Feature story

Horn of Africa in crisis: famine, displacement and HIV

20 September 2011

Credit: UNAIDS/P.Virot

The ongoing drought and famine in the Horn of Africa has put the lives of millions of people in Somalia, Kenya, Djibouti and Ethiopia at serious risk. An estimated 13 million people in the region are in urgent need of humanitarian assistance, including food and medical care.

Central and southern Somalia are the areas hardest-hit in the region, where protracted civil conflicts, weak state structures and limited access to humanitarian assistance pose a complex set of challenges. According to the United Nations High Commissioner for Refugees (UNHCR), there are more than 800 000 Somali refugees in the Horn of Africa, of whom over 250 000 have fled to Kenya, Ethiopia and Djibouti since January 2011.

HIV in emergency settings

While HIV data in central and southern Somalia is scarce, experience and evidence have shown that people in emergency settings tend to have limited access to HIV prevention, treatment, care and support. The health of people living with HIV is put at further risk when their nutritional needs are not met. Displacement, loss of livelihood and increased sexual violence can pose additional risks of HIV infection.

An estimated 3 million Kenyans—among them approximately 90 000 people living with HIV—are affected by drought and food insecurity, especially in the semi-arid regions of northern Kenya. Most HIV services in the country are currently functioning, and treatment interruption is still low. However, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and partners fear this situation may change as community-level interventions and nutritional support for people living with HIV are increasingly interrupted.

In recent weeks, many people in northern Kenya have moved to the slums of Nairobi, seeking a means to survive. City dwellers have faced a doubling of prices for key staple foods. The risk of unprotected transactional sex (or “food for sex”) is rising and could lead to an increase in the number of new HIV infections.

“If HIV-related vulnerabilities are not considered in emergencies, Kenya’s rallying call of an ‘HIV Free Society’ remains a far fetched dream,” said Prof. Alloys S. S. Orago, Director of Kenya’s National AIDS Control Council. “Reducing the vulnerability of people living with HIV in emergency situations requires the effective engagement of all stakeholders,” he added.

Response by UNAIDS and partners

Together with the World Food Programme (WFP) and UNHCR, the UNAIDS Secretariat and other Cosponsors have warned of the urgent need to provide HIV services to emergency-affected populations across the region.

In collaboration with regional partners and national authorities, the UNAIDS family has been working to assess the impact of the current crisis on the HIV epidemic and the related needs of affected populations across the Horn of Africa. This data is being used to effectively integrate HIV in the humanitarian response across the region.

If HIV-related vulnerabilities are not considered in emergencies, Kenya’s rallying call of an ‘HIV Free Society’ remains a far fetched dream

Professor Alloys S. S. Orago, Director of Kenya’s National AIDS Control Council

Many Somalis have fled to a refugee camp in Dadaab, northern Kenya, where comprehensive reproductive health and HIV services are available, including emergency obstetric care, HIV prevention services and the provision of antiretroviral treatment. All camp hospitals provide services for survivors of sexual violence, such as post exposure prophylaxis for HIV prevention, contraception and psychosocial support. 

In Kenya, the UN family is collaborating with the national government and non-governmental organizations (NGOs) to ensure that HIV services are available in emergency-affected areas. UNHCR is conducting baseline surveys in the refugee camps and WFP is providing data on nutrition and HIV for the north and north eastern provinces, where drought-affected local populations also require continued HIV prevention, treatment, and care and support services.

In Ethiopia, UNHCR and partners—including more than 10 international NGOs—are working in refugee camps to reduce the transmission of HIV, prevent sexual violence, and provide care for survivors of sexual violence. From the start of the emergency, blood safety measures have been reinforced and male condoms have been made available. For people living with HIV, a national antiretroviral protocol is followed, including CD 4 testing, clinical monitoring and the promotion of treatment adherence.

As part of a wider continental response, the African Union (AU) recently pledged more than US $350 million to the humanitarian crisis in the Horn of Africa. At a meeting of AU Ministers and Heads of State on 25 August, all speakers expressed solidarity with affected populations and emphasized the need to tackle both the current crisis and underlying root causes, including conflict and climate change.

The UNAIDS family and partners will continue to monitor and respond to HIV needs in the Horn of Africa based on the 2010 IASC guidelines for addressing HIV in humanitarian settings. The HIV response in the region is guided by the UNAIDS vision of Zero new HIV infections, Zero discrimination and Zero AIDS-related deaths.