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