ArticlesPrevalence of HIV infection in conflict-affected and displaced people in seven sub-Saharan African countries: a systematic review
Introduction
There is a common belief that conflict fuels the HIV/AIDS epidemic, and consequently, refugees and internally displaced people fleeing humanitarian emergencies have a high prevalence of HIV infection.1, 2, 3, 4, 5, 6 However, this assumption has been questioned.7, 8, 9 Much of the research behind these claims has not been rigorously assessed and seems to have ignored elements during conflict that might reduce transmission. A notion is emerging about how the HIV epidemic is affected by conflict and forced displacement that depends on the interaction of several complex and commonly countervailing factors.
Sub-Saharan Africa is disproportionately affected by both conflict and the HIV pandemic. Only during the past few years have reports with sufficient data for prevalence of HIV infection become available to make comparisons within and between populations affected by conflict and displacement. These new data allow for a more thorough and scientific assessment of the subject. We asked whether there is evidence to show that conflict increases HIV transmission and whether refugees fleeing conflict have a higher prevalence of infection than do surrounding host populations. We compared prevalence of HIV infection in populations directly affected by conflict with that in populations not directly affected by conflict but located nearest to the conflict, and compared prevalence in refugees and in the nearest surrounding host communities.
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Search strategy and selection criteria
From May, 2005, to September, 2006, we searched PubMed, Medline, and Embase from January, 1981, onwards without language restrictions, using Medical Subject Heading terms to identify papers that dealt with the topic of HIV and armed conflict or HIV epidemic. Database searches were done with one or more combinations of the following terms: “HIV”, “AIDS”, “conflict”, “war”, “insurgency”, and “refugee”. Once countries were selected, searches were then done by combination of country names and one
Results
The figure shows the selection of studies meeting inclusion criteria. Nine articles and reports included original data from at least one of the authors. The findings are summarised by country. Although some data for prevalence of HIV infection are available in the DRC since the late 1980s,10, 16, 18, 19 until recently there have been no reliable data from the east, which has been affected by conflict. A 1997 study20 in western DRC (Kinshasa, Mbuji-Mayi, and Bwamanda) showed prevalence to have
Discussion
From original data combined with a systematic review of published work, we conclude that there is insufficient evidence that HIV transmission increases in populations affected by conflict. Furthermore, there are insufficient data to conclude that refugees fleeing conflict have a higher prevalence of HIV infection than do their surrounding host communities. In many circumstances, comparisons of HIV prevalence in both situations show the opposite result.
Data collection during conflict, although
References (83)
- et al.
HIV prevalence and trends in Sub-Saharan Africa: no decline and large subregional differences
Lancet
(2004) - et al.
Estimates of HIV-1 prevalence from national population-based surveys as a new gold standard
Lancet
(2003) - et al.
HIV prevalence among pregnant women in Kigali, Rwanda
Lancet
(1995) - et al.
The spread and effect of HIV-1 infection in sub-Saharan Africa
Lancet
(2002) Rape and HIV/AIDS in Rwanda
Lancet
(2002)- et al.
A high prevalence of HIV-1 infection among pregnant women living in a rural district of north Uganda severely affected by civil strife
Trans R Soc Trop Med Hyg
(2006) - et al.
Postexposure prophylaxis in immunodefienciency virus (HIV) infection following sexual assault
Am J Med
(1999) HIV and conflict. A double emergency
(2002)HIV/AIDS and emergencies: analysis and recommendations for practice
Network HPN Paper
(2002)- et al.
HIV surveillance in complex emergencies
AIDS
(2001)
Forced migration and transmission of HIV and other sexually transmitted diseases: policy and programmatic responses
HIV/AIDS, conflict and reconstruction in sub-Saharan Africa. Durban
Transmission and prevention of HIV and sexually transmitted infections in war settings: implications for current and future armed conflicts
AIDS
HIV/AIDS among conflict-affected and displaced populations: dispelling myths and taking action
Disasters
Conflict and HIV: a framework for risk assessment to prevent HIV in conflict-affected settings in Africa
Emerg Themes Epidemiol
AIDS and evidence: interrogating some Ugandan myths
J Biosoc Sci
Joint UN programme on HIV/AIDS. UNAIDS/WHO global HIV/AIDS online database
Conflict database
Improving projections at the country level: the UNAIDS Estimation and Projection Package 2005
Sex Transm Infect
Uncertainty in estimates of HIV/AIDS: the estimation and application of plausibility bounds
Sex Transm Infect
Guidelines for conducting HIV sentinel serosurveys among pregnant women and other groups
Guidelines for measuring national HIV prevalence in population-based surveys
HIV/AIDS epidemiological surveillance report for the WHO African region. 2005 Update
Measuring trends in prevalence and incidence of HIV infection in countries with generalised epidemics
Sex Transm Infect
Evidence of stable HIV seroprevalences in selected populations in the Democratic Republic of the Congo
AIDS
Political and socioeconomic instability: how does it affect HIV? A case study in the Democratic Republic of Congo
AIDS
Study on the HIV/AIDS prevalence in the Health Zone of Kalemie in the region of North Katanga
HIV sentinel surveillance among pregnant women attending antenatal clinics
Project for expansion of HIV/AIDS activities in the refugee camps of Ngara district and Kigoma region
HIV sentinel surveillance in refugee camps of Ngara district and Kigoma region
Western Tanzania refugee camps HIV/AIDS sentinel surveillance August - October 2003 report
HIV/AIDS indicator survey
HIV, syphilis, herpes simplex virus 2, and behavioral surveillance among conflict-affected populations in Yei and Rumbek, southern Sudan
AIDS
HIV-1 Infection in Juba, Southern Sudan
J Med Virol
AIDS Epidemic Update December, 2004: 1–87
SNAP situation analysis: behavioral and epidemiological surveys and response analysis
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