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: 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

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. 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

7. 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

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