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 Wednesday 03 October 2007
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AFRICA: Taking a new view of HIV and people who flee conflict

Photo: Derk Segaar/IRIN
Refugees fleeing violence can face a new risk of HIV infection in host countries
Conflict and displacement translate into high numbers of HIV infections, fuelling the global epidemic. Or does it? It's an assumption that has stigmatised refugees and displaced people, but experts are now turning the hypothesis on its head.

According to Dr Paul Spiegel, senior HIV/AIDS technical officer with the United Nations High Commission for Refugees (UNHCR), in many cases, conflict and humanitarian emergencies may actually work to limit HIV infections.

Some factors associated with conflict do increase vulnerability to HIV infection: the breakdown of health services, the use of rape as a weapon of war, food insecurity, and increased incidence of commercial and casual sex. But other factors appear to play a protective role. These include the isolation of communities from higher prevalence in urban areas, better access to reproductive health services and HIV/AIDS education in refugee camps, and the breakdown of commercial sex networks.

Whether these factors ultimately result in low transmission rates is largely dependant on the pre-conflict HIV prevalence of the affected community, said Spiegel. In countries where the prevalence was low, such as Sierra Leone, southern Sudan and Angola, it has remained low after years of conflict compared to neighbouring countries that have not been at war.

According to Spiegel, in northern Uganda, prevalence has actually decreased over the course of a protracted conflict, and even in areas associated with a high incidence of rape, such as Rwanda and eastern Democratic Republic of Congo (DRC), population-wide HIV prevalence appears to have been unaffected. There is, however, a good deal of anecdotal evidence to the contrary, especially in the DRC, where the conflict sucked in fighters from neighbouring countries.

At a session on the theme of HIV/AIDS programming in conflict settings at the International AIDS Conference in Toronto, Canada, in July, Spiegel said: "Every situation is different, but we have a lot of good data now ... The problem, though, is translating it. Because it's complicated, it's often interpreted in different ways - I'm not trying to be controversial, I'm just looking at the data we have and not letting my preconceptions influence me."

Refugees tend to migrate from countries in conflict, where the HIV infection rate is often lower, to more stable host countries where it is higher. "A common misperception is that refugees bring HIV with them into host countries, thereby spreading the infection to the surrounding host population; this is often not the case," Spiegel noted in a study examining HIV/AIDS among conflict-affected and displaced populations.

Nonetheless, the stigma persists. "Refugees, migrants and other foreigners are convenient scapegoats for 'bringing HIV' into the country," said Laurie Bruns, UNHCR's Senior Regional HIV/AIDS Coordinator for southern Africa. "When refugees are subject to these beliefs, they tend not to seek health services that would actually protect them from HIV."


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