ODI Briefing Paper 50
Context is critical for tailored responses
The global HIV epidemic may have stabilised, and the number of new infections has fallen slightly since 2001. But there is no room for complacency. In 2007, 33 million people were living with HIV, and two million people died as a result of AIDs-related illnesses. Sub-Saharan Africa continues to bear the brunt of the global epidemic, accounting for more than two-thirds (68%) of all adults and 90% of all children with HIV (UNAIDS, 2008). In many regions, high levels of HIV infection coincide with humanitarian emergencies. In 2006, 1.8 million people living with HIV were also affected by conflict, disaster or displacement – 5.4% of all HIV positive people.
HIV and AIDS pose multi-sectoral challenges in good times – challenges that can undermine progress on poverty reduction and economic growth. These are exacerbated by humanitarian crises that may increase in severity in the face of climate change and economic crisis. It could be that the challenges of HIV will, increasingly, be located in fragile states or areas.
An increased understanding of what kinds of HIV prevention, treatment and care and support programmes and policies work in different emergency contexts is vital. If HIV-related vulnerabilities are not considered in emergencies, commitments made to ensure Universal Access to HIV prevention, treatment, care and support by 2010 are unlikely to be reached.
The dynamics and impact of HIV in humanitarian crises are complex. They depend on the kind of crisis: is it the result of conflict, a rapid-onset natural disaster (such as a flood or cyclone), or a slow-onset emergency caused by drought or environmental degradation? It also depends on the HIV prevalence rate before the crisis, the political situation, the scale and duration of the crisis, the existing infrastructure and services and the level of awareness of HIV. Despite growing awareness of the risks, HIV in emergencies is often addressed as one set of issues, with one set of responses. To highlight the vast range of effects and impacts, depending on the context, UNAIDS and the World Food Programme (WFP) asked ODI to develop a framework and typology to provide more detailed information and guidance for humanitarian responses on HIV in different types of emergencies.
Case studies from five countries facing very different emergencies and HIV prevalence rates, were backed by a literature review. The countries represent three, often overlapping, types of emergency: conflict, rapid onset and slow onset. We examined the impact of emergencies on three areas: the risk of HIV transmission; people's ability to cope; and the effects on health-related services (Samuels et al., 2008).
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