Over the last two decades, complex emergencies resulting from conflict and natural disasters have occurred with increasing frequency throughout the world.
At the end of 2001, over 70 different countries experienced an emergency situation, resulting in over 50 million affected persons worldwide. Sadly, the very conditions that define a complex emergency - conflict, social instability, poverty and powerlessness - are also the conditions that favour the rapid spread of HIV/AIDS and other sexually transmitted infections.
The long-term consequences of HIV/AIDS are often more devastating than the conflicts themselves: mortality from HIV/AIDS each year invariably exceeds mortality from conflicts. Most people are already living in precarious conditions and do not have sufficient access to basic health and social services. During a crisis, the effects of poverty, powerlessness and social instability are intensified, increasing people’s vulnerability to HIV/AIDS. As the emergency and the epidemic simultaneously progress, fragmentation of families and communities occurs, threatening stable relationships. The social norms regulating behaviour are often weakened. In such circumstances, women and children are at increased risk of violence, and can be forced into having sex to gain access to basic needs such as food, water or even security. Displacement may bring populations, each with different HIV/ AIDS prevalence levels, into contact. This is especially true in the case of populations migrating to urban areas to escape conflict or disaster in the rural areas. As a consequence, the health infrastructure may be greatly stressed; inadequate supplies may hamper HIV/AIDS prevention efforts.
During the acute phase of an emergency, this absence or inadequacy of services facilitates HIV/AIDS transmission through lack of universal precautions and unavailability of condoms. In war situations, there is evidence of increased risk of transmission of HIV/ AIDS through transfusion of contaminated blood. The presence of military forces, peacekeepers, or other armed groups is another factor contributing to increased transmission of HIV/AIDS. These groups need to be integrated in all HIV prevention activities. Recent humanitarian crises reveal a complex interaction between the HIV/AIDS epidemic, food insecurity and weakened governance. The interplay of these forces must be borne in mind when responding to emergencies.
There is an urgent need to incorporate the HIV/AIDS response into the overall emergency response. If not addressed, the impacts of HIV/AIDS will persist and expand beyond the crisis event itself, influencing the outcome of the response and shaping future prospects for rehabilitation and recovery. Increasingly, it is certain that, unless the HIV/AIDS response is part of the wider response, all efforts to address a major humanitarian crisis in high prevalence areas will be insufficient.
GUIDELINES for HIV/AIDS interventions in emergency settings
Inter-Agency Standing Committee Task Force on HIV/AIDS in Emergency Settings