The Joint UN Programme on HIV/AIDS (Geneva) - June 21, 2001

A destabilizing factor * Since early 2000, the UN Security Council has highlighted the threat posed by the HIV/AIDS epidemic to global peace and security. It has held several discussions on HIV/AIDS-the first time the world's top political body has addressed a health and development issue.

In July 2000, the Security Council passed Resolution 1308, emphasizing the need to combat the spread of the virus during peacekeeping operations.

* The links between AIDS and issues of security are many, and the epidemic destabilizes societies in profound ways. As parents and workers succumb to AIDS- related illnesses, the structures and divisions of labour in households, families, workplaces and communities are disrupted, with women bearing an especially heavy burden.

From there, the effects cascade across society, reducing income levels, weakening economies and undermining the social fabric.

* The economic and developmental impact can be especially dramatic. It is estimated that gross domestic product (GDP) growth shrinks by as much as 1-2% annually in countries with an HIV prevalence rate of more than 20%.

Over several years, the loss of economic output accumulates alarmingly. Calculations show that heavily affected countries could lose more than 20% of GDP by 2020.

* The epidemic increases the strain on state institutions and resources, while undermining the social systems that enable people to cope with adversity. In badly affected countries, education and health systems are compromised, economic output shrinks and state institutions, such as the judiciary and police, are undermined. In some societies, increased social and political instability can result.

Flourishing amidst insecurity * The epidemic thrives in settings already marked by high degrees of socioeconomic insecurity, social exclusion and political instability. Individuals subjected to those conditions-migrant workers, displaced people, refugees and ostracized minorities worldwide-face much higher risks of infection.

* Similarly, it is often the absence of economic security that propels people into sex work for a living, and many end up in prison, where they face a higher risk of infection.

* In regions hit by famine, repression or violent conflict and war, populations are more at risk of HIV infection.

Social systems are disrupted, families are separated and communities are displaced. This social dislocation and rampant insecurity create fertile settings for HIV transmission.

* In the worst affected countries, HIV is spreading fastest among those under 24 years of age-especially among women and girls, who tend to have less access to the information and services they need to protect themselves against infection.

* According to recent studies, adolescent girls in several African countries are five to six times more likely to be HIV-positive than boys their own age. Women and girls are also less able to control the terms on which they have sex, and face greater risks of sexual coercion and violence. The use of rape as an instrument of war and repression adds another serious dimension.

As the epidemic's grip strengthens, instability and insecurity are likely to worsen, creating a vicious cycle.

AIDS in the military and emergency operations * In the past decade, HIV/AIDS has emerged as a major threat in emergency settings. Humanitarian operations can place both relief workers and local populations at greater risk of infection. The increased likelihood of sexual violence and prostitution among refugee populations broadens and accelerates the spread of HIV.

* In conflict situations, children and young people are especially vulnerable to HIV/AIDS. Those unable to escape conflict zones face high risks of sexual abuse, forced military recruitment and prostitution.

The uncertainty and insecurity experienced by children in refugee camps also encourage earlier sexual activity, typically in the absence of sexual health education and related services. It is therefore essential that young people (especially refugee children and former combatants) caught in the midst of wars and other emergencies be reintegrated into their communities and societies.

* The military is an increasingly important factor in the epidemic, although most armies and governments are reluctant to reveal HIV statistics. Military personnel are at high risk of exposure to sexually transmitted infections (STIs), including HIV. In peacetime, STI rates among soldiers are estimated to be two to five times those among the civilian population.

In times of conflict, the discrepancy is even larger. In some countries with adult HIV prevalence rates of 20%, it is estimated that as many as 50% of military personnel could be HIV-positive.

* Conflict resolution and peacekeeping measures are important elements of strategies designed to contain HIV/AIDS.

In settings of war and conflict, the main perpetrators of sexual abuse and exploitation are the young men who staff regular armed forces and other armed groups. Even in peacetime, the likelihood of unsafe commercial sex appears to rise in the presence of military bases or units.

Underscored is the need to step up HIV prevention and care in armies and in international peacekeeping forces.

Confidential and voluntary counselling and testing can be expanded and health care for soldiers improved. Examples set by senior officers and officials can help offset the secrecy, stigma and shame that cloak the epidemic.
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