Service Priorities

HIV & STIs

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"We know with increasing certainty what disaster awaits if the response to AIDS continues to be inadequate. We also know how to strengthen that response in ways that will save millions of lives... We know what needs to be done to stop AIDS. What we need now is the will to get it done." - Joint United Nations Programme on HIV/AIDS (UNAIDS)¹

"[Sexually transmitted infections] (other than HIV) cause considerable mortality and morbidity in both adults and newborns. In addition, STIs facilitate the transmission of HIV infection... [and] STI prevalence rates continue to rise in most countries." - The World Health Organization (WHO)²

Together, HIV and sexually transmitted infections (STIs) are responsible for the destruction of health on a massive scale. For people living in emergency settings, preventative measures and treatment for HIV and STIs are rarely available.

By January 2006 AIDS had claimed more than 25 million lives since its recognition in 1981, and nearly 40 million people were living with HIV around the world.³ STIs account for a significant portion of illness worldwide, with more than 340 million new cases of curable STIs (mainly gonorrhoea, syphilis, chlamydia and trichomoniasis) occurring globally in adults aged 15 to 49 each year.⁴

HIV and STIs spread - and kill - most quickly in populations affected by poverty, social unrest and lack of health infrastructure. These factors are commonly present in humanitarian emergencies.

Factors

Specific factors contribute to the vulnerability of refugees and internally displaced persons (IDPs):

As people move during and after crises, populations with low prevalence of HIV and STIs may mix with populations with relatively high prevalence, exposing more people to infection
People living with HIV are particularly vulnerable to diseases and opportunistic infections (OIs), and OIs are unlikely to be treated when health resources are lacking
The urgent need for blood transfusions and limited resources for screening in emergency settings may lead to lack of universal precautions (practices to prevent the transmission of infection in health care settings) by humanitarian programmes
Scarce health resources result in lack of availability of condoms, limiting people's ability to protect themselves from infection
The poverty, social instability and powerlessness that characterise emergencies, as well as the violence endemic to conflict settings, may lead to weakening of social norms that regulate behaviour, including sexual behaviour
Rape and other forms of gender-based violence during conflict and displacement enhance the risk of HIV and STI transmission

In the developed world, HIV prevention and AIDS treatment are widely available, and STIs are routinely treated before they lead to permanent disability or death. Refugees and IDPs are entitled to these same options, but there is much to be done before this standard of care becomes a reality.

Priorities for Action

Measures to combat HIv and STIs in emergencies should include:

Widespread availability of both male and female condoms, as well as information on correct condom use
Provision of post-exposure prophylaxis (PEP) to survivors of rape to minimise HIV transmission
Community education programmes to reduce transmission of HIV and STIs and to encourage appropriate care in the case of infection; all such programmes should include outreach to military and peacekeeping forces
Treatment of STIs
Confidential voluntary counselling and testing (VCT) for clients with unknown HIV status
Prevention of mother-to-child transmission (PMTCT) of HIV
Prevention and treatment of OIs for HIV-positive clients
Provision of antiretroviral (ARV) therapy for HIV-positive clients, as indicated
Enforcement of universal precautions

Facts and Figures

There are an estimated 39.5 million people living with HIV worldwide; of these, 4.3 million were infected in 2006 alone⁵
There are 24.7 million people with HIV in sub-Saharan Africa, the region of the world currently experiencing the highest concentration of global emergencies⁶
In sub-Saharan Africa, 57% of adults with HIV are women, and young women aged 15 to 24 are more than three times as likely to be infected as young men⁷
5 - 10% of HIV infections worldwide are due to contaminated blood products and could be prevented through adherence to universal precautions⁸
Every day, about 500,000 young people, mostly women, are infected with an STI⁹
80 - 90% of the global burden of STIs occurs in the developing world¹⁰

Case Study: Addressing HIV in the democratic Republic of Congo

The conflict in the Democratic Republic of the Congo, which continues in pockets of heightened violence in a number of provinces, plays a large role in the destruction of a national health system that was already in disrepair.

Now the country is in the grip of a widespread AIDS epidemic. According to UNAIDS, HIV prevalence "varies from 1.7% to 7.6% depending on the region, and may be as high as 20% among women who have suffered sexual violence in areas of armed conflict."¹¹

The RAISE Initiative works with the International Rescue Committee (IRC) in partnership with the Ministry of Health in 17 hospitals throughout five provinces to reduce transmission of HIV. Programme activities include STI treatment, HIV prevention and care including VCT and PMTCT referral services, and ensuring universal precautions are observed.

UNAIDS (2006). "Report on the Global AIDS Epidemic." (New York: UNAIDS) Link
WHO (2006). "Global Strategy for the Prevention and Control of Sexually Transmitted Infections, 2006-2015: Key Message." (Geneva: WHO) Link
UNAIDS/WHO (2006). "2006 Report on the Global AIDS Epidemic: Executive Summary." (Geneva: UNAIDS & WHO) Link
WHO (2006). "Prevention and Control of Sexually Transmitted Infections: Draft Global Strategy, Report by the Secretariat." (Geneva: WHO) Link
UNAIDS/WHO (2006). "AIDS epidemic update: December 2006." (Geneva: UNAIDS & WHO) Link
Ibid.
Ibid.
WHO (2002). "Blood Safety: Aide-Memoire for National Blood Programmes." (Geneva: WHO) Link
UNFPA (2004). "Sexually Transmitted Infections: Breaking the Cycle of Transmission." (New York: UNFPA) Link
WHO (2006). "Prevention and Control of Sexually Transmitted Infections: Draft Global Strategy, Report by the Secretariat." (Geneva: WHO) Link
UNAIDS. "Congo (Democratic Republic of)." Link

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