Managing HIV among refugee populations

More than 40,000 Congolese refugees living in camps in neighbouring Rwanda depend on the generosity of donors and their host nation, who provide them with everything from food and water to education and health services. Most fled the conflict in North and South Kivu provinces in the eastern Democratic Republic of Congo (DRC) and have been in Rwanda for the whole of the war. The decade-long fight has been one of the world's most brutal, and many refugee women and children could have contracted the HI virus in vicious sexual attacks. Rwandans are all too familiar with sexual violence, used as a weapon during the 1994 genocide when rape was commonplace, but arriving Congolese refugees are often stigmatised because the local population perceived them as "bringing" HIV into Rwanda. "While it is true that some refugees hosted in Rwanda have suffered from sexual violence and that they are vulnerable to HIV-AIDS, they certainly do not pose any special risk to local hosting populations. Let's not stigmatise refugees, in particular not in a conflict affected country like Rwanda," said Dr Dieudonne Yiweza, senior regional HIV/AIDS coordinator for central Africa with the United Nations High Commissioner for Refugees (UNHCR). "In fact, surveys have shown that, generally, refugee populations flee from areas with lower prevalence to higher-prevalence areas." In most cases, HIV prevalence in the camps was lower than among the host populations. "We [UNHCR and its partners] are trying to develop interventions that can prevent the virus from spreading among the refugees and treat those already infected." The measures include providing VCT [voluntary counselling and testing], prevention of mother-to-child transmission services and provision of antiretroviral therapy [ART], in collaboration with the Conseil national de lutte Contre le Sida [the National AIDS Council], and access to free ARVs from government hospitals. Yiweza said they had also undertaken awareness-raising activities among the refugees to prevent stigmatisation of HIV-positive people and were trying to ensure that harmful suggestions, such as mandatory testing and discrimination against HIV-positive refugees, were not implemented. Still, the refugees were desperately poor and vulnerable: young girls were selling sex to support themselves and their families, but Yiweza said they were educating "at risk" groups, such as teenagers and single women, about the dangers of unprotected sex. A code of conduct had also been instituted to prevent people in authority from sexually exploiting refugees. Returning Rwandan refugees often faced the same stigma, because the local community wrongly assumed they were returning from neighbouring countries with a higher prevalence. "The returning refugees are often better educated about HIV and should be used as resources for promoting HIV/AIDS interventions among host populations in areas of return," Yiweza commented. UNHCR and its partners, in collaboration with governments, were working to ensure that repatriated HIV-positive refugees and the surrounding populations could access HIV prevention and care services. Since most refugees fled to neighbouring countries, Yiweza stressed the importance of cross-border cooperation in HIV/AIDS management. "The governments and institutions in the region need to share information, so that all refugees are well informed about the pandemic and are able to access and continue accessing services wherever they go."