An online article in Time magazine a few weeks ago sent Malawians on Facebook in to a fury. The article is ‘No Help Is Coming’: How Devastating Floods Are Fueling Sexual Violence and the Spread of HIV in Malawi’. The author’s argument is during such crises when men and women are living in camps, the shortage of food, lack of privacy, living in tents increases sexual violence as men try to find food and shelter with women in nearby communities. The author uses a few stories of women to explain her point, so it isn’t necessarily based on strong evidence and the title is sensationalised however it raises the issue of safeguarding women and preventing the spread of HIV.
According to avert.org which is mostly where I took this information from people affected by humanitarian emergencies and armed conflict are often at increased risk of HIV – though these crises do not always translate into an increase in infections.
Humanitarian emergencies and conflict disrupt normal social and economic structures and activities and often involve mass displacement. The breakdown of social cohesion, lack of income, shortage of food, sexual violence, increased drug use and the disruption of health, education and infrastructure that characterise complex emergencies all contribute to putting populations affected by these crises at greater risk of HIV and present challenges for those already living with the virus.
Moreover, populations most at risk of HIV in times of stability (such as women, sex workers and men who have sex with men) may become more vulnerable during humanitarian crises as existing forces of marginalisation intensify and their needs are deprioritised.
Health systems are also put under strain in emergencies and during outbreaks of conflict. This can hamper the treatment and prevention of HIV. Healthcare staff may find it harder to do their jobs and access facilities—this could be due to a range of factors including safety, access to facilities and non-payment of wages. Similarly, patients may not be able to access healthcare facilities. Emergencies can also cause problems with the supply of medication, including antiretroviral drugs, and prevention items such as condoms and testing kits.
However, the challenges presented by emergencies do not always translate into increased infections. The spread of HIV during crises is always context-specific.
UNAids emphasises that stronger integration of HIV treatment and prevention into emergency planning (at national, international and organisational levels) is crucial to ensure HIV services can continue in humanitarian contexts.