HIV infection in conflict settings

by Clara Presler
(New York, July 17, 2007)--It has long been believed that conflict fuels HIV infection. High incidence of human rights abuses, including sexual violence, and mass displacement have been shown to heighten the risk of HIV transmission. As UNAIDS stated in Guidelines for HIV/AIDS Interventions in Conflict Settings, “Sadly, the very conditions that define a complex emergency—conflict, social instability, poverty and powerlessness—are also the conditions that favor the rapid spread of HIV/AIDS and other sexually transmitted infections.”

But the exact relationship between HIV infection and conflict settings is not understood and difficult to track. A recent study by UNHCR, in fact, questions whether or not conflict heightens HIV-infection at all. "Prevalence of HIV infection in conflict-affected and displaced people in seven sub-Saharan African countries: a systematic review" looks at seven countries affected by conflict and that have data on HIV prevalence over the last 5 years: DRC, southern Sudan, Rwanda, Uganda, Sierra Leone, Somalia, and Burundi. The study found that there is insufficient evidence to conclude that populations affected by conflict have a higher prevalence of HIV infection. Among its specific findings was that that 9 out of 12 sets of refugee camps surveyed had lower HIV-prevalence than the host community. In some urban areas affected by conflict, prevalence decreased at similar rates as those unaffected by conflict.

While the study acknowledges some weaknesses of the survey—the restricted nature and quality of the work, the fact that populations once affected by conflict may not have been identified in the surveys due to displacement and/or death, and that traumatized populations may be unwilling to undergo voluntary HVI testing—it offers numerous explanations for its findings. Among these are that mass killings, forced displacement, and hiding can reduce social interactions that expose individuals to HIV. Also, refugees tend to come from rural areas, which often have lower rates of HIV infections.

Another important consideration is that the risks may be balanced: while some modes of transmission may be less prevalent during conflict (e.g. male migration), other modes may be more prevalent (e.g. sexual violence). Also, in post-conflict reconstruction, mobility and transport increase again which, compounded with the recent violence of war, could create an upsurge in infection. Moreover, conflict can, in the long term, damage the government’s ability to carryout education programs around health and limit the delivery of health services.

Press coverage of study:
AllAfrica.com (7/9/07)
Reuters (6/29/07)