CONFLICT FUELS HIV/AIDS CRISIS
By Kamala Sarup

July 28, 2004 - (Weekly Telegraph) The massive and rapid spread of HIV/AIDS in Nepal is a significant threat to national peace and security. Health workers involved in HIV education have complained that due to the Maoist insurgency they are facing problem to spread the message to the remote villages. HIV/AIDS and conflict also create a double jeopardy for women. Women are the main victims of conflict. When the economy and the social infrastructure are destroyed, and male heads of households are missing, women carry a disproportionate burden as single-parent heads of families.

For a woman living in Nepal and heading a household, the risks of being infected by HIV/AIDS are high. Her efforts to feed her famil! y may put her in a vulnerable situation where she is more likely to be coerced into sex in exchange for money and resources. This situation exposes her to HIV infection.

The situation in Nepal deserved particular attention because the Maoists war had not allowed the country to set up the necessary conditions required to combat HIV/AIDS. The security conditions have directly affected the spread of HIV/AIDS, and that conflict and civil unrest can increase vulnerability to HIV/AIDS particularly among women and children. Political instability, and political crisis have an undeniable impact upon Nepalese public health. Nepalese public health can be effective only in as much as the security of victims or armed conflict is guaranteed.

The impact of this sexual victimization of women on the spread of HIV/AIDS is compounded by the general absence of condoms in areas affected by conflict. The collapse of educational systems associated with conflict further exacerbates problems! and has the double effect of curtailing prevention efforts taught in the classroom and pulling children away from their studies, often into a chaotic and predatory environment.

Medical doctor Dr. Hari Mehata, while speaking with the Telegraph, not only made these queries but also said, "Young women and poor children without social protection are the first to be constrained into sexual transactions and prostitution by the lack of alternatives. In western Nepal, displaced people said the spread of HIV/AIDS was hastened by poverty, lack of occupation, and the lack of reproductive health services. In big cities girls and women exchanged sex for food.

In war-affected parts of Nepal too, studies showed that girls and mothers became sex workers to earn a living because of their social and economic vulnerability, they exposed to coercive sex, especially in conflict situations. Young people should not have to exchange sex for basic survival items! ". He said "Widespread rape, and sexual exploitation of young people in conflicts are a serious violation and greatly increase the risk of HIV transmission".

Now we have questions how to assure as a condition of support that disarmament and reintegration programs and reconstruction programs take appropriate consideration of HIV/AIDS? How Nepal government will provide adequate funding within peace operations budgets to incorporate HIV/AIDS awareness, prevention and treatment programs for all military forces and combatants?

How to ensure that HIV/AIDS prevention and conflict prevention activities go hand in hand ? How to ensuring that HIV/AIDS is fully taken into consideration as part of humanitarian accords, peace negotiations? How to adopt a multi-sectoral approach to tackling HIV/AIDS, including the security and defence sectors? How to provide condoms as part of the standard equipment for all members of the armed forces ? What hinders success in building t! he capacity of people affected by conflict, to prevent HIV infections and provide essential services to those who are directly affected by HIV/AIDS?

Investing in the health sector makes good sense for conflict prevention as well as for socio-economic development. Health can help peace also in operational terms. On other hand, media can play a great role in creating awareness among the general public. Education and awareness are the two powerful instruments, which can check the spread of the disease. Dr. Mehata further said "HIV/AIDS should be addressed during a conflict rather than waiting until it has ended. Humanitarian pauses and ceasefires should incorporate the opportunity for prevention education, distribution of condoms and voluntary testing. Negotiations for peace agreements should include the possibility for the full range of prevention, testing, counselling and, to the extent feasible, treatment programs for all combatants, whether regular or irre! gular forces, as well as among displaced civilians.

It should be on the agenda during peace negotiations, which would require including public health officials on negotiating teams or at least among those providing facilitation. Consideration should be given to offering assistance, as an inducement to stop fighting, to combatants with HIV/AIDS, including treatment for diseases like pneumonia and tuberculosis that attack those whose immune systems have been weakened and, when they are medically indicated and can be sustained, anti-retroviral medicines".

HIV/AIDS, moreover, can make it harder to bring conflict to an end. To ensure a sustainable and lasting peace, it is not enough simply to halt the fighting and implement disarmament and reintegration programs. Law and order and governance have to be re-established quickly, regional and local administrations set up, schools and clinics opened.

Dr. Mehata further said " Lack of negotiating power, unsafe sex, a! nd disbelief about HIV/AIDS are factors that greatly increase the risk of HIV infection in conflict situations . For HIV to be addressed in situations of conflict may well require a psychological and political revolution. The invisible will need to become a political priority. The HIV epidemic rages in situations where power is exercised without regard for others, whether that power be economic, social, sexual, psychological or the power of force. It spreads where there is a disregard for life, an intolerance of difference, a devaluing of women, a lack of a will to live, a breakdown of community values, violence and conflict".

Once our leaders have acknowledged that a problem exists, educational and preventive programs can be instituted to help contain the spread of the disease. The capacity to see beyond the visible immediate, to encompass prevention as well as treatment, causes as well as symptoms, will need to be developed for HIV, as it has been for conf! lict traumatised children, for example. "A child out of school for any time at all is immediately more vulnerable to violence, to sickness and disease, exploitation and abuse," he said. "A child denied an education is in the long term more likely to be poor, to die unnecessarily young, and to have children while they are still children themselves."

Though this year budgets for humanitarian aid have increased, but funds are disbursed with short-term commitments. Within a complex emergency, with thausends of displaced people who suffer recurrent epidemics of meningitis, malaria and other infectious diseases, should have assess the response to HIV/AIDS within the larger context of the humanitarian response. Loss of health infrastructure is terribly destructive, but can also represent an opportunity for rebuilding a health care system that is more responsive to public health and needs at the grassroots, and that involves traditional healers.

It is important to consider how the HIV/AIDS pandemic in Nepal contributes to further instability and conflict on the continent and how violent conflict in turn creates conditions favourable to the spread of the virus. Nepal governments still fail to recognize that AIDS is more than a public health issue. The spread of HIV also serves to prolong conflict as it places new strains on health and economic infrastructures and destabalises family and social structures. There are several factors that contribute to the spread of HIV/AIDS in emergency situations and which subsequently effect gender relations.

Warfare is an amplifier of disease, creating ideal conditions for its spread, including famine, destruction of health and other vital infrastructure, large population movements, and the breakdown of family units. In such situations, defences are weak. Awareness of HIV/AIDS is low; denial and stigma are widespread. Health services, destroyed or overwhelmed, are severely under-resourced and do not offer adequate care or effective protection against HIV/AIDS. Violent conflict in some part of Nepal is protracted and almost endemic. Successful HIV-AIDS programs appear to depend on strong community involvement. In emergency environments, the health priorities are to save lives and then to preserve health. It is at the second stage that it is critical to mainstream HIV/AIDS issues, psychosocial care. Psychosocial care isextraordinarily important.

The relationship of the HIV/AIDS pandemic to violent conflict in Nepal must be addressed how the explosion of HIV/AIDS may contribute to further instability and conflict on the continent in coming years? and how instability and violence encourage conditions favorable to the spread of the HIV virus?

From: http://www.nepalnews.com.np/contents/englishweekly/telegraph/2004/jul/jul28/views.htm