Elizabeth*, a widow with six children, remembers the first day she went to be tested for HIV. “It was frightening and I walked up to the door of the testing center but I didn’t go in,” she says. When she gathered the courage to go back and get tested, she found out that she was positive and went to the hospital to get treatment. But Elizabeth notes that many women in her Kenyan community face social stigma that makes it harder for them to get the treatment they need. “Community members are not very supportive to people living with HIV/AIDS.” Elizabeth and a group of women in her town are working to change this by taking others to get treatment and providing them with ongoing support.
(Adapted from “The Challenges of Living with HIV/AIDS in Northwestern Kenya,” The IRC Blog, Joanne Offer, 1/19/2010).
Sexually transmitted infections thrive under crisis conditions and in unstable societies, where extreme poverty and lawlessness are prevalent. And, women and girls are particularly vulnerable to infection, with limited access to prevention, treatment and care—and their family and community lives disrupted.
During crises, adolescents may begin to have sexual relations at an earlier age and women and children may be coerced into having sex in order to meet their survival needs. During times of war or conflict, the risks of sexual abuse, domestic violence and exploitation rise. Additionally, close proximity to peacekeeping forces, military and police has long been associated with higher rates of sexually transmitted infections (STIs).
Sexually transmitted infections have significant consequences for global public health. According to the World Health Organization (WHO):
Any emergency health response must include treatment for STIs and ensure these services are readily available, as highlighted in the Inter-agency Field Manual on Reproductive Health in Humanitarian Settings, the authoritative guidance for reproductive health care in crisis- and conflict-affected areas.
In 2010, there were approximately 34 million people living with HIV globally. In the past, humanitarian agencies did not offer HIV and AIDS programs when responding to emergencies, because HIV/AIDS was not perceived as an immediate, life-endangering threat. However, the humanitarian community now acknowledges that HIV and AIDS prevention and treatment must be provided from the early stages of an emergency. Essential HIV programs should be developed following the Inter-agency Standing Committee (IASC) Guidelines for HIV/AIDS in Emergency Settings and the Inter-agency Field Manual on Reproductive Health in Humanitarian Settings. At the onset of a new crisis, aid workers should ensure that:
The Women’s Refugee Commission is committed to ensuring that guidance for preventing and treating STIs, including HIV, is fully implemented at every stage of a humanitarian emergency and that standards are met consistently.
*Names changed for anonymity