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Dr. YIWEZA, T.S. Dieudonn é Dr. SPIEGEL, Paul UNHCR

HIV among Internally Displaced Persons in the Democratic Republic of Congo: Increased Vulnerability of and Risks to Women. Dr. YIWEZA, T.S. Dieudonn é Dr. SPIEGEL, Paul UNHCR. Background (1). >10 years of conflict in the Democratic Republic of Congo (DRC) has been characterized by:

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Dr. YIWEZA, T.S. Dieudonn é Dr. SPIEGEL, Paul UNHCR

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  1. 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

  2. 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

  3. 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

  4. Method • Objective – assess HIV/AIDS services • Target population: IDPs and surrounding host communities • Methods: • Review of existing information • Observations of health, food, etc, at district/local level • Semi-structured interviews with key informants • Focus group discussions

  5. 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

  6. 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

  7. 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 Access to Prevention

  8. 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

  9. 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

  10. 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

  11. 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.

  12. 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

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