Countries in crisis: but what about people and HIV?

Conflict and disaster can be devastating for many people, including people living with HIV. Unfortunately in these situations, people living with or at risk of getting HIV are often overlooked in the international community’s response to the crisis.

We are consciously learning from our experiences in ‘fragile states’ in order to expand on this work; this means countries suffering or recovering from civil war, political crises or natural disasters. We try to make sure that aid relief responds better to people who are vulnerable because of HIV. Different situations in Cote d’Ivoire, Haiti and South Sudan show how important this is, and how vital it is to work with local organisations, as they are in the best position to respond. 

Countries in crisis: what about people living with HIV?

Cote d’Ivoire has had a military-political crisis for over a decade. Government elections in 2010 and a wave of military offenses in 2011 resulted in 3,000 deaths and the internal displacement of one million people. The healthcare system has been hugely disrupted. For the 450,000 people living with HIV, their access to healthcare and medicines is now very difficult. Many displaced people live in camps, where the risk of getting HIV increases. 

In Haiti in January 2010 a massive earthquake struck, affecting 3.5 million people. Death and destruction on a massive scale meant that rescue and short-term survival came first, leading to enormous gaps in the HIV response. In Haiti, 120,000 people are living with HIV and 13,000 of them are under 14. After the earthquake, palliative care and ARV adherence were difficult to manage; soon less than half of people with HIV had accessed ART sites, and there were shortages of ARVs and TB drugs. One and a half people were made homeless and huge numbers moved into provincial towns and camps. Hundreds of thousands of people, including many living with HIV, began living in makeshift camps in appalling conditions. 

South Sudan became an independent state in July 2011, but two years later it once again was plunged into conflict. This destroyed vital infrastructure and caused further massive internal displacement. After the latest conflict, 4.5 million (out of 11.8 million) needed humanitarian assistance and 4.1 million people needed food. There are 900,000 displaced people, the vast majority of them living in camps where their risk of getting HIV increases. In South Sudan, an estimated 150,000 people are already living with HIV and 20,000 are under 15. 

We try to make sure that aid relief responds better to people living with or at risk of getting HIV.

Lessons for a better response 

In any sort of crises like these, the problems for people living with HIV are manifold. They do not get the health care, support and medicines they need from their health and social systems and yet their specific needs are not met by international responses to the crisis. Furthermore, people living in camps are more exposed to getting HIV, yet they lack the services and information about this problem. 

At the Alliance we ask some serious questions. When international organisations prepare to respond to disasters, how can they better plan for HIV prevention, care and support services? How can their planning be informed by the experiences of people living with HIV? How can national and international partners better coordinate within an overall emergency response in the area of HIV?

We have learnt some fundamental lessons through our experience of working in Cote d’Ivoire, Haiti and South Sudan. Civil society organisations (CSOs) have local expertise, on the ground agility and established networks. These organisations and networks, including people living with HIV networks, need to be better linked to national and local disaster preparedness training and systems. Furthermore HIV treatment and prevention should be integrated into emergency planning. Emergency planning should plan for the fact that most people at risk of infection of HIV often become more vulnerable during an emergency. 

Much better coordination is needed, between international organisations responding to crises, but also with and between local organisations on the ground. Donors need to channel emergency funds to the essential work that local organisations do, as they can most easily reach the groups of people at risk. Donors also need to react more quickly and provide more immediate and flexible funding, to enable CSOs to carry out a better-coordinated response. 

Alliance partners

Our Linking Partners in Cote d’Ivoire, Haiti and South Sudan are: 

Cote d’Ivoire: Alliance Nationale Contre le SIDA (ANS-CI) supports community groups to respond to HIV. ANS-CI helps link people living with HIV to treatment and care, prevent new HIV infections and reduce AIDS-related deaths. ANS-CI has played an important role in previous emergency responses in Cote d’Ivoire including participating in the HIV cluster, delivering essential services, advocating for the needs of people living with HIV, and taking part in enhanced security planning and strategic communication with the Ministry of Health and others.

Haiti: Promoteurs Objectif Zerosida (POZ) helped create associations and networks of people living with HIV (PLHIV) and leads innovative work on reducing HIV-related stigma and discrimination. Its mission is to reduce the impact of HIV, AIDS and other STIs through community mobilisation and supporting people living with HIV. POZ played an important role in the emergency response following the 2010 earthquake, working in camps for internally displaced people to reach those people most at risk to HIV infection and advocating on behalf of victims of sexual assaults.

South Sudan: the Alliance for Community Health Initiatives (ACHI) currently supports 92 community-based organisations across 23 counties in eight of South Sudan’s ten states. ACHI played a leading role in the formation and subsequent capacity building of the South Sudan Network of people living with HIV in 2007. Building the capacity of local and central government structures, as well as civil society, for an integrated HIV response is at the heart of ACHI’s approach. 

[add link to fragile states case study?]