HIV/AIDS and emergencies: analysis and recommendations for practice

analysis and recommendations for practice

Summary of a published review¹

A Humanitarian Policy Network paper recently reviewed issues related to HIV/AIDS and emergencies. The paper states that the link between emergencies and HIV vulnerability is essentially two-fold. First, the vast majority of humanitarian crises take place in countries were rates of HIV infection are already high, which means that preexisting risks of infection and discrimination are significant. Secondly, the destruction, disruption, dislocation and displacement that emergencies typically cause can exacerbate vulnerability by increasing the risk of infection among affected populations. For example, loss of livelihoods might cause women to turn to sex work, or rates of sexual abuse by armed groups might increase.

Despite these links, HIV is not generally seen as a priority in emergency operations. The author of the paper states that in failing to take HIV into account from the earliest stages of planning and implementation of an emergency response, humanitarian practitioners may be, unwittingly, exacerbating levels of infection. The review sets out a series of recommendations to redress this situation, which include:

Policy Making

Agencies providing a humanitarian response need to revise existing policies and strategies to take account of issues raised by HIV. Disaster preparedness policies need to recognise HIV as a priority. This might include establishing the prevalence of HIV infection in an emergency affected or prone area.

Risk Assessment

This should include an assessment of the vulnerability to HIV of affected populations and aid workers. Particular attention should be given to the composition of the displaced and surrounding host population to establish, for example, whether they are mostly women and children, single women, unaccompanied children or armed men. As part of a wider risk assessment, agencies should also determine which factors might heighten people's HIV vulnerability, and which should be targeted with specific interventions, e.g. cultural beliefs, attitudes and practices concerning sexuality and sexual health, whether illicit drugs are being used, etc.

Decisions/practices influencing vulnerability to sexual violence or exploitation

Where displacement has occurred, risk of sexual violence should be taken into account, for example, when planning accommodation and temporary shelter.

Decisions/practices influencing power relations

Men with decision-making powers, and those who control accommodation design, food resources and future opportunities (e.g. employment, refugee entitlements and visa concessions), often barter these for sex. Rape at the hands of the men who police a relief operation is common and redress rare. Relief agencies do have an opportunity to influence structures that affect women's HIV vulnerability. For example, agencies can ensure that displaced women are involved in decisions about accommodation design and layout, and that women have some measure of control over how resources are distributed and the running of the relief site.

Provision of Health Care

There are many HIV-related concerns that should inform health care practice. These include ensuring the safety of blood transfusions, HIV-free surgical and other skin piercing instruments, and measures that minimise the risk of HIV infection from needlestick injuries or clinical waste. Measures that minimise risk of HIV infection through sex, and the provision of the same standards of care for people with HIV related illness as for other sick people, should also be considered.

Implications for humanitarian agencies

Organisations need to address the underlying factors that heighten people's vulnerability to HIV in emergencies. To do this, agencies may need to review the preparation and training they offer staff and volunteers. Staff and volunteers will need a thorough understanding of the specific vulnerabilities to HIV of all refugee and displaced people, and more particularly of women, young girls and young boys. Staff may also need help in overcoming their own fears and prejudices towards people infected with, or affected by, HIV.

At an international level, agencies need to foster more discussion with and between organisations, so as to encourage the development of clear, user-friendly and easily applied guidelines and policies.

The key argument of the review is that HIV needs to be seen as a cross-cutting issue, with implications for existing relief programmes and modes of responding to an emergency. HIV considerations need to be integrated into these already-existing channels, rather than being addressed in a 'stand-alone' isolated HIV programme. If this is to happen, an accurate understanding and strong commitment from senior managers is required at strategic and policy levels. This needs to be accompanied by sufficient financial and personnel resources to ensure that such policies are acted on in every emergency situation where HIV is present, or potentially so.

¹Smith, A (2002). HIV/AIDS and emergencies: analysis and recommendations for practice. Humanitarian Practice Network (HPN) paper, No 38, Feb 2002