Post on 15-Jan-2016
description
HIV among Internally Displaced Persons in
the Democratic Republic of Congo:
Increased Vulnerability of and Risks to Women
Dr. YIWEZA, T.S. Dieudonné
Dr. SPIEGEL, Paul
UNHCR
Background (1)
• >10 years of conflict in the Democratic Republic of Congo (DRC) has been characterized by:
- Displacement of populations; >1 million internally displaced persons (IDPs) in 2007
- Collapse of health and social systems
- Human rights abuses and violations incl. sexual violence
Background (2)
• In Feb –Mar 2007, UNHCR with others UN agencies, NGOS and Gov. institutions conducted HIV rapid assessment to review services in 4 provinces hosting IDPs and returnees
Method• Objective – assess HIV/AIDS services • Target population: IDPs and surrounding host
communities• Methods:
1. Review of existing information
2. Observations of health, food, etc, at district/local level
3. Semi-structured interviews with key informants
4. Focus group discussions
Results - Protection• Sexual violence: Rape used as war weapon:
– Most perpetrators are armed persons – Survivors range from 2 yrs to > 60yrs old– Clinical mgt of rape, including PEP unavailable
• Stigma: mandatory HIV testing for IDP and returnee women been suggested “because they have been raped”
• Physical, psychosocial and legal protection needs of women and girls are unmet
Access to Prevention
• Knowledge of HIV prevention among women and girls – insufficient
– No access to IEC materials and media like in Masisi, Moba and Mitwaba areas
– Condoms unavailable and their use unknown: in Moba and Mitwaba, condoms were just not available or too expensive (Bunia)
– Increased number of sex workers and their clients
– Education system – severely affected – less access to essential information
In normal circumstances, antenatal care is source of HIV information
Access to Prevention
• Health services collapsed: – Universal procedures not followed:
shortages of syringes, gloves and poor training of service providers
– Blood for transfusion - often not screened for HIV: in Moba, HIV test not available since conflict started, no blood banks in most of referral hospitals
– Emergency obstetrical care not available
– Inadequate services - clinical mgt of
rape survivors
Delivery room
Education
• Schools closed • Teachers engaged in more
lucrative jobs (NGOs, trade)• Girls have less access to
education: – Lack of financial means
(priority given to boys)
– Teen pregnancy
– Caring for younger siblings
– Engaged in various “coping mechanism” for family survival
Access to Care and Treatment
• Lack of basic HIV and AIDS services (e.g. STI treatment): only 3 health centre out of some 10 use the syndromic approach
• Staff not motivated and properly trained• Lack of drugs and supplies • Facilities destroyed • Long distances to reach health facilities (some as
far as 40-60 Km)• Social and family supportive systems broken and
women often left alone
Social-Community Aspects
• Women and girls forced to engage in sex work for survival and protection– While selling sex may enable them to survive.
• Blame, rejection and stigma of rape survivors or single women; limits access to health or community supportive services where available
• Women suffering from infertility, due to untreated STIs, are at risk of being divorced
Lessons learnt (1)
• High risk behaviours, practices and vulnerabilities were on the rise.
• Practical, feasible and short-term interventions to promptly prevent and respond to HIV should be put in place with special focus on women, girls and boys.
Lessons Learnt (2)• Such measures include:
Global and national efforts to restore peace– End the war – peace and reconciliation among many groups – Rehabilitate protection structures: legal and justice institutions– Human rights abuse and violations: fight against impunity, stigma and
discrimination
Emergency humanitarian assistance should include– Rehabilitee the health care delivery system: reliable referral system for
OEC, clinical mgt of rape, blood transfusion, etc. – Advocacy for effective inclusion of HIV in EMR at all level– Improve Coordination: must be multisectoral and decentralized
Community based interventions– Support community based social structures – Peer education including use of female relief workers and peace keepers – Basic health facility-based HIV prevention and treatment (IASC) including
clinical mgt of rape, rehabilitations, supplies