Your daily Selection of IRIN Africa PlusNews reports, 4/2/2003

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U N I T E D N A T I O N S

Office for the Coordination of Humanitarian Affairs

Integrated Regional Information Network

CONTENT:

1 - SOUTHERN AFRICA: New challenge of HIV/AIDS in humanitarian crises

1 - SOUTHERN AFRICA: New challenge of HIV/AIDS in humanitarian crises

JOHANNESBURG, 2 April (PLUSNEWS) - In a humanitarian emergency, HIV/AIDS

prevention and reproductive rights are not likely to be seen as a

priority.

But Africa's refugees and displaced persons face the prospect of a life of

poverty, powerlessness and social instability: conditions that increase

their vulnerability to HIV/AIDS.

" Refugees and IDPs [internally displaced persons] are often at a higher

risk of HIV/AIDS, but often in crises, reproductive health is put on the

backburner, " Helen , regional HIV/AIDS advisor for the UN

Population Fund (UNFPA) told PlusNews.

Southern Africa's current humanitarian crisis, threatening 14 million

people, has been marked by a growing realisation of the devastating impact

of the epidemic. The explosive combination of acute food shortages and

HIV/AIDS has called for new ways of dealing with this emergency.

Hunger and diminished access to health services, including reproductive

health care, are taking a heavy toll on women, adolescents, and other

vulnerable groups across a region that has the world's worst HIV/AIDS

prevalence figures.

Reproductive health can no longer be sidelined, humanitarian officials

warn. UN agencies and NGOs are now faced with the challenge of addressing

this in their relief responses to the people in six southern African

countries, who have been pushed to the edge by successive crop failures,

government policy errors and poverty.

" We have to take it extremely seriously, especially in this context [the

Southern African emergency], " said.

According to Dr Gebreamlak Ogbaselassie, a UNFPA regional adviser on

sexual and reproductive health, poverty and the food insecurity crisis are

having a " nightmare " effect on maternal health in particular.

Malnutrition makes pregnant women more susceptible to infection,

miscarriage and premature labour, increasing the likelihood that pregnant

and lactating women who are HIV-positive will transmit the virus to their

children.

To make matters worse, food shortages and high poverty levels are

contributing to a decrease in the number of women seeking family planning

services and antenatal care. The number of home deliveries is also on the

rise, as the constant search for food for their families leads women to

neglect their own health, he added.

Family planning services are especially important when war has destroyed

the health system on which people depend.

Angola has one of the highest maternal mortality ratios in the world,

estimated at 1,500 per 100,000 compared to neighbouring Namibia's 370 per

100,000. The HIV/AIDS epidemic has not yet reached its peak - infection

rates appear to be a modest 8.6 percent, compared to rates of 20 percent

and upwards in the region.

Increased population movements within the country, however, will

contribute to the rising prevalence rate. " The impact of HIV/AIDS does

have the attention of humanitarian agencies, now the challenge is for us

to translate this into action, " CARE assistant country programme director,

Bulten, told PlusNews.

Despite considerable strides made in improving the health care of women

and children in IDP and refugee camps, Bulten admitted that until

recently, relief organisations had done " very little " about HIV/AIDS

prevention.

" The provision of condoms is a very recent development, and we still have

a long way to go in education and awareness, " he said.

" This issue has not been addressed adequately, because of competing

demands, technical capacity and funding issues, noted Otieno, the

reproductive health (RH) technical advisor for the International Rescue

Committee.

" I believe that over the past 10 years, a lot has improved with regard to

RH services for displaced and war affected populations, as shown in a

recent study. This study compared the reproductive health outcomes among

the displaced and war affected of 52 refugee settings/camps in seven

countries, with those of host populations and country-of-origin

populations, " she said.

" The study concluded that refugees had better health outcomes than the

host and country-of-origin populations, " Otieno added.

Nevertheless, refugees were often left out of HIV/AIDS prevention

campaigns run in host countries, and condom distribution in refugee camps

has remained " alarmingly low " , Albert Edgar Manyuchi, project officer for

the Jesuit Refugee Services told PlusNews.

" You need the right personnel on the ground to educate people, because the

policies are there - it is just a matter of implementation, " he said.

UNAIDS has recommended a number of ways in which the problems facing

refugees and the displaced can be overcome.

A " minimum package " for HIV/AIDS prevention and care in an emergency

setting includes a safe blood supply, the provision of supplies for

universal medical precautions, condoms and basic HIV/AIDS information. The

physical protection of refugees and displaced people from violence and

abuse was also essential for reducing the risk of HIV/AIDS.

When refugees are already HIV-positive, " comprehensive care should be seen

as a component of basic care in any refugee situation " , a UNFPA field

manual on refugee conditions warned.

Nutritious food is the first line of defence for people living with AIDS

(PWAs). In emergencies, supplementary feeding for PWAs is often neglected.

For Ogbaselassie at UNFPA, the solution lies in inter-agency

collaboration.

" Working with food distributors, such as the World Food Programme, will

ensure that the special nutritional needs of lactating mothers and

HIV-positive people are addressed, " he said.

According to UNAIDS, the provision of treatment is also an essential

HIV/AIDS intervention in refugee camps, but the realities are different.

Dukwi refugee camp in northeastern Botswana is home to around 4,000

refugees from 16 countries. A system of peer educators, based on refugee

volunteers, was introduced in 2001 by the Botswana Red Cross, but failed

due to a lack of motivation. The educators, who were supposed to provide

HIV/AIDS instruction and support within the community, received no

incentives in terms of payment or increased food rations.

Similarly, there was little inducement for the refugees to get tested or

declare their status. " People are ready to go for voluntary testing, the

problem is once they have tested HIV-positive there is no assistance. They

don't receive any extra food or antiretroviral drugs, " one of the peer

educators told PlusNews.

Condoms are available at the camp's dispensary, but the process of

obtaining them is bureaucratic. This is a common problem in most refugee

camps, Manyuchi noted.

" There is a general reluctance to dispense them. The camp officials have

this idea that handing out condoms will create chaos ... little do they

know that withholding them [condoms] will be the reason for the chaos, "

Manyuchi added.

[ENDS]

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