African Church Information Service

Pedro Shipepechero - Nairobi

Contrary to wide expectations, transmission rate of the AIDS virus among refugees in camps in East Africa is still one of the lowest in the region. But reduced funding of the UNHCR's programmes currently being experienced, analysts say, could trigger a spiral of the spread of HIV/AIDS, besides hastening progress to the terminal stages among HIV/AIDS patients, reports AANA Correspondent Pedro Shipepechero.

A ccording to data provided by the United Nations High Commission for Refugees (UNHCR) regional office in Nairobi, infection rates in Kakuma and Daadab refugee camps in northern Kenya and Ngara refugee camp in western Tanzania average between two and five per cent, compared with the region's average of 10 per cent.

However, the commission's senior health co-ordinator, Dr Mohammed Qassim, says these statistics are not foolproof as the HIV/AIDS sentinel surveillance has not been instituted to generate reliable data for the UN humanitarian agency.

Past experiences show that the fleeing populations, particularly women and girls, are exposed to rape or provide sex in exchange for protection in situations of armed conflict at the risk of contracting the killer virus.

"One reason why the infection rates are low among refugees is that most of the displaced people who arrive in the camps come from rural areas where cultural taboos disprove of casual sex", says Dr Qassim.

The same cultural norms that disprove of promiscuity, however, says the medic, have been an inhibition to the flow of information on the AIDS pandemic. He says that the refugees, especially adults, shy away from discussing sex openly, which they say must be done in privacy.

It is for the same reason that condom acceptance is still low even among the refugees who have the correct information. Consumption averages 100 condoms per 1,000 people. Most of the users of the contraceptive are the youth, who do so to protect themselves against contracting common sexually transmitted infections such as gonorrhoea, syphilis and genital inflammations, and pregnancy, says Dr Qassim.

"It is difficult to discuss the problem openly with adults and we have to turn to the youth to spread awareness - including the use of contraceptives - to the rest of the refugee population," he says.

"All camps appear to have a problem in providing condoms in public places with enough privacy to allow people to take them without feeling embarrassed," says UNHCR in one of its reports on the situation of HIV/AIDS in refugee camps in the region.

Dr Qassim observes that a return to calm in countries such as Rwanda, Burundi and the Democratic Republic of Congo (which together account for the source of the more than two million refugees in the Great Lakes Region) could result in a fresh wave of danger as returning infected refugees could become a new medium of transmission of the killer virus.

A report on the exploratory mission undertaken by UNHCR in western Tanzania and northern Kenya in June-July last year, says of the risks in the camps: "From the limited data available, it appears that that HIV/AIDS prevalence is lower in most camps than the host country. Therefore, behavioural change and communication programmes in the camps should concentrate on high-risk and bridging groups, for it is these (returnees) who will spread the disease to the general population."

The high-risk groups in the UNHCR context are commercial sex workers and the youth who engage in sex as a pastime. "Having been uprooted from their homes, the refuges are usually idle and indulge in sex as a form of entertainment ," says the UNHCR health co-ordinator.

The UNHCR findings, however, point out that the low infection rates in the camps could be overlying a gloomier scenario as there has never been a systematic method of screening the refugees of HIV/AIDS.

The report notes: "The prevalence of HIV among blood donors is currently being used in camps as a proxy for population prevalence," which it says, is only acceptable until antenatal surveillance systems are established and mortality registers stating "the underlying cause of death" are in place.

Food and other supplies to refugee camps have been scaled down partly due to cutbacks in international funding of the UNHCR activities and escalating conflicts.

In September last year, UNHCR announced it would reduce its humanitarian missions in the region as a result of reduction in funding. This was after its Atlanta-based Centre for Disease Control in the United States said it would cut down its $300,000 per annum funding of the organisation's health programmes.

In northern Kenya, supplies to refugees have been checked by the Southern Sudan People's Liberation Army offensive against the Sudanese government installations.

In the Great Lakes Region, the activities of the Movement for Liberation of Congo and the Rally for Congolese Democracy rebels in the east, which border Rwanda and Burundi, have prevented supplies from reaching the more than four million people in the region displaced by the fighting in the region.

The World Food Programme food rations for the refugees has dropped from 2,100 calories per day to 1,700, which the health co-ordinator describes as "survival rations."

"The refugees do not have a choice as they are a dependent lot. The present level of malnutrition has made many of them susceptible to infections as their immunity has been compromised by insufficient diet and food quantities," he says.

Dr Qassim says that current reduction in funding of UNHCR's programmes is likely to trigger a spiral of the spread of HIV/AIDS, besides hastening progress to the terminal stages among HIV/AIDS patients.

According to the UNHCR survey, girls aged between 14-18 years are particularly vulnerable to HIV/AIDS and sexually transmitted infections, as they engage in sex in exchange for gifts - often money to buy food and clothing - because they are the most afflicted by poverty and hunger.

Since the beginning of last year, international humanitarian agencies have been forced to scale down their operations with the return to relative peace in Uganda, Rwanda, Burundi, Ethiopia, Eritrea, Mozambique and Angola.

The operations have been redirected to new trouble-spots in the world, particularly in the Middle east and East Asia that have in recent months witnessed a sharp rise in terrorist activities and US-led military retaliation to terrorism.

Against the backdrop of the growing global threat posed by the HIV/AIDS scourge, UNHCR faces a growing challenge of not only protecting the refugees from harm, but also ensuring that they do not become a medium of transmission of the virus to either the host population or their villages of origin.