Food aid and plastic sheeting are the hallmarks of every disaster, but not always condoms and antiretrovirals, even though humanitarian agencies recognize the link between emergencies and the increased risk of HIV and AIDS.
"Often HIV prevention is not prioritized, especially in sudden-onset emergencies, but actually HIV prevention is a life-saving issue requiring prioritization in the emergency response," said Mumtaz Mia, UNAIDS regional humanitarian response advisor for East and Southern Africa.
Research indicates that the relationship between HIV and emergencies is complex, but experts agree that humanitarian crises deepen vulnerability.
"Recent studies in Haiti, Kenya and Mozambique found an increase in consensual and transactional sex, which is likely to be unprotected, given the frequent unavailability of condoms - an aspect which, clearly, can increase the risk of HIV transmission," said Mia.
Unsurprisingly, research by the British think-tank, the Overseas Development Institute (ODI) , found that consensual sex was a natural response to the boredom of camp life, or as a way of seeking solace; transactional sex was equally prevalent as an attempt to benefit from a bad situation.
The meeting and mingling of people, and the erosion of social controls, is one consequence of displacement that humanitarian workers are increasingly recognizing.
Sari Seppänen, a programme officer with UNAIDS, noticed that after the outbreak of political violence in Kenya in 2007, young displaced people gravitated to one another. "In one instance, a large group of youth was grouped together in one part of the camp separate from their parents, which created quite an opportunity for sexual networking," she said.
James Wanyama, national programme officer with UNAIDS in Uganda, said HIV risk was exacerbated by the lack of access to condoms as a result of a breakdown in supply services during the protracted conflict in northern Uganda.
"The displacement of people into highly congested camps, increased idleness, coupled with poverty, leads to risky sexual behaviour," he said. "There was a breakdown in the community social norms that protected women, girls and other young people from risky behaviour; this was also associated with rape and other forms of gender-based violence."
Need to follow existing guidelines
According to Seppänen, humanitarian workers need to be trained in the guidelines for handling HIV prevention in emergencies as laid out by the Inter-Agency Standing Committee (IASC), a mechanism for coordinating humanitarian assistance by key UN and non-UN partners.
Among the prevention interventions the IASC recommends are: safe blood transfusion services; regular supplies of condoms; management of sexually transmitted infections; education in HIV risk reduction; provision of reproductive health services; availability of prevention of mother-to-child transmission services; creation of measures to prevent and effectively respond to sexual violence, and life-skills training for young people so they can avoid risky casual sex or transactional sex.
"People in shelters often receive hygiene or cooking kits that could include condoms," the authors of a recent ODI briefing paper, HIV in Emergencies: One Size Does Not Fit All, suggested.
"The growth of transactional sex, combined with the influx of groups such as truck drivers, humanitarian workers and military personnel, can increase the risk of HIV transmission, especially where condoms are unavailable," they pointed out.
"Ways to counteract this coping strategy need to be explored ... such as timely, targeted micro-credit schemes, as well as more HIV prevention campaigns for high-risk groups."
Better contingency planning
Too often, Seppänen said, the response to HIV in humanitarian emergencies is knee-jerk, leading organizations to make on-the-spot decisions that may be flawed.
UNAIDS' Mia commented: "HIV can only be managed in emergencies if the response is better coordinated, and HIV is properly integrated into the mainstream emergency response from preparedness to recovery."
"For HIV to be effectively addressed in humanitarian response, it has to be within the framework of the national AIDS response, with the leadership and coordination mechanisms set up for the AIDS response," she noted. "The engagement and leadership of national AIDS authorities, in partnership with civil society, is therefore vital."
A 2007 study, Estimates of HIV burden in Emergencies, found that 10 of the 15 countries with the largest number of people living with HIV in 2005 were affected by humanitarian crises or major conflict between 2002 and 2006.
The study also estimated that 1.8 million people living with HIV in 2006 were affected by emergencies, representing 5.4 percent of the global number of people infected with the virus.
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