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HIV/AIDS among Conflict-Affected and Displaced Populations: Challenges and Response

This article highlights the programmatic and operational challenges faced in addressing HIV/AIDS among conflict-affected and displaced populations. It discusses the principles of response, implementation strategies, and the realities, challenges, and opportunities in providing comprehensive interventions in these settings.

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HIV/AIDS among Conflict-Affected and Displaced Populations: Challenges and Response

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  1. HIV/AIDS among Conflict Affected and Displaced Populations: Programmatic and Operational Challenges Dr Dieudonne Yiweza Senior HIV/AIDS Régional Coordinator, Central Africa

  2. Displacement Cycle

  3. Principles of Response • Objectives: • Affected population lives in dignity, free from discrimination, and human rights respected • Reduced HIV Transmission • Access to prevention interventions linked to care and treatment programmes

  4. Principles of Response cont • Protection: • No mandatory testing • No “persecution” on basis of HIV status • Coordination: • Multisectoral coordination • Inclusion of affected population • Response: • Focused and hierarchical approach

  5. Implementation: Phased and Hierarchical Approach • IASC HIV Guidelines for Emergencies • Minimum essential HIV/AIDS interventions provided (e.g. blood, UP, STI, Condoms, IEC) • Comprehensive interventions (link prevention with care/treatment): e.g. VCT, PMTCT, PEP • Antiretroviral therapy (ART) when provided to surrounding host population • Consider repatriation/reintegration and availability in areas of return

  6. Implementation: Realities, Challenges and Opportunities • Often come from and arrive in rural, remote, inaccessible and underserved zones • Majority: children, young people and women • Little to no health and social facilities available • Host population often as poor or poorer • Level of interactions with local pop. important • Gov’t institutions often non-existent or poorly functioning • NGOs sometimes not in place due to lack of funds, logistical issues or security reasons

  7. Realities, Challenges and Opportunities cont. • Not included in host country/district plans • Delay on external relief • Multiple needs thus prioritising essential • Cross-border aspects • Urban vs. rural caseloads • Scattered vs. concentrated groups • New vs. protracted situations

  8. Scattered vs. Concentrated Populations • Much easier to develop strategies when population is considered • When scattered, need innovative strategies including community approaches

  9. Inclusion in Host Country and District Plans • Often not included in various national strategic plans (e.g. development, HIV) • Considered responsibility of ‘international community’  Need continuous advocacy at national, regional and global levels • Examples include: • World Bank MAP in DRC : HCR and DRC NAC agreement; programs for refs, IDPs and returnees • South Africa, Namibia, and Zambia: free ART to local and ref populations

  10. Interaction with Surrounding Host Populations • Often very close contact with host pop. • Latter have similar needs, if not more • Usually in both pop: majority of pop. are youth and women = at risk groups • Often host pop. use displaced pop’s facilities  Need to integrate the 2 groups in programmes, trainings, M&E and funding plans

  11. Cross-border Aspects • Surrounding countries often affected by conflict(s) • Similar pop. have similar needs across borders • Needsub-regional approach • Continuity of services • Similar testing algorithms and treatment • Lower costs for prevention and treatment services • Improved program efficiency • Great Lakes Initiative on AIDS (GLIA) • Oubangui-Chari Initiative • Mano River Union Initiative

  12. Repatriation • HIV prevention package during repatriation (e.g. awareness, condoms, leaflets, F/U information) • Affected pop. become human resources for HIV interventions in return areas: • Return areas often underserved w poor HIV programs • Trainings , knowledge acquired during asylum (NGOs, host country programmes) • F/U of PLWHAs and continuation of HIV activities in return areas • Need cross border coordination and • Preparation in return areas for F/U and continuation of programs including ART

  13. Repatriation and Long-term ART • In Host country: • Available to surrounding pop • When to start? • Who pays and duration of funding? • In Country/area of return: • Availability of ART to local pop • Who pays and how much? • Treatment protocol issues • Need sub regional approaches • Advocacy in both countries: commitment and equity issues

  14. ART in 2005: DRC case

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