HIV/AIDS

Citation:

Seckinelgin, Hakan, Joseph Bigirumwami, and Jill Morris. 2011. “Conflict and Gender: The Implications of the Burundian Conflict on HIV/AIDS Risks.” Conflict, Security & Development 11 (1): 55–77.

Authors: Hakan Seckinelgin, Joseph Bigirumwami, Jill Morris

Abstract:

Sexual and gender-based violence in many conflict and post-conflict contexts are creating vulnerabilities to HIV. The paper is based on research conducted in Burundi in 2007-08. The country was in a long-term civil war from the early 1990s until recently and has been the locus of post-conflict disarmament, demobilization and reintegration programmes, providing a coherent and focused study. The research finds that the relationship between conflict and HIV/AIDS is a function of pre-existing gender relations that also regulate sexual life and determine critical female vulnerabilities. When put under stress by armed conflict, these vulnerabilities become amplified, creating conditions for increased spread of HIV. Analysis of how gender relations and vulnerabilities change according to the specific social and economic circumstances generated by military mobilization, organization and deployment, in relation to civilian displacement and insecurity, in a range of distinct circumstances, provides a framework for understanding HIV vulnerabilities during and after the conflict.

Topics: Armed Conflict, Civil Wars, DDR, Displacement & Migration, Gender, Women, Gender-Based Violence, Gendered Power Relations, Health, HIV/AIDS, Post-Conflict, Sexual Violence Regions: Africa, Central Africa, East Africa Countries: Burundi

Year: 2011

Citation:

Seckinelgin, Hakan, Joseph Bigirumwami, and Jill Morris. 2010. “Securitization of HIV/AIDS in Context: Gendered Vulnerability in Burundi.” Security Dialogue 41 (5): 515–35. doi:10.1177/0967010610382110.

Authors: Hakan Seckinelgin, Joseph Bigirumwami, Jill Morris

Abstract:

In this article, it is argued that concerns about the impact of HIV/AIDS on national and international security do not adequately address the ways in which people, particularly women, are made vulnerable to HIV/AIDS in conflicts. In fact, policies inspired by the security framing of HIV/AIDS can engender new vulnerabilities in post-conflict contexts. The article analyses the ways in which gender relations create vulnerabilities for various groups when such relations are put under pressure during periods of conflict. Drawing on research conducted in Burundi, the article argues that postulated links between security and HIV/AIDS fail to take into account the vulnerability structures that exist in societies, the ways in which these are instrumentalized during conflict and in post-conflict contexts, and how they are also maintained and changed as a result of people’s experiences during conflict.

Topics: Armed Conflict, Gender, Gendered Power Relations, Health, HIV/AIDS, Post-Conflict, Security Regions: Africa, Central Africa, East Africa Countries: Burundi

Year: 2010

Citation:

Mannell, Jeneviève. 2010. “Gender Mainstreaming Practice: Considerations for HIV/AIDS Community Organisations.” AIDS Care 22 (S2): 1613–19. doi:10.1080/09540121.2010.525611.

Author: Jeneviève Mannell

Abstract:

Gender is well recognised as a critical consideration for HIV/AIDS organisations. Since the 1990s, HIV/AIDS policy-makers, donors, non-governmental organisations and transnational corporations have adopted gender mainstreaming as the process for integrating gender into development programmes and institutions. There is an increasing body of literature on the successes and challenges of practicing gender mainstreaming within organisational environments, however, little has been said about this practice within HIV/AIDS-specific organisational environments. As a contribution to this gap, this reflective paper aims to generate debate about some of the considerations for gender mainstreaming practice in HIV/AIDS organisations. It draws on the author's experience conducting a gender mainstreaming review with a southern African HIV/AIDS capacity-strengthening organisation, as well as a review of the development literature on gender mainstreaming. The paper looks at three key issues facing gender mainstreaming: (1) donor requirements on disaggregating data by sex; (2) connecting gender mainstreaming with the priorities of community HIV/AIDS organisations; and (3) the role of resistance to gender mainstreaming as neo-colonial. Preliminary understandings of these issues suggest that current approaches to gender mainstreaming may not be flexible enough to consider the multiple ways gender and HIV/AIDS interact in different sociocultural contexts. There is an urgent need for further debate and in-depth research into these issues, given the challenge they pose for HIV/AIDS organisations and donors that have chosen to make gender mainstreaming a criterion for HIV/AIDS funding.

Topics: Coloniality/Post-Coloniality, Development, Gender, Gender Mainstreaming, Health, HIV/AIDS, NGOs Regions: Africa, Southern Africa

Year: 2010

Citation:

Dworkin, Shari L., and Megan S. Dunbar. 2010. “Uncovering Tensions and Capitalizing on Synergies in HIV/AIDS and Antiviolence Programs.” American Journal of Public Health 101 (6): 995–1003. doi:10.2105/AJPH.2009.191106.

Authors: Shari L. Dworkin, Megan S. Dunbar

Abstract:

Research frequently points to the need to empower women to effectively combat the twin epidemics of HIV/AIDS and gender-based violence. Simultaneously, there has been increased attention given to working with men in gender equality efforts. The latter approach intervenes on masculinities as part of the fight against HIV/AIDS and violence. No research has considered these two lines of work side-by-side to address several important questions: What are the points of overlap, and the tensions and contradictions between these two approaches? What are the limitations and unintended consequences of each? We analyzed these two parallel research trends and made suggestions for how to capitalize on the synergies that come from bolstering each position with the strengths of the other.

Topics: Gender, Masculinity/ies, Gender-Based Violence, Gendered Power Relations, Gender Equality/Inequality, Health, HIV/AIDS, Nonviolence, Violence

Year: 2010

Citation:

Spiegel, Paul B., Anne R. Bennedsen, Johanna Claass, Laurie Bruns, Njogu Patterson, Dieudonne Yiweza, and Marian Schilperoord. 2007. “Prevalence of HIV Infection in Conflict-affected and Displaced People in Seven Sub-Saharan African Countries: a Systematic Review.” Lancet 369 (9580): 2187–95.

Authors: Paul B. Spiegel, Anne R. Bennedsen, Johanna Claass, Laurie Bruns, Njogu Patterson, Dieudonne Yiweza, Marian Schilperoord

Abstract:

Violence and rape are believed to fuel the HIV epidemic in countries affected by conflict. We compared HIV prevalence in populations directly affected by conflict with that in those not directly affected and in refugees versus the nearest surrounding host communities in sub-Saharan African countries. Seven countries affected by conflict (Democratic Republic of Congo, southern Sudan, Rwanda, Uganda, Sierra Leone, Somalia, and Burundi) were chosen since HIV prevalence surveys within the past 5 years had been done and data, including original antenatal-care sentinel surveillance data, were available. We did a systematic and comprehensive literature search using Medline and Embase. Only articles and reports that contained original data for prevalence of HIV infection were included. All survey reports were independently evaluated by two epidemiologists to assess internationally accepted guidelines for HIV sentinel surveillance and population-based surveys. Whenever possible, data from the nearest antenatal care and host country sentinel site of the neighbouring countries were presented. 95% CIs were provided when available. Of the 295 articles that met our search criteria, 88 had original prevalence data and 65 had data from the seven selected countries. Data from these countries did not show an increase in prevalence of HIV infection during periods of conflict, irrespective of prevalence when conflict began. Prevalence in urban areas affected by conflict decreased in Burundi, Rwanda, and Uganda at similar rates to urban areas unaffected by conflict in their respective countries. Prevalence in conflict-affected rural areas remained low and fairly stable in these countries. Of the 12 sets of refugee camps, nine had a lower prevalence of HIV infection, two a similar prevalence, and one a higher prevalence than their respective host communities. Despite wide-scale rape in many countries, there are no data to show that rape increased prevalence of HIV infection at the population level. We have shown that there is a need for mechanisms to provide time-sensitive information on the effect of conflict on incidence of HIV infection, since we found insufficient data to support the assertions that conflict, forced displacement, and wide-scale rape increase prevalence or that refugees spread HIV infection in host communities.

Topics: Armed Conflict, Displacement & Migration, Refugees, Health, HIV/AIDS, Sexual Violence, Rape Regions: Africa, Central Africa, East Africa Countries: Burundi, Democratic Republic of the Congo, Rwanda, Sierra Leone, Somalia, South Sudan, Uganda

Year: 2007

Citation:

Spiegel, Paul B. 2004. “HIV/AIDS Among Conflict-affected and Displaced Populations: Dispelling Myths and Taking Action.” Disasters 28 (3): 322–39.

Author: Paul B. Spiegel

Abstract:

Conflict, displacement, food insecurity and poverty make affected populations more vulnerable to HIV transmission. However, the common assumption that this vulnerability necessarily translates into more HIV infections and consequently fuels the HIV/AIDS epidemic is not supported by data. Whether or not conflict and displacement affect HIV transmission depends upon numerous competing and interacting factors. This paper explores and explains the epidemiology of HIV/AIDS in conflict and addresses the unique characteristics that must be addressed when planning and implementing HIV/AIDS interventions among populations affected by conflict as compared with those in resource-poor settings. These include targeting at-risk groups, protection, programming strategies, coordination and integration and monitoring and evaluation. Areas for future HIV/AIDS operational research in conflict are discussed.

Topics: Armed Conflict, Displacement & Migration, Health, HIV/AIDS

Year: 2004

Citation:

Singh, Sonal, Edward Mills, Steven Honeyman, Bal Krishna Suvedi, and Nur Prasad Pant. 2005. “HIV in Nepal: Is the Violent Conflict Fueling the Epidemic?” PLoS Medicine 2 (8): 705-9.

Authors: Sonal Singh, Edward Mills, Steven Honeyman, Bal Krishna Suvedi,, Nur Prasad Pant

Topics: Armed Conflict, Health, HIV/AIDS Regions: Asia, South Asia Countries: Nepal

Year: 2005

Citation:

Watts, Charlotte H., Anna M. Foss, Mazeda Hossain, Cathy Zimmerman, Rachel V. Simson, and Jennifer Klot. 2010. "Sexual Violence and Conflict in Africa: Prevalence and Potential Impact on HIV Incidence." Sexually Transmitted Infection 86 (3): iii93-iii99. 

Authors: Charlotte H. Watts, Anna M. Foss, Mazeda Hossain, Cathy Zimmernam, Rachel V. Simson, Jennifer Klot

Abstract:

Background and aims: Sexual violence (SV) is common during conflict. Despite reports of  rape-related incidents of HIV infection, ecological analyses have found no association between SV and HIV at a population level. This has led to debate in the humanitarian, security and public health arenas about whether SV is an important HIV risk factor in conflict-affected settings. This paper uses published  evidence on sexual violence in Africa and modeling to explore when SV may increase individual HIV risk and community HIV incidence.    

Methods: Publications on sexual violence in conflict settings were reviewed and a mathematical model describing the probability of HIV acquisition was adapted to include the potential effect  of genital injury and used to estimate the relative risk of HIV acquisition in  ‘conflict’ versus ‘non-conflict’ situations. An analytical equation was  developed to estimate the impact of SV on HIV incidence.          

Results: A rape survivor's  individual HIV risk is determined by potentially compounding effects of genital  injury, penetration by multiple perpetrators and the increased likelihood that  SV perpetrators are HIV infected. Modelling analysis suggests risk ratios of  between 2.4 and 27.1 for the scenarios considered. SV could increase HIV  incidence by 10% if rape is widespread (>40%); genital injury increases HIV transmission (threefold or more); at least 10% of perpetrators are HIV infected and underlying HIV incidence is low (<0.5%).        

Conclusion: The analysis illustrates that SV is likely to be an important HIV risk factor in some conflict-affected settings. More generally, it indicates the limitations of using broad aggregate analysis to derive epidemiological conclusions. Conflict-related initiatives offer important opportunities to assist survivors and prevent future abuses through collaborative programming on reconstruction, HIV and sexual violence.

Topics: Armed Conflict, Health, HIV/AIDS, Post-Conflict, Post-Conflict Reconstruction, Sexual Violence, Rape Regions: Africa

Year: 2010

Citation:

Hankins, Catharine, Samuel Friedman, Tariq Zafar, and Steffanie Strathdee. 2002. “Transmission and Prevention of HIV and Sexually Transmitted Infections in War Settings: Implications for Current and Future Armed Conflicts.” AIDS 16 (17): 2245–52.

Authors: Catherine Hankins, Samuel Friedman, Tariq Zafar, Stephanie Strathdee

Abstract:

Armed conflicts often constitute ‘complex emergencies’, defined as situations affecting large civilian populations which combine war or civil strife with food shortages and population displacement. Wars can increase the spread of sexually transmitted infections (STI) and facilitate HIV transmission through sexual routes, injection drug use (IDU), contaminated blood transfusions and occupational injuries; furthermore,they can create synergistic conditions for interacting epidemics. Armed conflicts can influence HIV epidemic dynamics in surrounding countries and beyond, both directly by affecting HIV transmission itself and indirectly through reallocation of health-related public funds toward security and defense measures. Poverty, powerlessness and social instability, all of which facilitate HIV transmission, are extremely heightened in complex emergencies, but HIV is rarely seen as a priority. We review the effects of war on HIV and STI transmission and critically appraise short- and medium-term approaches to prevention. Our intent is to stimulate thinking about the potential for increased HIV/STI transmission in current and future armed conflicts, with particular reference to Afghanistan, and to encourage timely interventions to prevent a worsening HIV epidemic in Central and South Asia.

Keywords: Asia, HIV, sexually transmitted infections, sexually transmitted diseases, injection drug use, prevention of sexual and blood-borne transmission, war settings, Afghanistan

Topics: Armed Conflict, Economies, Poverty, Health, HIV/AIDS, Reproductive Health, Sexual Violence, Sexuality Regions: Asia, Central Asia, South Asia Countries: Afghanistan

Year: 2002

Citation:

Morris, Margot. 2005. “Gender, HIV/AIDS, and Refugees - Reconceiving Vulnerability and Promoting Transformation: a Kenyan Case Study.” Dialogue 3 (1): 1-40.

Author: Margot Morris

Abstract:

This article examines the way in which UNHCR is responding to the feminisation of HIV/AIDS within refugee camps. It argues that UNHCR must transform the complex of gendered power structures that place refugee women at an increased risk of contracting HIV/AIDS. It finds that there are significant structures that heighten the risk of female refugees contracting the disease. Current approaches to HIV/AIDS interventions are examined through a gendered understanding of how the epidemic impacts on women and girls. It is contended that approaches that empower women and transform gendered structures are the most appropriate mechanism for addressing the feminisation of HIV/AIDS within refugee camps. Finally, this article examines a case study of two refugee camps within Kenya. It demonstrates that existing HIV/AIDS programmes within these camps are an inadequate response to the feminisation of the disease and argues that UNHCR must employ empowering and transformational strategies.

Topics: Displacement & Migration, Refugees, Refugee/IDP Camps, Gender, Women, Girls, Gendered Power Relations, Health, HIV/AIDS, Humanitarian Assistance, Context-Appropriate Response to Trauma, International Organizations Regions: Africa, East Africa Countries: Kenya

Year: 2005