Expanding HIV/AIDS Prevention, Treatment, and Care Programs for Refugees

World AIDS Day reminds us that millions of people around the world live every day with the reality of HIV or AIDS. Providing comprehensive health care and services to HIV-infected populations can be challenging in any setting, but for people displaced from their homes and communities by war, violence, or persecution, the need for HIV/AIDS services -- and the challenges of providing it -- are often even greater. Through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the United States government has significantly expanded access to HIV/AIDS prevention, treatment, and care programs for conflict-affected populations.

Today, over 15 million people throughout the world are living as refugees, and another 27 million people have been displaced within their own countries due to conflict. In addition to surviving violence or persecution, refugees and displaced people must also cope with losing access to the family, community, and social networks that sustain them, including access to vital services such as HIV/AIDS education, access to condoms, voluntary counseling and testing, and treatment. Unfortunately, refugees often are not included in national and international HIV/AIDS programs in the countries that host them, and thus do not have access to prevention, care, and treatment at a time when their vulnerability to infection and sickness is most acute. For example, women and children are often exposed to increased levels of sexual violence when they are forced to flee their homes. And sadly, without adequate assistance, women affected by conflict may see no better alternative than to exchange sex for food, shelter, or protection for themselves and their families.

The increased burden of providing HIV/AIDS care to refugees is often perceived as unmanageable by host countries whose health care systems are already stretched thin meeting the needs of their own citizens. Working through the United Nations High Commissioner for Refugees (UNHCR), partner ministries, and non-governmental organizations such as the American Refugee Committee and the International Rescue Committee, PEPFAR is the single largest source of HIV/AIDS funding for refugee populations. In fiscal year 2010 (which ran from October 2009 through September 2010), PEPFAR provided close to $5 million for HIV/AIDS prevention, treatment, and care programs for refugees living in Botswana, Ethiopia, Kenya, Rwanda, Uganda, and Zambia.

With PEPFAR support, UNHCR and its NGO partners have significantly expanded HIV/AIDS programming for refugees:

• In Botswana, HIV-positive refugees in the Dukwi Camp now have access to anti-retroviral therapy.
• In Ethiopia, UNHCR and NGO partners have put in place comprehensive HIV/AIDS services for refugee populations, including care for orphans and vulnerable children.
• In Kenya, both voluntary counseling/testing (VCT) and prevention of mother-to-child transmission (PMTCT) services have been significantly scaled up in both the Kakuma and Dadaab refugee camps.
• In Rwanda, HIV-positive refugees are assisted with food, psychosocial support, and vocational training. Life-skills education is offered through community centers with an emphasis on protecting children from exploitation.
• In Uganda, community educators, peer counselors, and faith leaders organize educational events focused on HIV/AIDS prevention in schools for refugees in the Western Settlements.
• In Zambia, refugee children benefit from HIV/AIDS education through life skills workshops complemented by drama troupes.

Gender inequalities and gender-based violence (GBV) may increase vulnerability to HIV/AIDS. The U.S. government has demonstrated a strong commitment to empowering and protecting women and girls, including in conflict-affected settings. As part of its new initiative to combat GBV in priority countries, PEPFAR is scaling up GBV response beginning with the Democratic Republic of the Congo (DRC), Mozambique, and Tanzania. In the DRC, the United States has already invested over $17 million in the last year to target GBV in the East, where over two million people have been displaced by conflict. The intent is to scale up small pilot projects for preventing and responding to GBV into coordinated, integrated, and sustainable programs.

The United States government's programs to expand access to HIV/AIDS prevention, treatment, and care programs is both a success to build on and an opportunity to reach more of the world's conflict affected populations in the future.

Bryan Schaaf serves as a Health Officer in the Bureau of Population, Refugees, and Migration.