Conflict and HIV: A framework for risk assessment to prevent HIV in conflict-affected settings in Africa

Abstract

In sub-Saharan Africa, HIV/AIDS and violent conflict interact to shape population health and development in dramatic ways. HIV/AIDS can create conditions conducive to conflict. Conflict can affect the epidemiology of HIV/AIDS. Conflict is generally understood to accelerate HIV transmission, but this view is simplistic and disregards complex interrelationships between factors that can inhibit and accelerate the spread of HIV in conflict and post conflict settings, respectively. This paper provides a framework for understanding these factors and discusses their implications for policy formulation and program planning in conflict-affected settings.

HIV in Nepal: Is the Violent Conflict Fuelling the Epidemic?

“…Several factors contribute to the propagation of HIV in times of conflict (Box 1) [17]. While accurate numbers are hard to come by, the recent conflict may have contributed to the propagation of HIV/AIDS by fuelling displacement [18].…”

HIV Treatment in a Conflict Setting: Outcomes and Experiences from Bukavu, Democratic Republic of the Congo

“…Although the inter-relationship between HIV and conflict is increasingly clear [3–6], the effect of conflict and instability on the incidence and prevalence of HIV can be unpredictable [6]. Much of the evidence on risks is unreliable, and conflict may both protect a population from HIV by isolating communities from the spread of infection, and increase an individual's risk through displacement, sexual violence, and breakdown of communities and health-care institutions.…”

HIV Infection Among Internally Displaced Women and Women Residing in River Populations Along the Congo River, Democratic Republic of Congo

“…However, the higher HIV prevalence detected among female IDP in this survey underscores a potential for increased transmission among women in the context of displacement in the DRC. Potential contributing factors to higher prevalence observed in female IDP compared to females in the river population may include population movement from higher prevalence areas from which IDP originate to lower prevalence host communities, sexual mixing and unprotected sex between IDP and new social networks in host communities, and increased HIV transmission through conflictrelated sexual violence towards female IDP (Amowitz et al 2002;Mock et al 2004;Spiegel 2004;Spiegel et al 2007). …”

“…Absolute estimates of HIV prevalence among adults in the DRC were lower than rates observed in neighboring countries of Angola (3.7%), Congo (5.3%), Tanzania (6.5%), Uganda (6.7%), Central African Republic (10.7%), and Zambia (17.0%; UNAIDS 2006). Prolonged conflict in the DRC may have minimized HIV acquisition on a population level through reductions in mobility and sexual contact with these outside communities (Mock et al 2004;Spiegel 2004;Spiegel et al 2007). However, the higher HIV prevalence detected among female IDP in this survey underscores a potential for increased transmission among women in the context of displacement in the DRC.…”