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It has long been evident that HIV/AIDS is more
than a health hazard: it is also one of the most
important factors contributing to individual and
collective vulnerability. Today more than 33
million people worldwide are living with
HIV/AIDS. The effects of AIDS and associated
diseases on households and communities are
increasingly evident in the form of suffering,
early mortality, loss of manpower and income,
and the breakdown of overloaded services and
solidarity networks. Furthermore, the economic
impact of HIV/AIDS and the stigma attached to
the disease can contribute to marginalisation,
inequities and, ultimately,
to social
instability and associated human-induced
hazards.
The vast humanitarian implications of the
pandemic become even more dramatic in conflict
and emergency situations. HIV spreads fastest
wherever poverty, social disenfranchisement and
instability prevail. And nowhere are these
conditions more extreme than in complex
emergencies. Physical, financial and social
insecurity erode the caring and coping
strategies of individuals and households. This
often results in forced high-risk sexual
behaviour and sexual abuse. HIV/AIDS is often
neglected in dealing with emergencies and
displacement situations as agencies concentrate
on providing basic needs, shelter and the
treatment of more immediate disease and
infection. However, evidence links war and
forced migration to the spread of HIV/AIDS. Over
the past five years, HIV/AIDS has changed the
landscape of war more than any other single
factor, calling for an immediate response in
these situations.
The impact is particularly acute on women and
children who make up the largest proportion of
refugees and displaced people. Women and
children become increasingly vulnerable as they
lose their social and economic base, and their
access to basic needs and services in emergency
situations throughout the world. In many parts
of Africa, HIV/AIDS is now the main threat to
human survival: close to 19 million people have
already died of AIDS, and estimates are that up
to half of all 15-year-olds will die from the
disease in the worst affected countries.
The chaotic and brutal circumstances of war
aggravate all the factors that fuel the HIV/AIDS
crisis. War breaks up families and communities,
creating millions of refugees and placing women
and children in great peril of sexual attack or
systematic rape, which is often used to
terrorise opposing forces. At the same time war
destroys the health services that might have
been able to identify and treat the diseases
associated with HIV/AIDS or screen the blood
transfusions that might transmit it. And it
destroys the educational systems that might have
been able to teach prevention, and slow the
spread of the disease. AIDS aggravates the
effects of war by contributing to social
instability, leaving millions of children
orphaned and killing teachers, health workers,
and other public servants.
Developing countries carry a debt burden of
about US$ 2 trillion and also carry 95% of the
HIV/AIDS burden. About half of the people with
HIV become infected by age 25 and are likely to
die with AIDS by 35 leaving their children to be
raised by grandparents or to fend for themselves
in child-headed households. More than 10 million
people living with HIV are between 10 and 24
years of age. At least 50% of all new infections
occur in the 10-24 age groups, with 7 000 new
infections worldwide every day.
These statistics underline the imperative to
include HIV/AIDS prevention and counselling in
all programmes related to the reintegration of
war-affected young people, especially
ex-combatant and refugee children. Over 90% of
all HIV-infected children under the age of 15
started life as babies born to HIV-positive
mothers. Recent studies indicate that the
administration of antiretroviral drugs can
reduce HIV transmission at birth, but without
access to these drugs or other interventions
around one in three HIV positive pregnant women
will pass the infection on during pregnancy, at
birth, or through breastfeeding.
In conflict situations women have no choice but
to breastfeed. In refugee camps, there is little
or no access to safe water let alone formula or
the money to buy it with. In these circumstances
breastfeeding is likely to be the safest method
of infant feeding. This makes even clearer the
urgent need for women to have access to testing,
counselling and anti-retroviral drugs. Africa's
refugees and displaced persons face the prospect
of a life of poverty, powerlessness and social
instability: conditions that increase their
vulnerability to HIV/AIDS. "Refugees and IDPs
(internally displaced persons) are often at a
higher risk of HIV/AIDS, but often in crises,
reproductive health is put on the backburner,"
the regional HIV/AIDS advisor for the UN
Population Fund (UNFPA), has told IRIN, the UN
news and information network.
Growing realisation of the devastating impact of
the epidemic has marked southern Africa's
current humanitarian crisis, which threatens 14
million people. The explosive combination of
acute food shortages and HIV/AIDS has called for
new ways of dealing with this emergency. Hunger
and diminished access to health services,
including reproductive health care, are taking a
heavy toll on women, adolescents, and other
vulnerable groups across a region that has the
world's worst HIV/AIDS prevalence figures. UN
agencies and NGOs now face the challenge of
addressing this in their relief responses to the
crisis facing people in six southern African
countries: people who have been pushed to the
edge of survival by successive crop failures,
government policy errors and poverty.
To avoid the escalation of HIV/AIDS in emergency
and displaced situations it is necessary to have
a holistic response that addresses all the
factors that contribute to its spread in such
circumstances. Unless relief agencies adopt a
comprehensive approach that addresses the causal
factors they will simply be dealing with the
symptoms. At the core of this holistic approach
is a multi-sectoral response involving:
- protection, legal rights and human rights
issues for women, girls and boys;
- gender-sensitive camp layout and access to
food, water, fuel and resources;
- provision of reproductive health services,
including gender sensitive HIV/AIDS education
and condom distribution, and care for people
living with HIV/AIDS;
- education, skills training and social and
economic opportunities directed at women,
children and young people;
- separation of the military and combatants from
civilian populations where possible; and
- adoption of universal precautions against
HIV/AIDS.
UNAIDS has recommended a number of ways in which
the problems facing refugees and displaced
people can be overcome. A ‘minimum package’ for
HIV/AIDS prevention and care in an emergency
setting includes a safe blood supply, the
provision of supplies for universal medical
precautions, condoms and basic HIV/AIDS
information.
The physical protection of refugees
and displaced people from violence and abuse is
also essential for reducing the risk of HIV/AIDS
transmission. Nutritious food is the first line
of defence for people living with AIDS (PWAs).
In emergencies, supplementary feeding for PWAs
is often neglected.
UNFPA believes that the solution lies in
inter-agency collaboration. "Working with food
distributors, such as the World Food Programme,
will ensure that the special nutritional needs
of lactating mothers and HIV-positive people are
addressed," a UNFPA representative stated. With
conflict and natural disaster fuelling the
spread of HIV/AIDS in the developing world, the
UN Inter Agency Standing Committee Task Force on
HIV/AIDS in Emergency Settings (IASC-TF) has
recently released a practical handbook on
effective interventions in the field. Earlier
guidelines developed by the UN's refugee agency
(UNHCR), UNAIDS and the World Health
Organisation (WHO) for crisis situations mainly
concentrated on the health aspects of HIV and
did not consider the impact of the pandemic on
other sectors. The new publication, titled
Guidelines for HIV/AIDS Interventions in
Emergency Settings, aims to assist individuals
and organisations in their efforts to address
the needs of people living with and affected by
HIV/AIDS in emergency situations. "Most of the
humanitarian partners were developing their own
tools without understanding the disease as a
multi-sectoral problem. I would say that the
issue of HIV/AIDS in emergency situations was
mainly dealt with through prevention activities,
to avoid it spreading," the coordinator of
the IASC-TF, told PlusNews. With these
guidelines, governments, NGOs and UN agencies
are able to deliver a multi-sectoral response to
HIV/AIDS in the early phase of emergency
situations.
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