1. Introduction
The HIV/AIDS epidemic has been increasing steadily on a global scale. According to UNAIDS, an estimated 33.2 million people world-wide were living with HIV/AIDS as of 2007. The groups most at risk of contracting HIV are women, children, mobile populations and rural poor people.
There is a direct link between poverty and HIV/AIDS, because the disease flourishes where there is deep-seated inequality and widespread denial of basic human rights. Major drivers of the epidemic include gender norms and inequality, perceptions of what are appropriate sexual norms and practices, and HIV-related stigma and discrimination that further marginalise key vulnerable populations and limit their access to various services.
The rise in HIV/AIDS dramatically affects both demographics and economics. The HIV epidemic is eroding the economic capacity of those nations seriously afflicted with the disease. At a household level, primary and secondary income earners are falling sick, and are no longer able to support the family’s household expenditures. In many cases, one or both parents have died from AIDS, orphaning their children and leaving them to be cared for by others, including the elderly. According to UNAIDS, 15.2 million children were orphaned by AIDS in 2005. These children are at increased risk of poor health, lack of educational opportunities, poverty and forced recruitment into warfare.
For international NGOs, HIV/AIDS is a challenging cross-cutting issue to solve. What was once thought of exclusively as a health issue today is considered for its influence on education, livelihoods, gender inequality and food security.
1.2.1 Increased risk of transmission
Humanitarian crises and emergencies can create situations or conditions that heighten an individual’s risk to HIV. The emergency situation creates the following conditions that increase the risk of HIV transmission among the population:
- During a crisis, the effects of poverty, powerlessness and social instability are intensified, which increases vulnerability to HIV/AIDS.
- As social networks and livelihoods collapse due to emergencies and conflicts, people are subjected to situations with a high risk of HIV.
- Emergencies can lead to the fragmentation of families and communities, which threatens stable relationships. When social norms that regulate behaviour are weakened, women and children are at increased risk of violence, and can be forced into having unsafe sex to gain access to basic needs, including security.
- Loss of livelihoods and income may force women into transactional or commercial sex.
- Evidence demonstrates that the incidence of rape and gender-based violence increases during emergencies (refer also to Chapter Gender).
- Displacement may bring populations, each with different HIV/AIDS prevalence levels, into contact, especially in the case of populations migrating to urban areas to escape conflict or disaster.
- Emergencies place stress on health infrastructure, and inadequate supplies hamper HIV/AIDS prevention efforts. An inadequacy of services facilitates HIV/AIDS transmission through lack of precautions, unavailability of condoms, limited access to treatment for sexually transmitted infections and contaminated blood.
- The presence of military forces, peacekeepers or other armed groups contributes to increased transmission of HIV/AIDS through forced sexual activity. Women seldom have control over sexual negotiation or the relationship.
- The breakdown of school, health and communication systems, which are usually used to programme against HIV transmission, increases the risk of transmission in emergencies.
- Pregnant women and newborns are often unable to access services critical to preventing vertical transmission of HIV (including VCT, prophylaxis and education on breastfeeding).
- www.wfp.org/food_aid/doc/HIVAIDS_Emergencies.pdf
1.2.2 Increased vulnerability of people living with HIV/AIDS
People living with HIV/AIDS are more prone to illness and death as a result of the emergency, and therefore must receive assistance and care that addresses their particular vulnerability. They are also more prone to epidemics, and their illness can have an impact on increased food insecurity and economic recovery. HIV/AIDS can aggravate the crisis, and delay the recovery and reconstruction rehabilitation.
The provision of care and treatment for people living with HIV/AIDS is also affected by emergencies. Caregivers may be killed or injured during an emergency. Health care systems break down (attacks on health centres, inability to provide supplies, flight of health care staff), and populations have limited access to health facilities because roads are blocked or mined, and financial resources are even more limited than usual.
PLWHA who have been receiving ART prior to the emergency are often unable to gain access to life saving drugs in emergency settings. Many ART regimens are interrupted through displacement, lack of proper records and the breakdown of social services. Inability to access treatment is life threatening, but even the interruption of regimens can have severe impacts on one’s health and can cause the surfacing of resistant strains. Modification of treatment regimens in response to availability of drug supplies should also be mitigated, and as much effort to maintain regimen consistency as possible should be prioritized in the response.
Per WHO guidelines, continuation of treatment for those already on treatment prior to the crisis should be considered a priority intervention and part of the minimum initial response to HIV even during the acute phase of an emergency. Organizations responding to emergencies and health providers have a vital social responsibility to continue treatment to the best of their ability. Emergency preparedness plans must integrate the issues of HIV treatment in order to save lives and mitigate the impacts of HIV.
