Cultural Practices that Influence the Spread of HIV/AIDS in the Sudan

Ahmed Bayoumi and Omer Nemeri

Medical and Research Center (MRC) and Omdurman Teaching Hospital (OTH)

Khartoum, Sudan

Sudan, the largest country in Africa, is geographically, culturally and ethnically a microcosm of the continent With more than 7,000 kilometers of international boundaries and nine neighbors, Sudan has great cultural diversity among more than 600 tribes largely living astride international frontiers and sharing similar customs and traditional values in both directions. By virtue of these geographical and cultural traits, Sudan occupies a unique position in the epidemiology of infectious diseases in Africa and, as such, has been exposed to serious epidemics, including the looming HIV/AIDS pandemic as more than 70 percent of people living with HIV/AIDS (PLWHA) belong to Sub-Saharan Africa.

In the Sudan, the number of reported cases of the syndrome has increased from 190 during the 5-year period 1985-89 to 3,027 during the period 2000-2004. The annual mean number of reported cases has increased from 38 to 606 (about 2 reported cases per day)  during the same periods, respectively. Taking 1985-89 as a base (=100%), by 2000-2004 the reported number of cases has increased by 1,595 % (or a 16-fold increase in a span of 20 years)..

The current (2005) cumulative number of HIV/AIDS is 11,284 cases, representing only the tip of the ice-berg. International comparative figures reveal that all of her 9 neighbors, except Egypt and Libya, have higher adult HIV prevalence rates, ranging between 15 percent in Kenya and 2.8 percent in Eritrea. The Sudan HIV adult prevalence rate in 2005 was 2.7 percent and the general population prevalence rate was 1.6 percent. While it is widely believed that transmission of HIV is predominantly by hetero-sexual contact or from mother-to-child during labor (vertical) or through unsafe blood transfusion, unique and shared culture-based practices, not hitherto investigated,  may have a role to play in transmitting HIV infection, besides other risk factors.

The objectives of this case control study (CCS) was to investigate the role of these culture-based practices, commonly performed in the Sudan, in HIV transmission as shared piercing and cutting instruments are used by all of them (tattooing, tribal markings, lip pricking in females, bloodletting, cupping, cautery, and sharing nail clippers, barber razor blade, or tooth brush). The CCS included 56 diagnosed HIV positive cases from Omdurman Teaching Hospital (OTH), and 112 controls from the same hospital. The study revealed that addiction of alcohol with hashish, risky sexual behavior, non use of condom, poor knowledge of STIs/HIV/AIDS transmission, proximity to AIDS case/death and sharing tooth brush, reusing disposable syringe, sharing barber razor blade and tribal markings were significant risk factors. It is recommended that unique culture-based practices involving blood letting through shared pricking and piercing instruments be adequately investigated through a large CCS, preferably in two different states, to delineate important risk factors of HIV infection in this country.

Professor Ahmed Bayoumi is MBBS, University of Khartoum  (1966), DPH, University of Dundee (1970) and MD, University of Khartoum (1974). In 1982 he was elected as MFPHM of the RCP of the UK, and in 1987 as FFPHM. In Sudan he worked with the Federal Ministry of Health (1966-1971), and the Medical Research Council (1971-1972), then joined the Institute of Public Health at Makerere University, Kampala, Uganda  (1972-1974), the Department of Community Health, University of Nairobi Medical School, Kenya (1974-1977) and the Department of Community Medicine, Kuwait University Medical School (1977-1987). In 1985-1986, he was a Research Scholar at the School of Public Health, University of Michigan, Ann Arbor. In 1987 he became Director-General, Health Manpower Development at the Sudanese Federal Ministry of Health. He then served as Founding Dean of the Faculty of Medicine, Al Neelain University, Khartoum (1999-2001) and since 1990 he has been running a private “Medical and Research Centre.”

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