revolves. They feared being tested.
Stigma - driven by fear and uncertainty - is one of the major barriers in tackling COVID-19 pandemic and has been experienced by both community members and health workers and health authorities tackling the spread of COVID-19 in South Sudan.
Mathew Tut, the Director of South Sudan's National Public Health Operation and Emergency Centre, contracted the virus a few weeks after it was detected in the country. Despite accepting his status and isolating himself from friends and family, he felt socially cut off, he recounts.
"I felt that the closest people who should have supported and encouraged me during such a difficult time had abandoned me and had left me at the mercy of the disease," says Tut. "The whole experience gave me very strange ideas... I wondered why people were avoiding me as if I have suddenly become a bad person. It was one of the most stressful moments of my life."
Known in his neighbourhood to be working in COVID-19 response, microbiologist James Ayei was treated with suspicion. "When the first case was confirmed in South Sudan, everyone in my neighbourhood knew that I was among the team testing samples collected from suspected COVID-19 cases all over the country. They began complaining that I was putting them at risk since I was working in the laboratory," he recounts.
"I was very hurt and angry when my friends, family, colleagues and neighbours started avoiding me for fear of contracting COVID-19. I am a human being. I am a microbiologist, and this is what I do for my living. Besides, what these people do not understand is that COVID-19 is a virus and can infect anyone, whether the person is working in a health facility or outside."
Addressing social stigma associated with COVID-19
With the increase in cases, people affected with COVID-19 as well as healthcare workers, who are in the frontline of the fight against the disease, are being discriminated against on account of heightened fear and misinformation about the infection.
"Stigma towards health workers and those who tested positive is becoming a reality," said Dr Richard Laku, the Incident Manager for COVID-19 Response at the Ministry of Health. "All stakeholders, including the community, need to work together to fight stigma and correct the perception of the community towards the public health and social measures."
Tut blames the lack of adequate information on the pandemic as the cause of this stigma; especially a lack of understanding of how transmission occurs, and how people should respond to infection. He emphasizes that when sharing important information, the media should encourage people to ask questions and seek clarification.
Stigma can block progress in reducing COVID-19 transmission, driving people to hide the illness to avoid discrimination, preventing them from seeking health care immediately and discouraging people from observing preventive measures like wearing masks and washing hands. It could also negatively impact the process of contact tracing - which is vital in interrupting the chain of infection and preventing onward community transmission.
In South Sudan, the World Health Organization and the Ministry of Health are actively sharing guidance to address stigma, which is included as part of the training of health care workers and volunteers. Messages are also incorporated into information materials for the public. Efforts are also being made to build trust and address the fear and misinformation.
"Building trust is critical when delivering hard messages about risk and disease transmission. Community engagement must be strengthened, and clear, regular, factual messages - using non-discriminatory language - must be disseminated within the community by our leaders, religious and others, in whom the community have confidence," says Tut.