Refugees show positive response to AIDS education

Refugees generally have a significantly lower HIV infection rate than their host communities, according to experts from the UN refugee agency, UNHCR.

A study conducted among pregnant women in more than 20 African refugee camps indicated that in five of the seven countries surveyed, refugees had a significantly lower HIV infection rate than the surrounding populations. In the other two, the infection rates were about equal.

In Kakuma camp in northwestern Kenya, home to about 80,000 mainly Sudanese refugees, the infection rate in 2002 was five percent, compared to 18 percent for the surrounding area of Lodwar.

UNHCR said the difference in the refugee HIV infection rates compared to the surrounding population was, in part, due to aggressive education and sensitising.

"But there are some factors out of our control that influence increased risk, like abuses that occurr during conflict, vulnerability during flight, and the break down of communities. The destruction of mobility during conflict, the isolation of many refugee camps and the availablity of good clinical services and education programmes have all helped to reduce HIV risk," Laurie Bruns, UNHCR's regional HIV/AIDS technical officer for Southern Africa told PlusNews.

According to Dr Paul Spiegel, a Canadian physician and epidemiologist who heads UNHCR's HIV/AIDS programmes, people automatically assumed that "increased risk" equalled "increased infection".

Despite the fact that refugees are often subjected to rape during conflicts, disrupted health care, and in some cases are forced to trade sex for goods or services (like food or transport), this did not seem to translate into higher infection rates. In addition, "chronic conflicts" like those in Angola and South Sudan, have actually curbed the spread of HIV/AIDS.

"In Sierra Leone and Angola, for example, you've lost the infrastructure. There is decreased mobility. Truck drivers are not moving around, not going to urban areas with higher HIV prevalence, sleeping with prostitutes and going back to infect their wives," Spiegel was quoted in a UNHCR statement as saying.

The number of condoms being used in refugee camps has also increased considerably. "At one time you could not talk about condoms in the camps. Now condoms are very much in demand. There have been changes in behaviour. The number of partners decreased significantly and transactional sex decreased as well," said Dr Patterson Njogu, UNHCR's expert on HIV/AIDS for East Africa and the Horn of Africa.

He added that many refugees, as well as local people in the host communities, were coming for voluntary testing and counseling.

In Kala camp in northern Zambia, where 21,000 Congolese refugees live, only 538 condoms were distributed in January 2003. But 11 months later, the figure had jumped to nearly 18,000 a month.

"When the refugees arrived in 1999 and 2000, condoms were kind of taboo, but we have just been extremely aggressive in education and distribution," said Bruns. "One big difference was that at first we only distributed condoms at health centres in the camp. Now we distribute them everywhere - in the markets, bars, at posts for food distribution."

Refugees are largely 'captive' audiences. "This means that we have a window of opportunity to provide them with as much education as possible on HIV and AIDS. We are also providing people with skills and training that they will be able to return home with. Many are trained as peer educators and community health care workers, which we know their communities that they'll return to really need," said Bruns.