Case for early HIV/AIDS intervention in refugee camps

Reproductive and sexual health services, including HIV/AIDS and sexually transmitted infections (STI) prevention and care, should be initiated in the early stages of a refugee crisis, a joint report by UNAIDS and the Office of the UN High Commissioner for Refugees (UNHCR) has recommended. The March 2003 report by the two agencies, "HIV/AIDS and STI Prevention and Care in Rwandan Refugee Camps in the United Republic of Tanzania", said efforts should focus on how to reach vulnerable groups in the refugee community, especially young people, single women and people living with HIV/AIDS. The joint report is based on an intervention programme carried out between 1994 and 1996 in Rwandan refugee camps in northwestern Tanzania. The agencies described it as the "first large-scale" HIV/AIDS and STI intervention programme to be implemented during a refugee crisis. Camps for Rwandan refugees were established following the 1994 genocide in Rwanda when an estimated 300,000 Rwandans were hosted in two camps in Ngara District, northwestern Tanzania. The UN agencies said that these refugee existed in conditions that could greatly enhance the spread of HIV, including family and social disintegration, poverty and a high level of violence, which had the potential for sexual violence. The intervention programme found that HIV/AIDS and STI prevalence among refugees who returned home after the intervention was lower compared with that of other Rwandan refugees who returned during the same period from countries such as Burundi and the Democratic Republic of the Congo. The UN agencies said that as a result of the early intervention in the Ngara refugee camps, there had been considerable success in converting reach and experience from past refugee crises into policy and practice. Among other recommendations, the agencies said that care of HIV/AIDS patients should be conducted with sensitivity, and community education carried out to counter stigmatisation of the disease. Although the HIV/AIDS and STI surveys carried out at the Ngara camps did not reveal apparent dramatic changes in the reported rates of STI and sexual behaviour, "the situation could have been considerably worse in the absence of any intervention," the agencies said. During and after the study, the agencies used the findings to influence policy by availing the information to policy-makers, relief agencies and other concerned organisations. "Following the Rwandan crisis [genocide] and the Tanzanian experience, a number of international organisations have included explicit policies on HIV/AIDS and STI case managements," the agencies reported. [The UNAIDS/UNHCR report is available online at: www.dec.org ]