HIV/AIDS among pastoralists and refugees in north-east Africa: a neglected problem

Abstract

The eight member states (Djibouti, Eritrea, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda) of the Intergovernmental Authority for Development (IGAD) have the largest proportions of cross-border mobile pastoralists and refugees in Africa. Although all IGAD countries have had national HIV/AIDS prevention, care and treatment programmes since the late 1980s, the IGAD Regional HIV & AIDS Partnership Program was (IRAPP) established in 2007 to mitigate the challenges of HIV among neglected pastoral and refugee communities. This article assesses vulnerability of pastoralists and refugee communities to HIV and interventions targeting these groups in the IGAD countries. Outcomes from this study may serve as a baseline for further research and to improve interventions. Published articles were accessed through web searches using PubMed and Google Scholar engines and unpublished documents were collected manually. The search terms were HIV risk behaviour, vulnerability, HIV prevalence and interventions, under the headings pastoralists, refugees, IGAD and north-east Africa for the period 2001-2014. Of the 214 documents reviewed, 78 met the inclusion criteria and were included. Most HIV/AIDS related studies focusing of pastoral communities in IGAD countries were found to be limited in scope and coverage but reveal precarious situations. Sero-prevalence among various pastoral populations ranged from 1% to 21% in Ethiopia, Kenya, Somalia and Uganda and from 1% to 5% among refugees in Sudan, Kenya and Uganda. Socioeconomic, cultural, logistic, infrastructure and programmatic factors were found to contribute to continuing vulnerability to HIV. Interventions need to be further contextualised to the needs of those impoverished populations and integrated into national HIV/AIDS programmes. HIV/AIDS remains a major public health concern among the pastoral and refugee communities of IGAD countries. This calls for IGAD to collaborate with national and international partners in designing and implementing more effective prevention and control programmes. Furthermore, interventions must extend beyond the health sector and improve the livelihood of these populations.

Spatial analysis of HIV-TB co-clustering in Uganda

“…Its presence could be attributed to the presence of refugees, mainly from South Sudan, and to people that were initially internally displaced into camps, during the Lord’s Resistance Army (LRA) war that happened in northern Uganda until 2008. Refugee camps and congested places have been shown to increase TB prevalence [6] and the HIV/AIDS is also known to progress in such settings [47] even when this complex relationship is not well documented [48]. What is not contested, however, is that living in such camps reduces the communities’ resilience to such epidemics [48].…”

Factors associated with prior engagement in high-risk sexual behaviours among adolescents (10–19 years) in a pastoralist post-conflict community, Karamoja sub-region, North eastern Uganda

“…HIV prevalence in North-eastern Uganda, where Karamoja sub-region is located, has tripled from 1.7% in 2000 to 5.3% in 2011 [35]. Because of tribal conflicts over the years, access to education and health services including information on HIV/AIDS and reproductive health has been a challenge [12, 31, 33]. Additionally, cultural practices such as wife inheritance (42.2%), tattooing (31.8%) and female genital mutilation (23.4%) [33] continue to increase the risk of HIV acquisition among adolescents in this sub-region.…”

“…Additionally inadequate HIV knowledge, lack of access to treatment and poor adherence to medication among adolescents [10, 11], among other factors, further taint this blurred picture in the struggle to end AIDS by 2030. Further evidence alludes to even worse indicators in conflict and pastoralist communities [12–14]. Crises due to conflicts have been documented to increase people’s vulnerability to HIV/AIDS acquisition especially among girls and women [15, 16].…”

Unified European support framework to sustain the HIV cascade of care for people living with HIV including in displaced populations of war-struck Ukraine

“…Ensure the identification of people with HIV, considering Ukrainian key populations with a high HIV prevalence [38][39][40][41][42] Registration of patients (including refugees) in need of ART; a proactive approach by health-care providers to identify those with HIV in key populations and overcome stigma; sufficient operational HIV expert teams on the ground; medical outreach teams to reach remote areas or areas without operational clinics because of warfare…”