Integration of HIV/AIDS activities with food and nutrition support in ...

to protect children’s welfare and rights from the effects of HIV/AIDS. 8 This initiative aims to
contribute to the fulfillment of these institutional mandates in the field.
1.2 HIV/AIDS in refugee populations
It is often assumed that refugee communities have higher HIV prevalence rates than their host
neighbours. Available data suggest, however, that the situation varies widely, with refugees often
exhibiting lower rates than neighbouring communities. The ultimate effects of conflict and
displacement on HIV transmission depend on many competing, interacting factors (Figure 1). 9
In some cases, the social isolation imposed by conflict protects populations from rapid spread
of the AIDS epidemic. On the other hand, while migration to another country may protect
refugees from active conflict, it may at the same time increase population mixing, often with
a population with higher HIV prevalence, thus accelerating HIV transmission. Refugees may
face a risk of HIV exposure during migration, when crossing transit points and borders, and
when seeking humanitarian and government services in the country of asylum. Refugee camps
may inadvertently increase HIV risk in the short term by placing poverty-stricken households
in highly dense settlements, often without adequate health care, health education, control of
sexual and gender-based violence (SGBV) or livelihood support in the early phase of the emergency.
Each situation is unique and context-specific, and must be examined carefully.
General food distribution is the main way in which international health programmes protect
the nutritional status of displaced communities. Such communities frequently settle in marginal
environments where access to water, productive agricultural land and markets is poor.
Their ability to farm, keep livestock or participate in regional markets depends on the policies
of the host government. Refugees in low-income countries are at risk of acute malnutrition
until essential nutrition, health, water, shelter and sanitation services are established. Long-term
refugee populations with access to adequate health and public health services, however, often
exhibit better health indicators than surrounding low-income populations. 10
1.3 How are HIV/AIDS and nutrition programmes currently
implemented among refugees?
Recent years have seen the establishment of a number of international guidelines for humanitarian
programmes. These guidelines provide frameworks for implementing and evaluating
assistance to crisis-affected populations. HIV/AIDS is still treated principally as a health-sector
problem, with support funds and project managers coming from the health sector. Water,
sanitation, shelter, food distribution, and longer-term interventions (e.g., agricultural production
and income-generating activities) tend to be implemented separately. Often, there is little
coordination among cooperating partner agencies, and no consideration of how cross-cutting
integrated programmes can be designed and implemented.
The increasing political momentum in Africa and globally to increase access to antiretroviral
drugs has shifted international attention from community-level prevention and mitigation to
8 UNICEF. Fighting HIV/AIDS: strategies for success, 2002-2005. New York: UNICEF, 2003.
9 Spiegel PB. HIV/AIDS among conflict-affected and displaced populations: dispelling myths and taking action.
Disasters 2004;28(3):322.39.
10 Spiegel P, Sheik M, Gotway-Crawford C, Salama P. Health programmes and policies associated with decreased
mortality in displaced people in postemergency phase camps: a retrospective study. Lancet 2002;360(9349):1927-34.
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