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HEALTH: Conflicts Make Women More Vulnerable to HIV

Zofeen Ebrahim

MEXICO CITY, Aug 8 2008 (IPS) - “I’m a survivor, and if I can live through all that has happened to me, so can other women,” said Floride Nyiraneza, 42, who is HIV positive and a widowed mother of four.

She was among the 250,000 women who were systematically raped in 1994, during the Tutsi genocide in Rwanda, when one million people were believed to have been slaughtered.

In 2001, when she could not go on anymore on her own, Nyiraneza sought the help of Avega, the Association of the Widows of the Genocide. “I received counselling, access to food, health education and that is how I survived the trauma,’’ she told IPS.

In 2003, Avega requested help from the international community to obtain HIV medication for women who had been raped during the genocide and were infected with HIV. A small group from the U.S., including physicians, activists and a journalist responded.

Nyiraneza, is a war “hero”, said Mary Robinson, former president of Ireland, while chairing a session titled: The Aftermath of War: Women, Children and Displaced Populations, at the 17th International AIDS Conference. She emphasised how important it was to “listen to these voices” of women who have suffered decades of conflict and demonstrated impressive courage and endurance. It was, she said, imperative to call them to “negotiating tables” because solutions to lasting peace lay with them.

The AIDS pandemic is today considered both a development and a security problem the world over. There is no data to suggest that HIV prevalence increases during and after conflicts and emergencies, particularly in countries that have low HIV prevalence. However, experts believe that conflict situations provide the ideal ground for the virus to breed.

Margaret Wambete from Kenya was another hero at the session whose memories of living in a camp for displaced people in Rift Valley are still fresh. “In December 2007, post-election violence broke out in Kenya and we had to flee our homes to take refuge in camps.”

In her hurry to reach the camp, she forgot to take her anti-retroviral drugs. “For three weeks I didn’t have access to my medication. I feared going back to my home to fetch the medicine.” She was not alone. There were 500 other people living with HIV/AIDS at her camp.

“It was terrible. I thought I’d die not of AIDS but of the conflict.” Being an economically independent person, and a well-respected local primary school teacher, Wambete felt humiliated to be living in such terrible conditions.

There was not only stigma, discrimination and rejection expressed by co-campers, but there was no proper shelter, health facilities or proper nutrition. “We had just one blanket to share among the six of us (her five children), and there was a serious food crisis.” One new mother, an HIV positive, she recalled, had to breast-feed her infant because there was no formula milk available.

After much cajoling and arm-twisting, through Wambete’s own efforts, she was able to get medications for those with HIV/AIDS from the Red Cross. “But not before at least ten among us had died.”

One of the speakers, Paul Spiegel, head of the United Nations refugee agency’s HIV and AIDS unit, disagreed with the impression that conflict, displacement and the widespread rape, that often take place during such difficult situations, lead to increased prevalence of HIV.

“We have found no clear link between conflict and HIV,” said Spiegel.

The UNHCR carried out a study and looked at population data in seven African nations including Burundi, Sierra Leone, Rwanda, Uganda, Sudan, Somalia and Democratic Republic of Congo.

“Data from these countries did not show an increase in prevalence of HIV infection during periods of conflict, irrespective of prevalence when the conflict began,” said the study, which was published last year in the British medical journal The Lancet.

Conceding that every single rape was a tragedy and every survivor must be supported and cared for, some of the possible explanations of the study could be, according to Spiegel: “Low transmission rates of HIV infection through sexual intercourse; lower HIV rates among assailants than previously believed or reduction in social mobility during conflict.”

However, the downside of this study, said Spiegel, is that it may be construed by donors to mean “limited funds, personnel, and interventions towards other groups and programmes in different contexts that may have larger public health effects”.

“Press exaggerates that the effect is large,’’ Spiegel said. The study, he added, was aimed at policy makers so that interventions are based on evidence and not on what is assumed to take place based on small studies.

Spiegel referred to the Avega report that stated that of the 1,125 female rape survivors of the post-Rwandan genocide, 70-80 percent were HIV positive and said that the ‘’AIDS community is under attack that we misuse data to suit our purposes to get more money’’.

Agreeing with Spiegel’s view that sexual violence during conflict does not necessarily lead to increased HIV prevalence, Fiona Perry, who works for the British-based TearFund’s Disaster Management Team as its HIV coordinator, said, more than conflict, it is the post-conflict displaced people, especially women and children who are at risk.

Talking with IPS, Perry, who is based in Kenya, said: “Take the case of Afghanistan, which has a low HIV prevalence rate and where you can’t really talk about HIV and AIDS. But it has all the ingredients that can topple the situation – the problem of injecting drug use is prevalent, there is gender inequality, gender-based violence is pervasive, has poor infrastructure and rampant illiteracy.”

TearFund intervenes at this juncture to “stop HIV from getting there”, said Perry. “After a war or conflict has ended, as communities try to pull themselves together and you see increased mobility of people including the military, when people migrate to urban centres looking for jobs, the infrastructure is being built and the country has suddenly opened, the chances of vulnerabilities to the virus increases,” explained Perry.

She also believes that disasters encourage risky behaviour. “The power struggle increases, boredom sets in and sex is the one thing men still have control over…this often leads to gender violence.”

“At times, after conflict, people want to procreate because they have so many dying,’’ Perry said. “I was in Congo last year and much to my dismay I found that rape and sexual violence had become common and is now a cultural norm. I went to MSF (Medicines Sans Frontiers) and found seven cases of rape of children, all under nine years of age.’’

“Unless all (NGOs and other agencies) remain engaged and their interventions have thought-out policies that are specially on the side of women and girls, we won’t be able to address pervasive gender-based violence,’’ said Robinson.