In the s systematic case detection and

In the 1960s, systematic case detection and treatment campaigns brought the disease under control, with fewer than 5000 cases reported per year. However, the political instability and conflicts of the strontium chloride Supplier following decolonisation in countries such as DR Congo, Angola, and Sudan led to the dismantling of health services, including disease control programmes for HAT and other diseases. Sleeping sickness came back with a vengeance, and long and deadly epidemics caused thousands of deaths from the 1970s to the late 1990s. In Uganda, sleeping sickness cases peaked and expanded to new areas from the late 1970s, during and following the civil conflict that occurred at the time. The violence caused movements of large numbers of people fleeing conflict in Uganda, and internally displaced people contributed to the spread of the disease to new areas during and after the conflict when they returned home. This spread had a delayed impact on sleeping sickness transmission in Uganda: registered cases reached a peak in the 1990s even though civil conflict had already been resolved. Uganda, with the assistance of the international community, invested heavily to reverse the situation and, during the past 8 years, the number of sleeping sickness cases has been declining steadily. However, as in the late 1970s and 1980s, people fleeing armed conflict could once again erase those achievements. This time, those fleeing violence are not internally displaced people within Uganda, but are South Sudanese people escaping the conflict in their country. According to the UN High Commissioner for Refugees, the civil war in South Sudan has caused more than 50 000 deaths and resulted in 900 000 refugees since 2013. A large number of these refugees have settled in neighbouring Uganda and DR Congo. The worsening of the conflict in July and August of 2016, has increased the flow of refugees crossing the South Sudan–Uganda border, and as of September, 2016, more than 370 000 South Sudanese were registered in refugee camps in Uganda. The communities on both sides of the South Sudan–Uganda border share the risk of sleeping sickness, as transmission of still occurs in this 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.