HIV/AIDS, Security and Conflict: New Realities, New Responses
de Waal, Alex, Klot, Jennifer F., Mahajan, Manjari, Forced Migration Review
Ten years after the HIV/AIDS epidemic itself was identified as a threat to international peace and security, findings from the three-year AIDS, Security and Conflict Initiative (ASCI)1 present evidence of the mutually reinforcing dynamics linking HIV/AIDS, conflict and security.
ASCI's findings reveal that a number of earlier, more alarmist, relationships assumed to exist between national-level state security and the HIV/AIDS epidemic were not borne out. Under-examined risks in humanitarian emergencies and postconflict transitions are highlighted, as well as threats posed by HIV/ AIDS to the operational capacity of armies and across the uniformed services (such as police, prison and border authorities). ASCI's gender analysis exposes flawed assumptions that continue to guide epidemiological and behavioural approaches to HIV/AIDS prevention and response in conflict situations and fragile states. By focusing on intermediary levels of interaction - between macro-level assumptions and micro-level behavioural and biomedicai approaches - ASCI offers a new agenda for action.
Summary of findings
* Prevailing indicators of state fragility fail to capture the impact of HIV/AIDS on local governance, human resources, service delivery and community survival.
* Prevalence of HIV within the uniformed services is related to age, rank, time in service, maturity of the epidemic, patterns of violence, military sexual trauma and command structures.
* HIV and AIDS can threaten the operational capability of armies primarily at the tactical level of operations. HIV/AIDS can affect combat effectiveness, unit cohesion, morale and discipline.
* Command -centred approaches to HIV prevention - i.e. that put responsibility for HIV policy and practice within the army command rather than on medical services alone - are likely to be more effective in reducing the risk of HIV infection and sexual violence among the rank and file than relying solely upon education and training based on individual behavioural, medical or human rights approaches.
* HIV prevention efforts have neglected police and other law enforcement and uniformed services, including the customs, naval, immigration and prison services.
* The risks of HIV transmission, especially in epidemics concentrated among injecting drug users and sex workers, are influenced by law enforcement practices and by the drugs trade, human trafficking and those who control sex work - pimps, 'protectors', traffickers and long-term clients.
* Post-conflict transitions are both a period of heightened vulnerability to HIV transmission and a neglected element in HIV and AIDS policy and programming.
* Greater policy attention and service continuity are needed in post -conflict situations to respond to increased population mobility, demobilisation of combatants, disruptions in humanitarian assistance to displaced persons in camp settings, and the excessive demands on health and social services in areas of return.
* Disarmament, demobilisation and reintegration (DDR) programmes are an important and consistently overlooked focus for HIV and AIDS prevention and response, especially among military and extended families, and women and children associated with armed forces.
* Forced sex may increase individual risk of HIV acquisition for different scenarios of coercion based on genital trauma, relative probabilities of HIV and other sexually transmitted infections, and inadequate access to health services.
1. Sexual violence needs to be recognised as a physiological and social factor in HIV transmission. Consistent with UN Security Council Resolutions addressing women, sexual violence and HIV/ AIDS (1308, 1325, 1820, 1882, 1888 and 1889), sexual violence and HIV prevention efforts must be more closely aligned in conflict -affected environments, including through urgently needed consensus on definitions and measurement. …