When is HIV/AIDS a disaster?

Providing HIV/AIDS services to people on the run from armed conflict or natural disaster seems, on the face of it, too complicated when trying to meet the pressing immediate demands of an emergency.

By failing to address people affected by HIV in such situations, however, aid organisations could be doing even more damage, warned the 2008 World Disasters Report, launched on 26 June by the International Federation of Red Cross and Red Crescent Societies (IFRC).

This year's report focused on HIV/AIDS - the first time the report has looked at just one condition - and found that overlooking the specific needs of people living with HIV/AIDS could increase the risk of new conditions and "aggravate existing conditions".

According to the IFRC, "the AIDS epidemic is a disaster on many levels", and although it would be misleading to talk of a global disaster, in about 14 countries it could certainly be called a disaster.

"In Swaziland, for example, 26 percent of the population - one in four adults - is HIV positive. This is the world's highest HIV prevalence rate ... This is a disaster."

But HIV was also a disaster for many marginalised groups in low-prevalence countries - such as injecting drug users, men who have sex with men, and sex workers - where these groups were stigmatised and often criminalised, and were at increased risk of infection, the IFRC said.

Running away from conflict

As treatment for HIV becomes more widespread, humanitarian organisations should prepare for emergency situations in which thousands of people accessing antiretroviral (ARV) drugs are forced to flee from where they currently get medicines and services, the report said.

"Whether we like it or not, people with HIV are travelling with the virus, they are displaced with the virus, therefore the humanitarian community needs to respond to their needs," Patrick Couteau, the IFRC's HIV coordinator for Southern Africa, told journalists on 25 June.

In Southern Africa, where around one million people die of AIDS-related illnesses every year, displacement was particularly relevant. Millions more have migrated within the region for economic or other reasons, while thousands have been displaced in South Africa due to recent xenophobic attacks on migrants, and even more have since returned to their home countries.

Photo: Tebogo Letsie/IRIN

Zimbabwean migrants seek refuge at a police station during the xenophobic attacks in South Africa.

Françoise Le Goff, head of the IFRC's Southern Africa zone, said such upheavals were "absolutely catastrophic" for HIV-positive people, who had limited access to clean water and food, and could not get their ARV medication while on the move or living in camps set up by the government.

"The bottom line is that our response to HIV is failing to keep pace with the complexity of what is still an evolving disaster, and we are still struggling to respond effectively," Couteau added.

When disaster strikes

2007 will be remembered as a particularly bad year, with an unusually high number of natural disasters: in Africa, 23 countries were beset by some of the biggest floods in decades; in Asia, tens of millions were affected by floods in Bangladesh, India, Nepal and China.

Scientists have predicted that natural disasters will become more frequent and intense as a result of climate change.

So where does HIV fit in? The report acknowledged that although it was "impossible" to make any direct link between HIV mortality and the natural disasters occurring in 2007, "there is no doubt that such events had negative impacts on millions of people living with or affected by HIV.

HIV-positive people suffer the same impacts as everyone else, but certain problems affect them even more. "Everyone is hurt when a disaster disrupts the supply of medications, but for someone on antiretrovirals, any disruption of the medical regime is likely to cause resistance to treatment," the report commented.

"Scarcity of food is hard on everyone, but for someone living with HIV, malnutrition is likely to speed up the progression of the infection."

The report cautioned that the shape of the global epidemic could be affected if climate change caused significant population movement between areas with greatly varying HIV prevalence levels.

But keeping HIV from falling off the agenda in emergencies is always a challenge when there are so many other urgent priorities. "In the poorest settings with the most devastation ... the problems are very deep, and the support for programming isn't sufficient."

The IFRC urged aid organisations planning emergency responses to take into account the HIV prevalence of the disaster area; to strengthen the ability of existing institutions to withstand the disaster event, and restore much needed health services as quickly as possible.

"At the same time, the development-related aspects of HIV responses must be taken into account, particularly in areas of chronic risk," it added. "HIV/AIDS is a long-term crisis. Humanitarian aid has a role to play, but agencies should recognise that it is only part of a wider response, and should be clear about what it can and cannot achieve."

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