Conflict Fuels HIV/AIDS Crisis
By Graça Machel (*)
Maputo- Over the past five years, HIV/AIDS has changed the landscape of war more than any other single factor. World- wide, HIV/AIDS has killed 3.8 million children and orphaned 13 million more. In many parts of Africa, HIV/AIDS is now the main threat to human survival: 18.8 million people have already died of AIDS, and in a number of the worst-affected countries it is estimated that up to half of all today's 15-year-olds will die from the disease.
The chaotic and brutal circumstances of war aggravate all the factors that fuel the HIV/AIDS crisis. War breaks up families and communities, creating millions of refugees and placing women and children in great peril of sexual attack or systematic rape used to terrorise opposing forces. It destroys the health services that might have been able to identify the diseases associated with HIV/AIDS or screen the blood transfusions that might transmit it.
And war destroys the education systems that might have been able to teach prevention and slow the spread of the disease. AIDS contributes to political instability by leaving millions of children orphaned and by killing teachers, health workers, and other public servants.
The relationship between AIDS and conflict is complex, but is mutually reinforcing. And both are compounded by poverty and the gender dimensions of conflict and the pandemic. Of the 17 countries with over 100,000 children orphaned by AIDS, 13 are in conflict or on the brink of emergency, and 13 are heavily indebted poor countries. Throughout the world, developing countries carry a debt burden of about USD 2 trillion and those countries also carry 95 percent of the HIV/AIDS burden.
Another factor accelerating the spread of HIV infection during conflict is involvement with military forces. In conflict situations, the main perpetrators of sexual abuse and exploitation are armed forces or armed groups. In addition, soldiers are typically young, sexually active men who are likely to seek commercial sex. Even during peacetime, they have sexually transmitted infection (STI) rates two to five times greater than those of civilian populations. During armed conflict their rate of infection can be up to 50 times higher. Under certain circumstances some armed forces already impose mandatory HIV testing, but voluntary testing, combined with confidential counselling, support and treatment, is far more effective-and almost nowhere available.
About half of the people with HIV become infected by age 25 and are likely to die with AIDS by age 35, leaving their children to be raised by grandparents or to fend for themselves in child-headed households.
More than 10 million people living with HIV today are between 10 and 24 years of age. At least 50 percent of all new infections occur in the 10-24 age group, with 7,000 new infections every day.
These statistics underline the imperative to include HIV/AIDS prevention and counselling in all programmes related to the reintegration of war-affected young people, especially ex-combatant and refugee children.
Over 90 percent of all HIV-infected children under the age of 15 started life as babies born to HIV-positive mothers. Recent studies indicate that the administration of anti-retroviral drugs can reduce HIV transmission at birth, but without access to these drugs or other interventions around one in three HIV-positive pregnant women will pass the infection on during pregnancy, at birth or through breastfeeding.
In conflict situations women have no choice but to breastfeed.
In refugee camps, there is little or no access to safe water, let alone formula or the money to buy it with, so that breastfeeding is likely to be the safest method of infant feeding, which makes even clearer the urgent need for women to have access to testing, counselling and anti-retroviral drugs. Yet that access does not exist for populations in developing countries even during times of peace.
Programming to prevent and treat HIV/AIDS must be vigorously pursued at the national and local level. In the absence of functioning health and education systems in conflict situations, humanitarian agencies and NGOs have provided health services for displaced populations that would be otherwise unreachable. All humanitarian responses in conflict situations should ensure, within the mainstream of health care, free voluntary and confidential counselling and testing for HIV/AIDS, proper screening of blood, and medical supplies to deal with the opportunistic infections that accompany HIV/AIDS. These services must be available throughout the whole population to avoid inadvertently creating a double standard.
No matter how difficult the circumstances, HIV/AIDS has to be confronted vigorously and resolutely. So far the response has been tragically inadequate. In 1998, only USD 300 million was spent by donor countries on the fight against AIDS. An estimated USD 3 billion is needed, half for prevention activities and half for basic care, excluding anti-retroviral drugs. Currently, no country in Africa spends more than one percent of its health budget on HIV/AIDS.
Drug treatment has become steadily more effective, but at present only a tiny minority of people in developing countries has any access to such treatments.
(*) Graça Machel, former Minister of Education in Mozambique, is a well-known activist on the rights of children, and has done extensive research on the impact of conflict on children.