Addressing the dual epidemics in fragile settings: HIV and gender-based violence in Africa

On 29^th August 2024, UNAIDS released a new report titled “The Missing Link: Rethinking and Reprioritizing HIV and Gender-Based Violence in Fragile Settings“. The report explored the interlinkages between HIV and gender-based violence (GBV) in fragile settings, particularly in the context of peace support operations. The highlights in the report include challenges and gaps in addressing issues and advocating for integrated, multisectoral approaches that prioritise human rights and gender equality. The report is timely, considering that Africa is home to 13 countries under Challenging Operating Environment (COE).

The Interconnection of HIV and Gender-Based Violence

Gender inequality is a root cause of both HIV transmission and GBV. The African continent faces a unique and pressing challenge at the intersection of the HIV epidemic and GBV, which together exacerbate public health crises and highlight the urgent need for gender-transformative interventions. Women and girls in Africa often face harmful gender norms and practices that increase their vulnerability to violence and limit their access to healthcare services, including HIV prevention and treatment. With an estimated 25.7 million people living with HIV in the WHO African Region as of 2022—accounting for 66% of global cases—the prevalence of GBV further complicates this crisis by increasing the vulnerability of women and girls to HIV infection and perpetuating cycles of stigma and violence. Survivors of GBV may struggle to negotiate safer sex, while those living with HIV often face discrimination, thus increasing their risk of violence and mental health challenges. In fragile settings, the interplay of conflict and displacement worsens these vulnerabilities, making it imperative to adopt comprehensive strategies that integrate HIV prevention and treatment with support services for GBV survivors. The UNAIDS report emphasizes that addressing these interconnected issues is crucial for the well-being of individuals and the broader stability of communities, calling for initiatives that empower women, involve men in promoting gender equality, and facilitate access to essential healthcare resources.

African Union’s Commitment

The African Union (AU) has made significant strides in addressing gender related issues through various declarations and initiatives. From the 2001 Abuja Declaration to the 2012 African Union Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB, and Malaria Response in Africa, the AU has consistently advocated for solidarity with those affected by HIV. Initiatives like AIDS Watch Africa have been established to monitor progress and hold governments accountable for their commitments to combat HIV and GBV.

Moreover, the AU has committed to eliminating gender-based violence through various protocols, including the Maputo Protocol, which addresses women’s rights and aims to eliminate harmful practices and violence against women. These commitments reflect a growing recognition of the need for integrated approaches that address both HIV and GBV in peace and security settings.

The Role of Peace Support Operations

Peace support operations play a crucial role in addressing the dual epidemics of HIV and GBV in fragile settings. The report highlights that the African continent hosts numerous peace support missions, with African nations contributing significantly to UN peacekeeping efforts. These missions provide a unique opportunity to implement HIV prevention and GBV response strategies in conflict-affected areas, where the risks of both epidemics are heightened.

For instance, the African Union’s Protocol on Integrating HIV Interventions in Peace Support Operations aims to ensure that peacekeeping forces are equipped to address the health needs of affected populations, including those related to HIV and GBV. By integrating health services into peacekeeping efforts, the AU is taking a proactive approach to mitigate the impact of these intertwined crises.

Challenges and Recommendations

Despite the progress made, significant challenges remain. The high prevalence of GBV across Africa continues to hinder effective HIV responses. The report identifies several key challenges in addressing HIV and GBV in fragile settings, particularly within peace support operations:

1. Deprioritization and Disconnection: Despite existing policies and commitments, HIV and GBV often remain deprioritized and disconnected within peace support operations, leading to inadequate responses and a lack of integrated approaches.
2. Capacity Gaps: There are significant gaps in the capacity of peace support operations to effectively address HIV and GBV, including insufficient training and resources for personnel, which hampers their ability to fulfill their mandates.
3. Stigma and Discrimination: HIV-related stigma and discrimination pose substantial barriers to accessing services and integrating responses to HIV and GBV, limiting the effectiveness of interventions and the willingness of affected individuals to seek help.
4. Lack of Accountability: The absence of robust accountability mechanisms at various levels makes it difficult to ensure that duty bearers fulfill their commitments to address HIV and GBV, resulting in a lack of oversight and community engagement in monitoring services.
5. Insufficient Evidence and Research: There is a lack of comprehensive data and evidence on the intersection of HIV and GBV, which hinders the understanding of the unique experiences and vulnerabilities faced by different populations in fragile settings. This gap in evidence limits the development of targeted and effective interventions.
6. Complex Operating Environments: The challenging and often volatile contexts of fragile settings complicate the implementation of effective responses to HIV and GBV, requiring tailored approaches that consider local realities and sensitivities.

The recommendations outlined in the report are both timely and critical, given the complex interplay between HIV and GBV in fragile settings, and they aim to foster a more holistic, human rights-based, and gender-transformative approach to addressing HIV and GBV in fragile settings:

1. Incorporate Clear Language in Mandates: Ensure that all relevant peace support operation mandates explicitly include language on HIV and GBV, and translate this into action through integrated, multisectoral responses grounded in gender equality and human rights principles.
2. Establish Robust Accountability Mechanisms: Create accountability mechanisms at all levels to ensure effective implementation of existing commitments on HIV and GBV. This includes facilitating community leadership in monitoring and providing feedback on services, with a focus on including women, key populations, and young people.
3. Commit to a Multisectoral Research Agenda: Duty bearers should agree on an actionable research agenda that addresses gaps in evidence regarding HIV and GBV. This agenda should empower communities to take ownership of evidence generation and inform action plans based on local realities.
4. Leverage Synergies Across Sectors: Promote collaboration between humanitarian, development, and peace sectors (the triple nexus) to maximize the impact of interventions addressing HIV and GBV, ensuring that opportunities for combined approaches are not missed.
5. Address Stigma and Discrimination: Tackle HIV stigma and discrimination, which hinder progress in integrating responses to HIV and GBV within peace support operations.
6. Strengthen Training and Capacity Development: Enhance training policies and capacity development efforts for peace support operations to ensure personnel are equipped to address HIV and GBV effectively.

As Africa is home to 13 COE countries as per the Global Fund risk management, there is an urgent need for integrated health services and protective measures in these fragile contexts, to address both HIV and GBV efficiently. Duty bearers are called upon to develop and implement policies that address the intersection of HIV and GBV, ensuring they are context-specific and inclusive by involving local communities in the design and implementation of related interventions to ensure they are culturally appropriate and effective.

Armelle Nyobe