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World AIDS Day: “Getting to Zero” in Humanitarian Settings


Sandra Krause, Director, Reproductive Health, looks at the condom dispenser in Eldoret Showground, Kenya

Today on World AIDS Day, the Women’s Refugee Commission celebrates the progress that has been made in addressing the epidemic, while acknowledging the distance still left to go. This year’s theme, “Getting to Zero,” in honor of UNAIDS’ (the Joint UN Program on HIV/AIDS) multi-year vision of achieving “Zero New Infections. Zero Discrimination. Zero AIDS-related Deaths,” speaks to a shifting reality of what is possible. We embrace this vision and draw attention to humanitarian settings, where HIV vulnerabilities are prevalent and under-acknowledged—and yet critical to this vision.

Globally, 33.2 million people are living with HIV. Two-thirds of them are in Sub-Saharan Africa, and women and adolescent girls account for more than 60 percent of people living with HIV. In developing countries—particularly those in, or recovering from, humanitarian crises—HIV and AIDS continue to have devastating impact. Extreme poverty, loss of livelihoods, lack of support networks and decaying health and legal systems all contribute to increased risk of infection.

Situations of conflict, postconflict and displacement exacerbate existing violence and present new forms of violence against women specifically. The use of rape as a weapon of war is widespread, as we’ve seen in recent conflicts in Bosnia, Rwanda, Sierra Leone and elsewhere. In Liberia, following the nearly five-year civil war, 49 percent of women reported physical or sexual violence by a fighter.

Research unequivocally shows a direct link between HIV and gender-based violence—especially among young women. Women experiencing domestic violence by their partners are particularly vulnerable, and have a 50 percent increased risk of contracting HIV.

Economic vulnerabilities and gender inequities cannot be understated when looking at HIV in humanitarian settings. The exchange of sex for money, protection, food or other commodities in conflict settings is of grave concern. Unfortunately, women and youth may turn to survival sex or commercial sex work in order to ensure their own, or their family’s, survival. They require protection and care at multiple levels.

Yet, while the situation presents many challenges, the humanitarian community has tools to reduce and respond to the risks. There are prevention and treatment measures that must be taken: providing condoms, practicing standard precautions to prevent infections at health facilities, ensuring a safe blood supply for blood transfusions, providing postexposure prophylaxis for survivors of sexual violence and making available life-saving antiretroviral drugs—these are all critical actions described in the Minimum Initial Service Package (MISP) for Reproductive Health in Crisis Situations. The MISP also calls for immediate measures to prevent sexual violence, such as meeting women’s and girls’ basic safety and survival needs (adequate quantities of food, fuel to cook it, water, etc.).

The Women’s Refugee Commission has long promoted the MISP standard, and we strongly advocate that the MISP activities are implemented from the earliest days of new emergencies. As a situation stabilizes, and communities shift towards recovery, we should then expand the reproductive health services offered and develop programs for women and girls that will increase their self-reliance and support safe spaces for them to reduce underlying risks.

It is essential for the international community to consider HIV in humanitarian settings and routinely address the vulnerabilities that relate to both gender-based violence and HIV. As positive momentum builds and progress in the HIV field continues, we must proactively bring these advancements to crisis-affected settings—improving prevention and treatment interventions, while reducing gender inequalities. Only then can we begin to realize the goal of “Getting to Zero.”