A number of converging factors can make post-conflict settings high-risk environments for the spread of HIV. The loss of access to basic health care, education and information during an armed conflict can leave communities without adequate knowledge or means of HIV prevention when warfare ends.
Southern Sudan has been affected by conflict since the 1950s. The Comprehensive Peace Agreement (CPA), signed on 1 January 2005, brought an end to the second civil war, and the process of development and recovery is underway. Efforts to develop coherent HIV policies, however, are in their infancy. In a vast area devoid of almost all infrastructure, the challenges are enormous. The limited data available reveal that HIV is prevalent across southern Sudan, but the exact extent is unknown.
Northern Uganda is in a phase of momentous transition. The end of hostilities between the Lord’s Resistance Army and the Ugandan government in 2006 paved the way for the return of hundreds of thousands of IDPs. The challenges of treating HIV in the post-conflict phase are almost as formidable as during the conflict itself.
Conflict has scarred Burundian society since independence in 1962, although in recent years a still fragile peace has emerged from a series of ceasefire agreements signed by armed groups.
The last half century has seen a dramatic increase in the number of conflicts and complex emergencies. Most have occurred in settings where conflict further weakened already inadequate national health, educational and other public services. The growth in frequency of conflicts and the number of people affected by them has prompted a strong commitment to emergency relief in the acute phase of crises but, by comparison, interest in post-conflict transition to recovery and reconstruction has been much more limited in both vision and scope.
Rates of HIV transmission are often presumed to increase in situations of violent conflict, due to high levels of sexual violence, poverty and displacement which create a high risk environment for the spread of HIV. Claims of a link between sexual violence and HIV infection have been supported by prevalence data amongst specific groups who suffered a high incidence of violence during war time.
Epidemiological analysis and mathematical modelling have demonstrated the significance of commercial sex and high-risk behaviours as factors in the widespread transmission of HIV. This has frequently singled out commercial sex-workers as a focal point of the spread of the epidemic. Research in the social sciences has spotlighted the multifaceted complexities of participants in sex work settings, describing their mobility, particular vulnerabilities and heterogeneities.
There is emerging evidence of how conflicts and disasters may lead to sex being sold or exchanged for accommodation, protection, food, gifts and other items or services. This can be attributed to many factors, including high levels of poverty, lack of livelihood opportunities, separation of families, breakdown in community support mechanisms and an increase in gender-based violence (GBV). Yet programmes addressing HIV and sex work in humanitarian settings are often poorly developed.
Early in the 1990s, large numbers of commercial blood donors in rural central China, most notably in Henan Province, were infected with HIV. According to conservative estimates released by the provincial government, more than 30,000 people in this province alone were infected.
Information about HIV prevention and mitigation must be integrated into education responses to emergencies to help ensure that learners and their teachers remain supported and safe. Education can offer one of the points of entry for health, protection and other sectors working on HIV prevention and response and facilitating referral to essential services for those affected by HIV.