Reproductive Health for Communities in Crisis
All sexually transmitted infections, including HIV/AIDS,
thrive under crisis conditions, which coincide with limited
access to the means of prevention, treatment and care.
Other conditions increasing the risk of exposure in
- Large movements of people;
- The break-up of stable relationships and the disintegration
of community and family life;
- Disruption of social norms governing sexual behaviour;
- Adolescents starting sexual relations at an earlier age;
- Coercion of women and adolescent girls and boys to
exchange sex for food, shelter, income and protection;
- Mixing of populations with higher rates of HIV
- Increased risk of sexual violence, including rape.
Rape by infected men directly exposes women to
HIV, and resulting abrasions or tearing of vaginal tissues
may increase the risk of infection dramatically.
In some conflicts, the planned and deliberate HIV
infection of women has been a tool of ethnic warfare.
An association of Rwandan genocide widows found
that two thirds of its members who had been raped
by Hutu militants were HIV-positive.
While data on HIV prevalence in refugee settings
are scarce, it is believed that displaced populations
are at increased risk of contracting the virus during
and after displacement.(4)
The STI/HIV/AIDS interventions needed in
refugee settings, once the situation has stabilized,
are much the same as those for settled populations:
information and education, condom promotion and
distribution, use of syndromic case management for
STIs, voluntary counselling and testing for HIV, precautions
to ensure safe blood supply, and prevention
of mother-to-child transmission.
But in post-conflict settings like Liberia and Sierra
Leone, where years of war and continual displacement
have created a situation in which growing
HIV/AIDS prevalence poses a major threat to postconflict
reconciliation and reconstruction, UNFPA
and partners have developed a more comprehensive
approach (see Box 28, page 71).