The Lack of HIV Programming in Refugee Camps is a Ticking Time Bomb

Migrant populations are fluid, difficult to identify, and are often left out of national HIV/AIDS prevention programming. What can development programs do to prevent an increase in HIV transmission among these groups?

For nearly four decades, HIV has not only been a public health emergency, but also one of the biggest barriers to global development. This disease costs national governments billions of dollars each year in treatment and prevention costs as well as opportunity costs in relation to immune-compromised citizens who are no longer able to contribute to the gross domestic product. Some studies have estimated that for every 10 percent HIV prevalence in a given country, gross national product (GNP) growth could decrease by more than one percent.

Luckily, in recent years, there has been a general reduction in HIV infection rates, thanks in large part to UNAID’s 90-90-90 goal. This goal seeks to ensure, by the year 2020, that 90 percent of all people living with HIV know their status, 90 percent of those people receive treatment with antiretroviral therapy (ART), and 90 percent of those individuals have viral suppression. The path to achieving this goal has not only improved the health of HIV+ individuals but also reduced infection rates. The increase in the number of people on ART and with a suppressed viral load has contributed to lower transmission rates, as viral suppression reduces transmission rates.

65.3 Million People Left Behind

Globally, the tides are turning in the fight against HIV/AIDS, yet there are subsets of the world where the virus is still taking a huge toll. Perhaps no marginalized group has been in the spotlight more in recent years than internally displaced persons (IDP) and migrant communities. There have been no large-scale studies conducted on HIV prevalence rates in IDP and migrant communities. Case-by-case studies indicate that these rates are always context-specific. In fact, some studies note that HIV rates among migrant communities are often lower than host communities. Nevertheless, the extremely fragile state of these communities notes a need for a focused and targeted HIV prevention model. Last month, the International Organization for Migration (IOM) published an article which found that while there is no correlation between migrant communities and HIV rates yet, there is a correlation between these communities and higher vulnerabilities to HIV, increasing the threat in the future.

Although current trends in HIV awareness and treatment are improving, migrant and IDP communities continue to be excluded. In 2010, one study found that 57 percent of countries with Global Fund co-sponsored national strategic plans to combat HIV omitted IDPs from the plan, and another 48 percent omitted migrants and refugees. Only 21 percent of countries included explicitly referenced activities targeting refugees and IDPs. With 65.3 million people forcibly displaced in 2015, a significant amount of people are being left out of HIV programming. These same communities are subject to other detrimental factors which can increase HIV transmission, including sexual assault, forced prostitution in return for food and other goods, and increased domestic violence and abuse; these factors impact young women the most.

A Ticking Time Bomb

The lack of HIV programming in IDP and migrant communities creates a void of HIV awareness within communities. Over time, the threat of this void increases and ultimately, HIV breakouts are inevitable. In fact, just this year, Borno State in Nigeria was faced with an HIV outbreak in several IDP camps, leading to a state emergency. None of these camps were promoting HIV awareness or health activities. The development community is aware of the dearth of HIV programming for migrant communities. Currently, the focus is to view the situation from a human rights perspective, which includes the right to health. Although true, focusing on HIV programming as a subset of the right to health means that tangible results must wait until a more thorough resolution is found.

A Matter of Global Security

In recent months, the focus of global health funding has been to identify the role of health in national security. I believe the best potential area to focus on the issues affecting migrant communities’ access to HIV programming is through the lens of global health security. Two primary characteristics of IDP and migrant communities are that they are 1) fluid and 2) difficult to identify. The fact that this population is continuously moving makes them particularly difficult to track, and they are often left out of census statistics. HIV poses a threat to the socioeconomic security of a state, and as shown, has a negative effect on health and the economy, devastating a country’s development. The goal of 90/90/90 is to ensure 90 percent of all individuals know their status. If migrant communities are not part of this programming, they are less likely to know their status. Failing to account for this population threatens the goal of 90/90/90 and hinders the reduction of HIV transmission rates.

Generally, national and international assistance for HIV programming does not discriminate in the target audience; however, this programming can be caught up in political dialogue, ill-informed donors, and general lack of awareness. Organizations like IOM realize there is a vacuum of programming for these marginalized communities. However, there is also a lack of statistics and awareness surrounding their plight.

What the Development Community Can Do

The global development community needs to better understand and study the plight of IDP and migrant communities in the fight against HIV. There is a lack of statistics on transmission rates, which are difficult to record in transient communities. The international community must utilize targeted research to bolster arguments to host countries and donors that these communities are under-supported and require assistance. Statistics showing the threat this issue has on a nation’s health security would be a viable method. Host governments must do a better job at affirming and publicizing these migrant communities so more accurate analysis can occur. It is apparent that the current situation is in a fragile state and that it threatens to erode the gains made in the battle against HIV/AIDS. By excluding these marginalized communities from health programming, host countries are hindering their total health security profile and potentially hindering their own growth.