Magazine article Forced Migration Review

Post-Conflict Transition and HIV

Magazine article Forced Migration Review

Post-Conflict Transition and HIV

Article excerpt

Research in Bosnia, the Democratic Republic of Congo, Haiti and Liberia has highlighted worrying neglect of HIV issues in the aftermath of conflict and displacement.

The last half century has seen a dramatic increase in the number of conflicts and complex emergencies. Most have occurred in settings where conflict further weakened already inadequate national health, educational and other public services. The growth in frequency of conflicts and the number of people affected by them has prompted a strong commitment to emergency relief in the acute phase of crises but, by comparison, interest in postconflict transition to recovery and reconstruction has been much more limited in both vision and scope.

Bosnia, Haiti and Liberia have all gone through protracted conflicts, and hostilities continue in eastern DRC. A research project undertaken by the International Centre for Migration Health and Development (ICMHD)1 and its research collaborators as part of the AIDS, Security and Conflict Initiative (ASCI) focused on how the transition from conflict is experienced by different groups of people and the effect it has on their attitudes to HIV and sexual and gender-based violence (SGBV). In DRC, Haiti and Liberia HIV remains a large and still growing problem. In Bosnia, where the epidemic has been far less evident, the growth in the number of reported cases of TB may be indicative of underlying, poorly diagnosed and unreported HIV. All four countries saw conflict produce extensive, repeated displacement of people and extensive sexual and gender-based violence, and in DRC and Liberia there was also widespread mutilation associated with that violence.

Post-conflict donor neglect

Our research suggests that in general the international community has given relatively little attention, either conceptually orprogrammatically, to the transition from conflict to recovery. In three of the countries surveyed where there was a clear end to open hostilities, there were no large-scale interventions designed to ensure the long-term human security of the populations concerned. Nor was there much evidence of any targeting of population groups whose vulnerability was due to or had been exacerbated by the conflict. Whatever recovery and social reconstruction have occurred or are now occurring in all four countries appear to have been coincidental and have largely bypassed many of the people who bore the brunt of the conflicts.

This neglect of people whose reinsertion into society is essential for recovery and reconstruction is creating a new marginalisation (real and perceived) from health and social services, including much-needed HIV initiatives. As well as placing lives at risk, this neglect could have serious implications for public health and future social and political stability.

The prevalence of HIV among people aged 15-49 in Bosnia, DRC, Haiti and Liberia in 2007 was estimated tobe 0.1%, 1.5%, 2.2% and 1.7% respectively but the lack of good data makes accurate estimation very difficult and in the three latter countries the situation may have been significantly worse. To what extent patterns of incidence and prevalence of HIV were influenced by conflict is not clear for the same reason.

What is clear is that displaced and sexually abused women conspicuously failed to benefit from post -conflict HIV and other health interventions. In none of the four countries did cessation of or reduction in hostilities bring much improvement to their lives. Indeed, displaced women in DRC, Haiti and Liberia reported that their situation worsened and they felt more at risk of being exposed to HIV after conflict than during conflict. This was particularly evident in Haiti and DRC where displaced women said they were living in constant fear that they or their daughters would become infected with HIV and they complained that whatever HIV interventions had been mounted had not taken them or their needs into account. …

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