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    • The communities on both sides of the South Sudan

    2019-05-21

    The communities on both sides of the South Sudan–Uganda border share the risk of sleeping sickness, as transmission of still occurs in this LDH-Cytotoxicity Colorimetric Assay Kit region. Most of the South Sudanese refugees come from endemic areas and have been accommodated in multiple camps in Adjumani and Yumbe districts, where the last few cases of the disease in Uganda have been reported in recent years. Unfortunately, sleeping sickness control might not be a priority for the humanitarian organisations that are managing the refugee camps. The influx of South Sudanese refugees in endemic regions of Uganda is poised to stress the ongoing control efforts led by the Ministry of Health. Targeted control measures should be put in place rapidly to diagnose and treat sleeping sickness cases among refugees and reduce the risk of transmission. Not doing so carries a strong risk of causing a resurgence of sleeping sickness cases in Uganda, condemning elimination efforts. If handled adroitly, this process could be an opportunity to show the commitment of national and international institutions to eliminating sleeping sickness, and to mitigate the problem before elimination is out of reach. We have the tools to provide a rapid and effective response to this latest challenge. Rapid diagnostic tests for sleeping sickness are now available, safer and more effective treatments can be used, and new vector control methods can be deployed—tools that have already contributed to reducing the number of sleeping sickness cases in Uganda and other countries. The Ministry of Health in Uganda, with assistance from the international community, should implement a sleeping sickness control programme for refugees using all the available tools. Acting rapidly and with determination will safeguard Uganda\'s elimination goals and will also reduce the risk of resurgence in South Sudan once the refugees go back home.
    Kent Buse and colleagues (September, 2016) make a compelling argument for HIV prevention initiatives to abandon educational interventions based on fidelity and abstinence. This approach is potentially hazardous and antithetical. It is important not to conflate the efficacy of the message with the persuasiveness of the messenger. The evidence is unquestionable that abstinence and fidelity reduce HIV transmission. The fact that this message appears neither popular nor palatable cannot justify health-care professionals failing to praise the veracity of this message. Indeed it should encourage all involved in health-care promotion to re-evaluate the manner in which the message is delivered. For example, Buse and colleagues clearly identify a problem, in some areas, where the fidelity and abstinence models of HIV prevention are expressed in pejorative terms relating to abuse and the risks of sex. The US Centers for Disease Control and Prevention (CDC) on their information website place abstinence as the first practice to reduce the risk of HIV transmission. Furthermore, their HIV risk reduction tool also emphasises the primacy of abstinence in HIV prevention. Abstinence encompasses a range of behaviours including delaying sexual debut and reducing number of sexual partners. The tool states that “not having sex is the best way to prevent getting or transmitting HIV”. A fundamental tenet of disease prevention in epidemiology is risk avoidance. The CDC estimates that every day in the USA in excess of 3200 people younger than 18 years smoke their first cigarette. Furthermore, every day approximately 2100 youths and young adults who have been occasional smokers become daily cigarette smokers. However, the primary message from the CDC is single-minded, uncompromising, and unequivocal that smoking kills and smoking cessation results in substantial health benefits. Evidence that this message does not dissuade the annual 1·2 million new smokers could never justify abdicating our professional responsibility to highlight behaviour and practices that engender low risk and those that attract high risk. The same would apply to diet, exercise, and sexuality. A sequitur from the logic presented by Buse and colleagues would be that doctors telling people that doughnuts and high-sugar drinks are unhealthy does not deter people from eating such foods, so doctors should abstain from promoting this message as a core aim in healthy eating.