Programs Reproductive Health Preventing Sexually Transmitted Infections and HIV
The relationship between conflict and vulnerability to sexually transmitted infections (STIs), including HIV/AIDS, is complex. Typically, all STIs thrive under crisis conditions — conditions of poverty, powerlessness and instability, often coinciding with limited access to the means of prevention, treatment and care. Refugees and displaced persons are especially vulnerable to STIs, including HIV. But new findings show that in some circumstances where displaced people have been isolated and less mobile, possibly because of forced migration, insecurity, destroyed infrastructure and diminished resources, HIV prevalence is lower than that of neighboring countries.
If not addressed or checked, STIs may spread rapidly among displaced populations for many reasons. Disturbance of community and family life may disrupt social norms governing sexual behavior. Adolescents may begin sexual relations at an earlier age, take sexual risks, such as having sexual intercourse without using a condom, and face exploitation in the absence of traditional socio-cultural constraints.
Women and children may be coerced into having sex to survive. During civil strife and flight, displaced persons, especially women and girls, are at increased risk of sexual violence, including rape. Proximity to peacekeeping forces, military and police, a population that long has been associated with higher rates of STIs, can facilitate the spread of HIV in refugee and internally displaced settings. HIV-positive women are ten times more likely to have encountered male violence than their HIV-negative counterparts. Finally, populations from low HIV prevalence areas may mix with populations from high prevalence areas, increasing the overall HIV rate in the region. There is insufficient data to determine how conflict and displacement affect HIV prevalence.
Until recently, HIV/AIDS programs were frequently excluded in relief agencies’ immediate response to emergencies. However, the humanitarian community now understands that an HIV/AIDS intervention must begin immediately at the onset of an emergency and involve other sectors, such as education. New evidence demonstrates the effectiveness of providing basic HIV/AIDS information and prevention methods among displaced populations. These essential HIV programs should be developed in adherence to the Inter-agency Standing Committee Guidelines for HIV/AIDS in Emergency Settings. At the onset of a new crisis, it is possible to guarantee the availability of free condoms and enforce respect for universal precautions against HIV/AIDS, for example. Longer term public-awareness campaigns can lead to the reduction of HIV/AIDS by changing sexual behavior patterns.
The most common route of HIV transmission is through sex. The World Health Organization (WHO) states that the presence of an untreated STI can greatly increase the risk of HIV transmission during sexual contact.
Through numerous reproductive health assessments in conflict settings, the Women’s Commission has identified a lack of knowledge and skills among humanitarian workers in particular reproductive health areas. These include a lack of awareness about the critical need for emergency contraception to prevent unwanted pregnancies, many of which result from rape or gender-based violence; poor adherence to guidelines on the treatment of sexually transmitted infections (STIs); and weak programming to address gender-based violence and HIV/AIDS. To support advocacy in these areas, the Women’s Commission, on behalf of the Reproductive Health Response in Conflict (RHRC) Consortium, produced three new publications and supported the development of a fourth to address these gaps.
The Women’s Commission conducted pilot training courses and field testing using these materials and is working to widely disseminate them and to ensure that resources are available to community-based groups and international organizations in a variety of languages and formats.
The Women’s Commission is also advocating for increased training in and use of the female condom, the only female-controlled method currently available to prevent HIV transmission. In Burundi, 63 percent of HIV-positive women who had tried the female condom preferred it to the male condom and over three-quarters thought that it empowered them to prevent unwanted pregnancy.
The Women’s Commission and UNFPA-Thailand supported a training and advocacy workshop on the female condom, with special emphasis among Burmese refugee and migrant youth in Thailand. The training brought together health workers and community leaders from all along the Thai-Burma border. Participants working with refugees, migrants and displaced people inside Burma learned about global experiences with the female condom, became advocates for the female condom in their communities and gained skills to counsel clients on female condom use. Twenty-three participants from 15 local and international organizations attended the training. A follow-up workshop was held four months later with all participants. For more on youth, click here.
Click here for key messages and stats and facts on STIs.
