Wars don't fuel African HIV crisis

War, refugee crises and large-scale rape of women in sub-Saharan African nations have not spawned higher HIV infection rates in this region hard hit by AIDS, according to a study contradicting a common belief.

Writing in the Lancet medical journal on Thursday, researchers said they tracked HIV infection rates in seven sub-Saharan nations beset by conflict -- Burundi, Democratic Republic of Congo, Rwanda, Sierra Leone, Somalia, Sudan and Uganda.

Of the 40 million people worldwide infected with the human immunodeficiency virus that causes AIDS, about 25 million are in the poor African countries south of the Sahara.

Running counter to a notion advanced by some experts that violence fuels the spread of HIV, the study found no evidence that infection rates rose in these nations during conflicts.

The study also found that the large numbers of refugees displaced by war have not multiplied HIV in the places to which they have fled, and that large-scale rapes during conflicts, while heinous, have not increased overall HIV rates.

"Assumptions that make intuitive sense should be properly researched before being propagated as fact," said lead researcher Dr. Paul Spiegel, chief of the public health and HIV section for the United Nations High Commissioner for Refugees.

Spiegel noted that HIV infection rates may increase in areas affected by conflict, but not to the same magnitude as similar regions not engulfed in war.

"In the seven countries we examined -- again, this may not apply to all countries that experience conflict -- the conflict appeared to keep the level of HIV infection lower than surrounding countries or in other parts of the same country which were not in conflict," Spiegel said by e-mail.

"Every case of rape is abhorrent and must be cared for properly," Spiegel added. "At the individual level, the person is at risk of becoming infected with HIV. However, given simple epidemiology, this may not translate into an overall increase in HIV prevalence at the country level."

DISRUPTED HABITS

Under ordinary circumstances, he said, men may leave their families to work in urban areas, have sex with HIV-infected prostitutes and then return home only to infect their wives, or have numerous concurrent sex partners.

But because war limits people's mobility within countries, such transmission patterns may be disrupted, Spiegel said.

Some nongovernmental organizations have asserted that HIV infection rates are worsened in conflict zones.

A 2002 report by the group Save the Children titled "HIV and conflict: a double emergency," stated, "In war, HIV/AIDS spreads rapidly as a result of sexual bartering, sexual violence, low awareness about HIV, and the breakdown of vital services in health and education."

Spiegel said such claims may stem from incorrect interpretation of data or inadequate study methods.

But Gopa Kumar Nair, Save the Children's HIV and AIDS adviser, said the data underpinning the Lancet study may not sufficiently reflect the reality on the ground.

"Our experience from the field clearly shows that there is a huge link between vulnerability to HIV and conflict. We have seen community-based health systems breaking down," he said in a telephone interview.

Separately, the Global HIV Prevention Working Group, which is backed in part by the Bill & Melinda Gates Foundation, called for increased international support for AIDS prevention efforts with the aim of averting 30 million of the 60 million HIV infections expected to occur by 2015.