ABSTRACT
Globally, there has been a significant rise in the number of conflicts over the past 50 years and this is principally due to increasing civil unrest between a country government and rebel insurgents. These conflicts are characterised by increasing disregard for humanitarian law and the deliberate targeting of civilians. The result has been the forced migration of civilian populations, either within the borders of their country as internally displaced persons (IDPs) or through crossing an internationally recognised border as refugees. Protracted conflicts over the last two decades which have resulted in large-scale forced migration, include those in Afghanistan, Angola, Burundi, Colombia, Democratic Republic of Congo, Iraq, Liberia, Mozambique, Rwanda, Sierra Leone, Somalia, Sri Lanka, Sudan, and Uganda amongst others. Forced migration is generally a long-term phenomenon with persons displaced for years and often decades. The displaced may live in camps, or be dispersed in rural or urban areas. The number of IDPs has gradually risen while the number of refugees (both
those recognised as refugees and those claiming refugee status) has fallen over the past two decades. At the beginning of the 1990s there were around 20 million IDPs and 20 million refugees. In 2007, there were around 26 million IDPs and 16 million refugees. Around 15 million of the displaced persons were in subSaharan Africa, and over three-quarters of these were IDPs (IDMC 2008; UNHCR 2008). The extent to which conflict and forced migration increase vulnerability to
HIV is context-specific and depends upon numerous overlapping individual, socioeconomic and epidemiological factors. These include sexual behaviour and sexual violence, gender inequality, loss of income, availability of education, living conditions, the type and the length of conflict and displacement, and access to HIV and sexual and reproductive health services. They also include the local characteristics of the HIV epidemic such as prevalence rates in areas of origin in the surrounding host community or among armed combatants, and mixing between these groups (Spiegel 2004). The aim of this chapter is to explore how conflict and forced migration may
influence vulnerability to becoming infected with HIV through altered consensual, coerced and, commercial sexual behaviour. The chapter focuses
specifically on refugees and IDPs in sub-Saharan Africa given the region’s high number of forcibly displaced persons and HIV prevalence. The chapter will firstly present arguments on how forced migration may increase vulnerability to HIV through altered sexual behaviour. The chapter then presents evidence on how conflict and forced migration may act as a protective factor against HIV infection. This is followed by a discussion on the research challenges and needs to help improve understanding of the complex and sometimes paradoxical effects of forced migration on sexual behaviour and HIV-related vulnerability and risk.
