Magazine article Forced Migration Review

HIV/AIDS, Security and Conflict: What Do We Know? Where Do We Go from Here?

Magazine article Forced Migration Review

HIV/AIDS, Security and Conflict: What Do We Know? Where Do We Go from Here?

Article excerpt

In the ten years since the Security Council's first resolution on HIV/AIDS, much has been learned about the dynamics linking HIV and AIDS, conflict and insecurity. Assessing progress made over the past decade in responding to these dynamics enables us to identify new opportunities for prevention and response.

The articles in this collection together with ihe findings from the AIDS, Security and Conflict Initiative (ASCI) consolidate a growing body of social science, public health, policy and operational research that challenges earlier assumptions about the interactive effects of HIV/AIDS and insecurity. Contributing authors draw attention to the social factors associated with forced displacement and migration and their central role in shaping HIV exposure risks. Collectively, they reflect an important shift in emphasis from behaviourial analyses of HIV transmission risks to a focus on the structural factors that shape individual behaviour. As demonstrated throughout this collection, risks vary across peacekeeping environments, camp settings, border areas and in regions with higher and lower HIV prevalence.

Important new pathways for HIV prevention and response are identified in the context of humanitarian and recovery initiatives relating to disarmament, demobilisation and reintegration, with respect to uniformed services, and sexual violence prevention and response. New challenges have also been identified. Despite dramatically increased access to HIV prevention, care and treatment, particularly in refugee camps, demand continues to outpace access and availability among those displaced by conflict as well as in resettlement and return areas.

The gendered nature of conflict-related poverty exacerbates risks for women who head households, for women who serve in or are associated with armed forces and groups and, notably, among women without any means of support or legal claims to marital property and assets. With little in the way of alternative livelihoods, many women and girls are forced into high-risk survival and transactional sex and early marriage. Others fall prey to illicit trafficking and sexual slavery. Responding to the range of social and physiological risk factors associated with sexual violence and exploitation in crises and fragile states will require far greater investment in emergency reproductive health care and STI prevention. It will also require gender-sensitive security risk assessments and response among displaced communities, along borders and in return areas and peacekeeping environments.

Some of the greatest gaps in conflict-related HIV prevention and care relate to the uniformed services including the police, military, navy and the correctional system. Significant advances have been made in pre- and post -deployment prevention, counselling, testing, care and treatment for military personnel, their families and other dependents. But similar investments have yet to be made among police, a group at far greater risk of transmission and with far greater potential to serve as agents of change within the communities fhey serve.

It is a bitter irony that the countries with the highest HIV prevalence in sub-Saharan Africa are not among those considered the most 'fragile' by current indices of good governance and economic development. This has obscured the urgency of need and related resource gaps, especially at local levels of governance. Even where well thought out, evidence-based programmes have been developed by governments, humanitarian or development agencies, far too many donors simply do not understand the need for comprehensive HIV programming in humanitarian and recovery settings or are under the false impression that it just cannot be done. …

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