Creative Approaches to HIV Prevention Among Refugees Can Promote Human Rights, Op-Ed Says

"Strategies to prevent the spread of HIV among refugees have often aimed to alter the behavior of individuals, and failed to take into account sufficiently the societal and contextual factors that determine vulnerability," Wendy Holmes of the International Health Unit at the Macfarlane Burnet Center for Medical Research in Fairfield, Australia, writes in the July 14 issue of the Lancet. HIV prevention strategies for refugees are influenced by the "uncertain, artificial and temporary nature of refugees lives, especially in camps," she writes. Refugees may be sexually assaulted or be forced to trade sex for food or other amenities, and the social pattern with regard to sexual behavior is often "disrupted" by conflicts. Intravenous drug use and needle sharing may also increase in refugee settings, she states. Access to health care may be "limited" and safe blood practices may not be followed in conflict situations, she continues. Because of these developments, a "human rights framework" serves as a "useful basis for understanding and addressing the vulnerability of refugees to AIDS," Holmes writes. Such a framework can "help to generate new creative approaches" to HIV prevention, but brings with it an "obligation to consider both how these activities may add to the protection of people's rights and whether they may have unintended consequences for the rights of individuals," she continues. HIV responses with regard to refugees must "respect people's right to self-determination, confidentiality, privacy, information and non-discrimination," Holmes continues. The call for mandatory HIV testing of refugees in camps must be "resisted" because it "breaches" these rights and is an "ineffective public health strategy," she states. Health care workers must also respect these rights because health care providers who discriminate against HIV-positive people are "potent generators of stigma." International groups and relief agencies working during a conflict are in a "good position" to "integrate" HIV education and care into their services, Holmes writes. In addition, "[s]tructured" community discussions and social interaction should be encouraged because they "restore morale, a sense of trust, hope for the future, promote equality and respect" and provide for "better understand[ing]" between men and women. These interactions "should not be viewed as a luxury, but as necessary to restore refugees' rights to dignity," she states. "In addition, efforts to prevent conflict, and to resettle those displaced as soon as possible, are obviously fundamental to addressing the vulnerability of refugees," Holmes concludes (Holmes, Lancet, 7/14).