Preventing HIV in crisis zones
All people everywhere need information, supplies and services to protect themselves against HIV and other sexually transmitted infections (STIs). But in times of crisis, many factors – including the breakdown of social and information networks, the separation of families, a lack of condoms, and an increase in sexual violence and high-risk behaviour – leave individuals especially vulnerable to contracting STIs, including HIV.
Confusion and despair heighten this vulnerability. Displaced people need HIV prevention and care services appropriate to their language, culture and current situation. But they are almost always overlooked in national HIV initiatives, and policies to meet their special needs are scarce.
As a Cosponsor of UNAIDS, UNFPA is assigned key roles in providing information and education, condom programming, and strengthening the HIV response in the context of humanitarian crises.
Information and education
Information about HIV and AIDS can be especially critical for those affected by crisis because their vulnerability may increase at the same time that traditional information networks break down. Refugee camps provide opportunities in this regard, as education and outreach can be linked to other structured camp activities.
Within UNAIDS, UNFPA is assigned the lead role in providing information and education related to HIV prevention. In crisis zones, the Fund uses a variety of strategies to empower displaced people with the knowledge they need to stay HIV-free. These include mass media campaigns, life-skills education, voluntary counselling and testing, and the creation of ‘safe spaces’ where adolescents can freely access information, services and peer support networks. UNFPA strongly advocates for linking HIV prevention with all other reproductive health interventions, such as maternal care.
UNFPA programmes additionally promote delayed sexual initiation among young people and help prevent mother-to-child transmission of HIV transmission. The Fund’s advocacy to prevent sexual violence in the aftermath of humanitarian crises also helps to reduce vulnerability to HIV.
Ensuring safe care in health facilities
Conflicts and natural disasters increase the number of people requiring medical care. Pregnant women who haemorrhage during delivery, landmine victims, and countless others caught up in conflicts and natural disasters require blood transfusions. Blood screening is critical to ensure a safe blood supply. Health workers must also have the supplies to maintain universal precautions to prevent transmission from patient to patient, health worker to patient, and patient to health worker.
UNFPA provides health facilities with emergency supplies and equipment, and trains health workers in their use. Included are supplies and equipment for safe blood transfusion and sterilization of instruments, and instructions for maintaining universal precautions for HIV prevention. UNFPA also provides the medication, testing equipment and training needed to administer post-exposure prophylaxis and to protect health workers who may have been exposed to infected blood.
Ensuring access to condoms and care
In desperate situations, high-risk sexual behaviour may increase, giving rise to an increase in STIs. Condoms are a critical element in a comprehensive, effective and sustainable approach to HIV prevention and treatment.
The vast majority of HIV infections are sexually transmitted. Condoms are the surest way to arm crisis-affected populations with dual protection against STIs and unwanted pregnancies. But condoms may become unavailable when health facilities are destroyed, supply lines are cut off or people become displaced. Because many people in crisis or refugee situations are destitute, it is essential that condoms be free and readily available to those who seek them. Condom provision must be accompanied by campaigns to raise awareness of their effectiveness in preventing STIs, their correct use, and where to obtain them.
UNFPA is the largest international supplier of condoms, and works with local and international partners to make free condoms available in crisis settings around the world. UNFPA also works with the United Nations High Commissioner for Refugees to supply male and female condoms to refugees and internally displaced persons in more than 20 countries.
STIs – such as gonorrhoea, syphilis, and chlamydia – are among the most common illnesses in conflict and displacement settings. Having an STI greatly increases the risk of HIV infection, making STI treatment an important part of HIV prevention. Early establishment of STI management, including condom provision, must be a priority as health services are restored. Female health workers and people trained to work with adolescents should also be available so women and young people feel comfortable seeking assistance.
UNFPA supports the prevention and treatment of STIs through the provision of condoms, drugs and other supplies, and by supporting the training of health care providers. Health workers are trained to recognize and diagnose symptoms, provide effective and confidential treatment, and conduct outreach and information campaigns, including notification and treatment of partners.
Working with armed forces
Among male population groups, military and police report the highest-risk behaviour and highest number of partners. STI rates among military personnel are significantly higher than those in civilian populations even in peacetime. These figures increase dramatically during conflict.
Young people are especially vulnerable. Half of all new STIs occur among 15-24 year-olds. HIV education programmes aimed at young uniformed personnel can help to slow the spread of STIs, including HIV.
Because young recruits often have strong influence among their peers, within and outside the service, changing their perceptions and behaviour can have ripple effects in the wider population. If properly educated, these recruits can transmit clear messages to society, especially youth, and carry these messages back to their home communities.
The importance of HIV prevention services for uniformed forces is widely acknowledged. Currently all major peacekeeping operations have full-time AIDS advisers. Smaller missions have AIDS focal points. UNAIDS is today assisting 53 Member States with comprehensive programmes to address AIDS among uniformed services. As one of the Cosponsors of UNAIDS, UNFPA collaborates closely with the UN Department of Peace Keeping Operations on comprehensive HIV prevention efforts. In Sierra Leone, for instance, the Fund coordinated the first joint programme to train peacekeepers in HIV prevention and gender awareness.
In Latin America and the Caribbean, UNFPA has helped institutionalize elements of UN Security Council Resolution 1325 for the armed forces and police in 14 countries. From Nicaragua to Colombia, this has meant integrating human rights – including reproductive and women's rights – sexual and reproductive health, maternal mortality and HIV/AIDS components into the policies, procedures, protocols, training curricula and health services of uniformed forces.