Conflict, displacement, food insecurity and poverty can make affected populations more vulnerable to HIV/AIDS.  Indeed, refugees are often blamed for spreading HIV/AIDs in host countries and discriminated against. Though this assumption is not generally supported by data, the complex relationship between HIV/AIDS and conflict-affected and displaced populations is often misunderstood.

Research from the United Nations High Commissioner for Refugees (UNHCR) looks at the epidemiology (incidence and distribution) of HIV/AIDS in conflict and issues to address when planning and implementing HIV/AIDS policies among displaced populations. The factors that increase the vulnerability of such populations to HIV/AIDS are well documented – breakdown in social structures, lack of income and basic needs, sexual violence and abuse, increased drug use and lack of health infrastructure and education.

However, factors that may actually reduce infection rates have not been properly considered. These include refugee movement to remote areas where HIV incidence may be lower and the improved protection, health, education and social services usually available in refugee camps.

Refugees are consistently left out of host countries’ national HIV/AIDS plans and in proposals submitted to major donors. This is not only discriminatory but also undermines effective HIV/AIDS prevention and care efforts since refugees and local populations interact daily. Also ignored are those displaced people who do not live in camps, do not receive direct support from UNHCR and are forced to rely upon existing host government services that often discriminate against them.

The author finds that:

• Although sexual violence was widespread in conflict-torn states such as Sierra Leone, Angola and southern Sudan, the relatively low pre-war HIV prevalence among the population and possibly also the paramilitaries may have limited subsequent HIV infection.
• It is rarely the case that refugees bring HIV with them into host countries: on the whole refugees migrate from countries in conflict with lower HIV prevalence to more stable host countries with higher HIV prevalence.
• In refugee camps in Kenya, Rwanda and Tanzania pregnant women have lower HIV prevalence rates than women in surrounding host communities.

Context-specific action should aim to:

• protect, train and educate women
• implement community-based programmes that provide care and support for orphans and other vulnerable children, including HIV prevention messages for those who may be forced into prostitution for survival
• ban compulsory HIV testing of displaced persons, denial of asylum or forced returns of refugees with HIV
• ensure that HIV testing follows established standards (confidentiality, pre- and post-test counselling and suitable appointments for follow-up)
• improve HIV/AIDS awareness training for humanitarian and peace-keeping personnel from countries with high HIV prevalence, as these groups may transmit HIV to refugees
• develop HIV/AIDS strategies with more flexible use of donor funds to provide services to both displaced persons and local communities through humanitarian and development organisations.

HIV/AIDS is not an issue that humanitarian agencies can afford to leave to others. Interventions must involve both the humanitarian and development sectors, begin at the onset of a conflict or emergency and be continued through every stage.

Source(s):
‘HIV/AIDS among conflict-affected and displaced populations: dispelling myths and taking action’, by Paul B. Spiegel, Disasters 28 (3), pp 322-339, September 2004

id21 Research Highlight: 28 April 2005

Further Information:
Paul B. Spiegel
United Nations High Commissioner for Refugees
DOS-HCDS
Case Postale 2500
1211 Geneva 2 Depot
Switzerland

Tel: + 41 22 7397882
Fax: + 41 22 7397353
Contact the contributor: spiegel@unhcr.ch

United Nations High Commissioner for Refugees (UNHCR)

Other related links:
'Refugee women and HIV/AIDS: what role for relief organisations?'

'Is the UNHCR doing its job? Combining refugee relief with local development in Africa'

'The consequences of refugee flows and managing the aftermath'

'Responding to displacement'

HIV/AIDS links from id21