Women and Girls in Complex Emergencies
Special consideration must be given to HIV prevention strategies in conflict situations. In northern Uganda, for example, “physical and structural violence (political repression, economic inequality, and gender-based discrimination) increase vulnerability to HIV infection. In settings of war, traditional HIV prevention that solely promotes risk avoidance and risk reduction and assumes the existence of personal choice inadequately addresses the realities of HIV transmission. The design of HIV prevention strategies…must recognize how HIV transmission occurs and the factors that put people at risk for infection. A human rights approach provides a viable model for achieving this aim” (Westerhaus et al., 2007).
The actual prevalence of HIV in areas of conflict is difficult to assess. Reliable information is likely to be unavailable during times of civil conflict and under repressive and hostile governments (Beyrer et al., 2007). There are insufficient data to make any conclusions about prevalence in people who are internally displaced and a review of survey data from seven countries affected by conflict—Democratic Republic of Congo, southern Sudan, Rwanda, Uganda, Sierra Leone, Somalia and Burundi—found insufficient data to support assertions that conflict, forced displacement and wide-scale rape increased HIV prevalence. Of the 12 sets of refugee camps, nine had a lower prevalence of HIV infection, two a similar prevalence and one a higher prevalence than the host communities (Spiegel et al., 2007: 2193-94).
There is, however, significant evidence that women and girls in complex emergencies often experience rape and other sexual violence that puts them at high risk for HIV (Shannon et al., 2008). For example, a population-based, random sample survey of 991 households of internally displaced families (with a total representation of 9,166 individuals) living in three camps in Sierra Leone found that 9% of female respondents reported having been victims of sexual violence related to the war and 13% of all households reported some member (male and/or female) having experienced sexual violence. Thirty-three percent of those abused reported being gang raped. Respondents who reported having “face to face” contact with the Revolutionary United Front (RUF) also reported higher incidences of sexual violence than did those who came into contact with other combatant groups, 53% compared to 6%. Twenty-three percent of the women who reported sexual abuse also reported being pregnant at the time of assault (PHR and UNAMSIL, 2002).
The post-conflict period may also be a very vulnerable time for HIV transmission, perhaps more so than during conflict (Spiegel et al., 2007: 2193-94). A survey conducted by IRC in 1997 found that since becoming refugees, 27% of 12-49 year old female refugees living in camps in Tanzania had been victims of sexual violence (RHR Consortium, ND). Refugees are especially at risk for missed services because, as non-nationals, they are not always covered by national health and HIV/AIDS programs (RHR Consortium, ND).
Donors and governments must be aware that “countries in the throes of complex emergencies are unlikely to prepare successful funding proposals to bilateral, multilateral, private sector donors or the…Global Fund on AIDS, Tuberculosis and Malaria (GFATM)” (Hankins et al., 2002: 2248). Yet the needs in these countries, especially among refugee groups, are as great, if not more so, than many others.