Civil conflicts and natural disasters across the globe have displaced and rendered millions homeless, making the battle against HIV/AIDS even tougher as governments grapple with the collapse of basic health service facilities.
The trajectory in which HIV transmission takes place in areas reeling under civil conflict and natural emergencies has yet to be systematically studied. In the current economic liberalization era, the health budgets of developing countries are shrinking and the complacency of state and non-state agencies towards human rights and humanitarian needs in emergencies and conflict situations exacerbate HIV vulnerability.
Rebuilding of health infrastructure does not figure as a priority in post-conflict situations, further reducing primary care and especially HIV care and support needs. This was emphasized by experts at the 8th International Congress on AIDS in Asia and the Pacific (ICAAP) held recently in Colombo, Sri Lanka.
J.V.R. Prasada Rao, Regional Director for Asia and the Pacific, UNAIDS, was disturbed at the increasing number of countries in the region engulfed in political instability and civil conflict. "At the time of the Kobe Conference two years ago, it was mainly Nepal that was severely affected by lack of services. Today, at least eight more countries in the region have slipped into unstable political situations - or intensified conflict - that have the potential to affect national AIDS programmes," he said.
Bijay Kumar of ActionAid Sri Lanka said that in a conflict situation, aid agencies needed to go beyond the usual public health approach to limit HIV, as rape is also strategically used as a war weapon. With little protection against violence during conflicts and emergencies, women are brutalized, their rights denied and violated, all fuelling the spread of HIV. He stressed that it is crucial in such situations to build lasting alliances between health, peace and AIDS activists.
A case in point is the deadly tsunami of December 26, 2004 that had devastating effects on many countries in Asia, leaving more than 232,000 people dead or missing and millions homeless. According to Robert Baldwin, Tsunami Project team leader of the Asian Pacific Network of People Living with HIV and AIDS (APN+), the effects of the tsunami would be felt for many years in the form of damaged health and community infrastructure, social upheaval, economic depression and disease vulnerability.
"While this has created ideal conditions for the spread of HIV, it has also meant that people who were already living with HIV and AIDS at the time of the tsunami have been negatively affected in a variety of ways," he said, while releasing findings of a study report titled 'The Asian Tsunami: An analysis of its effect on people living with HIV and AIDS', jointly sponsored by APN+ and the International Federation of Red Cross and Red Crescent Societies.
Baldwin said that most of the post-tsunami efforts related to HIV/AIDS have been focused on prevention, with only minor small-scale activities being focused on existing positive people. The study used peer-based survey methods to assess the immediate and long-term effects of the tsunami on positive people in three countries - India, Sri Lanka and Thailand. "We found that positive people faced increased challenges due to the tsunami such as illness, unemployment, poverty, psychological trauma and discrimination," he said.
A total of 36 positive people affected by the tsunami were interviewed between March 10 and April 24, 2006. Of them, the majority (61 per cent or 22 people) were from Tamil Nadu in India, with seven each from Sri Lanka and the southern Thailand province of Ranong. While a majority of the respondents were diagnosed with HIV before the tsunami, 15 of them reported being diagnosed since the natural disaster. This included two people in Thailand, one diagnosed the fateful day after being admitted to hospital for injuries and the other diagnosed a few days later due to illnesses that had developed.
"It appears from the pattern of illness and the stories told to us by the Indian respondents diagnosed since the tsunami that they mostly contracted HIV prior to the tsunami, but were not diagnosed until the HIV infection became apparent due to related illness, probably spurred on by deteriorating living conditions brought on by the calamity," remarked the APN+ activist.
He also brought attention to the fact that the study does not attempt to quantify the level that positive people were affected by the tsunami, but points out that in terms of meeting the needs of positive people there should have been a greater recognition that a focus on HIV prevention should not be to the exclusion of HIV care and support to those already living with the disease.
But while the pandemic now represents a major social and economic crisis in much of the developing world, one of the more striking features of the international responses to AIDS has been the declaration of the United Nations Security Council in 2000 that said that HIV/AIDS - a health issue - was a threat to international peace and security.
The available evidence to date on the links between HIV/AIDS and security suggests real and potentially significant risks to national, regional and global security from the pandemic, observed researcher Joe Thomas of the International Centre for Health Equity Inc, an Australia-based NGO. He warned that though "securitising" the AIDS pandemic could bolster international AIDS initiatives by raising awareness levels and resources, the language of security simultaneously pushes responses to the disease away from civil society toward military and intelligence organizations with powers to override the civil liberties of HIV-infected persons.
Observing that an important aspect to the whole issue of AIDS and security is that of HIV/AIDS prevalence in the military, Thomas said several empirical studies showed HIV infection among military forces to be higher than in the general population. "The military are highly mobile, face frequent dislocation, are prone to casual sex, are known for their high-risk behavior and are deployed in socially disrupted and conflict zones that provide the environment for the spread of the disease," he warned.
According to him, the virus has been employed as a systematic tool of warfare in conflicts in Liberia, Mozambique, Rwanda and Sierra Leone while there is also data on the systematic nature of sexual violence perpetrated against women with the intention of spreading HIV. On numerous occasions in the past 15 years, UN peacekeepers have been accused of sexually assaulting or abusing the populations they serve, he added.
Experts emphasized that the threats posed by HIV/AIDS to national security have not been fully understood and the challenges represented by the security implications of the pandemic must extend to "managing" HIV within the military as well as more interaction and collaboration between state and non-state actors and AIDS activists.