Conflict-affected displaced persons need to benefit more from HIV

Refugees and Internally displaced persons

Conflict-affected displaced persons need to benefit more from HIV and malaria national strategic plans and Global Fund grants.

Access to HIV and malaria control programmes for refugees and internally displaced persons is not only a human rights issue but a public health priority for affected populations and host populations. The primary source of funding for malaria and HIV programmes for many countries is the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). This article analyses the current HIV and malaria National Strategic Plans and Global Fund approved proposals from rounds 1-8 for countries in Africa hosting populations with refugees and/or internally displaced persons to document their inclusion. The review was limited to countries in Africa as they constitute the highest caseload of refugees and internally displaced persons affected by HIV and malaria. Only countries with a refugee and/or internally displaced persons population of >/= 10,000 persons were included. National Strategic Plans were retrieved from primary and secondary sources while approved Global Fund proposals were obtained from the organisation's website. Refugee figures were obtained from the United Nations High Commissioner for Refugees' database and internally displaced persons figures from the Internal Displacement Monitoring Centre. The inclusion of refugees and internally displaced persons was classified into three categories: 1) no reference; 2) referenced; and 3) referenced with specific activities. A majority of countries did not mention internally displaced persons (57%) compared with 48% for refugees in their HIV National Strategic Plans. For malaria, refugees were not included in 47% of National Strategic Plans compared with 44% for internally displaced persons. A minority (21-29%) of HIV and malaria National Strategic Plans referenced and included activities for refugees and internally displaced persons. There were more approved Global Fund proposals for HIV than malaria for countries with both refugees and internally displaced persons, respectively. The majority of countries with >/=10,000 refugees and internally displaced persons did not include these groups in their approved proposals (61%-83%) with malaria having a higher rate of exclusion than HIV. Countries that have signed the 1951 refugee convention have an obligation to care for refugees and this includes provision of health care. Internally displaced persons are citizens of their own country but like refugees may also not be a priority for Governments' National Strategic Plans and funding proposals. Besides legal obligations, Governments have a public health imperative to include these groups in National Strategic Plans and funding proposals. Governments may wish to add a component for refugees that is additional to the needs for their own citizens. The inclusion of forcibly displaced persons in funding proposals may have positive direct effects for host populations as international and United Nations agencies often have strong logistical capabilities that could benefit both populations. For National Strategic Plans, strong and concerted advocacy at global, regional and country levels needs to occur to successfully ensure that affected populations are included in their plans. It is essential for their inclusion to occur if we are to reach the stated goal of universal access and the Millennium Development Goals.

Despite public commitments by 189 countries to incorporate refugees and internally displaced persons in national HIV strategies, only Egypt and Sierra Leone have included activities for refugees in both their HIV national strategic plans (NSP) and approved Global Fund proposals. Out of 33 African countries with more than 10,000 refugees, 6 countries included them in NSP and 8 in approved Global Fund proposals. Out of 22 countries with more than 10,000 internally displaced persons, 3 countries included them in NSP and 5 in approved Global Fund proposals. This is surprising because refugees and internally displaced persons are often located in isolated and inaccessible areas where government services for the local population are usually poor and where funding proposals for integrated services could have positive direct effects for host populations. Thus, in addition to human rights principles and a public health rationale, there is a straightforward pragmatic health services strengthening justification for addressing the needs of conflict-affected displaced persons.