Reconsidering the impact of conflict on HIV infection among women in the era of antiretroviral treatment scale-up in sub-Saharan Africa: a gender lens

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As increasing international and local efforts focus on scaling up access to antiretroviral treatment (ART) in sub-Saharan Africa the United Nations High Commissioner for Refugees (UNHCR) Medecins Sans Frontieres and the Joint United Nations Program on HIV/AIDS have increasingly advocated that the lack of essential medicines in conflict settings including ART is a violation of human rights. HIV infection and armed conflict are disproportionately represented in sub-Saharan Africa with women and children experiencing the largest burden of harms and adverse health outcomes due to both HIV infection risk and impact of conflict. Given emerging disparities in access to ART among HIV-positive women in conflict zones there is an urgent need to reconsider the impact of conflict on HIV infection. Importantly recent evidence suggests that there may be a protective effect of armed conflict on HIV prevalence as a result of reduced mobility and urbanization disruption of sexual networks and decreased casual consensual sex. At the same time substantial evidence suggests an increased vulnerability to HIV in conflict settings among women and children due to widespread human rights violations rape as a weapon of war forced occupational exposure the need for women to turn to sex work to support themselves and their families (i.e. survival sex) and reduced access to HIV prevention and reproductive health services. Regardless inequitable access to ART scale up in conflict zones suggests a need to re-examine the complex relationship between conflict and HIV infection. (excerpt)