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Mass rape in conflict-affected countries could substantially increase incidence of HIV

Mass rape in conflict-affected countries could substantially increase incidence of HIV Implications for prevention and intervention Supervie V 1 , Halima Y 2 and Blower S 1 1 Semel Institute, David Geffen School of Medicine, University of California, Los Angeles, USA

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Mass rape in conflict-affected countries could substantially increase incidence of HIV

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  1. Mass rape in conflict-affected countries could substantially increase incidence of HIV Implications for prevention and intervention Supervie V1, Halima Y2 and Blower S1 1Semel Institute, David Geffen School of Medicine, University of California, Los Angeles, USA 2Global Campaign for Microbicides, Washington DC and Columbia University, New York, USA

  2. Research question: Does mass rape have an impact on the HIV epidemic?

  3. Introduction Sub-Saharan Africa is afflicted by a high number of armed conflicts. High HIV prevalence is a feature of many Sub-Saharan African nations. Mass rape as a weapon of war is a feature of conflict-affected countries. Forced migration has an impact on women’s vulnerability to HIV.

  4. It has been suggested that systematic rape may have a significant impact on HIV epidemics.  Save the Children UK reported that 2,000 women were tested for HIV following the genocide in Rwanda; 80% were found to be infected with HIV. HIV prevalence in rural Rwanda was considerably higher following the 1994 genocide; 11% in 1997 compared to 1% before the conflict. In 2004, HIV prevalence among Sudanese refugees increased to 21% compared to 2.6% in the general population. However compelling, these studies are qualitative and/or based on small samples.

  5. A modeling study by Spiegel (the UN High Commissioner for Refugees) et al, has investigated the impact of mass rape on the HIV epidemic. *  They concluded the impact on HIV prevalence to be negligible We used their model to investigate the impact of mass rape on the incidence of HIV. * Anema A., Joffres M.R., Mills E., Spiegel P.B., Widespread rape does not directly appear to increase the overall HIV prevalence in conflict-affected countries: so now what? Emerg Themes Epidemiol. 2008;5:11.

  6. Methods  We used demographic and prevalence data from the US Census Bureau’s International Data Base and UNAIDS/WHO  We used uncertainty analyses (10,000 simulations) to calculate annual number of infections and % of annual incidence of HIV due to mass rape among girls and women in 7 conflict-affected countries in Sub-Saharan Africa: Burundi Democratic Republic of Congo (DRC) Rwanda Sierra Leone Somalia Sudan Uganda

  7. Result 1

  8. Result 2

  9. What can be done? • Humanitarian aid organizations can provide emergency aid for crisis intervention.  Document cases and collect basic forensic evidence to provoke governments to take action and provide access to legal recourse.  Provide medical care for traumatic genital injury caused by forced sex, treatment for STIs, termination of unwanted pregnancies, PEP (PrEP?), link to testing, PMTCT, improve surveillance and protection to safeguard women. • Governments and normative agencies need to increase or execute their mandate •  Need to address means for enforcing policies to hold rapists to account in national and international courts for violation of Human Rights. •  The medical, physical and mental consequences of rape will have to be considered when making real world health policies – essential to combine services for rape survivors under one roof. • International legal and advocate communities can raise awareness and publicly call for support from UN and donor agencies.

  10. However none of this will be easy – and not all interventions are welcomed  In 2006, a Norwegian humanitarian organization was expelled from South Darfur following allegations of false reporting of rape cases. A government spokesman said that no rape cases had in fact occurred.  In 2005, two members of MSF were arrested following a report that detailed treatment they had provided to rape survivors in local hospitals.

  11. Conclusion Unstable and undemocratic regimes are a pervasive feature of international politics. Mass rape is an inadvertent consequence or used as a systematic weapon of war. Our analyses show that widespread rape in conflict-affected countries can significantly contribute to HIV incidence. Finally, while there is an ethical imperative to help rape survivors, it may also be possible to significantly reduce HIV incidence if care and treatment are offered to prevent and address the impact of mass rape in conflict countries.

  12. Rape in South Africa A woman is raped in South Africa every 17 seconds. (this does not include the number of child rape victims) Estimated that 1 in 2 women will be raped in South Africa. Between 28%-30% of adolescents reported that their first sexual encounter was forced.

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