UN study challenges assumptions on HIV spread and refugees in Africa

29 June 2007

A new study by the United Nations refugee agency disputes assumptions that violence and rape propel the HIV epidemic in conflict areas, with those forced to flee having a high prevalence of the virus.

Published this week in the British medical journal The Lancet, the report examined 12 refugee camps in seven African nations: the Democratic Republic of the Congo (DRC), Sudan, Rwanda, Uganda, Sierra Leone, Somalia and Burundi.

It found that nine of the camps had lower rates of infection than surrounding communities, two had a similar prevalence and only one had higher rates.

“In the seven African countries, conflict appeared to keep the HIV prevalence lower than surrounding countries that did not have conflict,” said Paul Spiegel, the report’s lead author and head of UNHCR’s HIV and AIDS unit.

“Since refugees come from these areas, refugees often have lower HIV prevalence than the surrounding communities, which ultimately will increase their vulnerability towards HIV,” he added.

The results also showed that there is no data to show that rape increased HIV rates, despite widespread rape in many countries.

But Dr. Spiegel warned that given the “right circumstances,” HIV prevalence could increase due to rape.

He added, “every single rape is a tragedy and we must provide strong care and support to rape survivors at all times.”

Dr. Spiegel emphasized that the survey’s results cannot be applied to all of the world’s conflicts.

“Every case must be examined individually and context is very important,” he said.

Dr. Spiegel also underscored that people should not interpret the results to mean that there is no cause to worry about HIV in conflict areas.

Previously reported high rates of HIV cases in conflict are due to poor survey methods and biased data interpretation, the report’s authors suggested.

The study is partially targeted at policymakers and the media “to not always blame refugees for everything,” Dr. Spiegel explained.

He called for the establishment of effective prevention programmes to protect refugees against HIV and that initiatives must be implemented in the post-conflict period to curb virus transmission as well.