Brown University researchers have shown that the incidence of HIV significantly increased in the 5 years leading up to violent conflict in sub-Saharan Africa.
“It implies that there is something going on in social, political, and health care environments in those years that are conducive to HIV spread,” Brady W. Bennett, a graduate student at Brown University School of Public Health, said in a press release.
Figure 1. In Nigeria, the rate of new HIV infections per 1,000 people per year increased during periods preceding armed conflict.
Source: Brady W. Bennett
Bennett and colleagues tracked HIV incidence in 36 sub-Saharan African countries between 1990 and 2012, correlating rates of the infection with periods of armed conflict in each country — defined as violence that resulted in at least 25 battle-related deaths. In their analysis, the researchers controlled for factors such as the country’s level of economic development, the number of refugees and the type of conflict. The study, however, did not account for the scale-up of ART in that region in 1996 — a potential limitation, the researchers said.
Compared with times of peace, the incidence of HIV increased by 2.1 infections per 1,000 people per year (95% CI, 0.39-3.87) in the 5 years before conflict, according to the researchers. The incidence rate actually decreased during the conflict itself, with 0.07 new infections per 1,000 people per year (95% CI, –1.44 to –0.01). Although some studies have suggested that countries are most vulnerable to HIV transmission during periods immediately following conflict, Bennett and colleagues said the rate remained relatively stable during this time, with 1.1 infections per 1,000 people per year (95% CI, –0.45 to 2.69).
The intensity of the conflict also appeared to have an effect on HIV incidence, the researchers said. For example, during conflicts with more than 1,000 battle-related deaths, the incidence of disease dropped by 1.5 new infections per 1,000 people per year (95% CI, –2.5 to –0.52), compared with conflicts resulting in less than 25 deaths.
Previous research has produced conflicting results regarding the impact of this type of violence on HIV incidence, according to the researchers. Some studies have indicated that armed conflict contributes to the spread of infection through numerous factors, including increased sexual violence and disrupted access to health care. According to WHO, the conflict in Syria resulted in significant increases in the spread of communicable diseases, both inside the country and among refugees who fled the violence.
However, other studies have suggested that HIV rates stabilize or even decrease during conflict.
“Conflict sometimes has the effect of isolating communities by destroying viable transportation systems (roads, bridges, etc.) and making travel more dangerous than in times of peace,” the researchers wrote. “Additionally, the disruption of some sexual activity (eg, visiting sex workers, having multiple sexual partners), and the influx of humanitarian aid may slow the spread of HIV/AIDS and depress prevalence and incidence.”
Bennett and colleagues also noted that conflict can undermine data collection and surveillance, and therefore new HIV infections may go undetected.
According to study researcher Mark N. Lurie, PhD, associate professor of epidemiology at Brown, the findings underscore the need for additional research to uncover the full extent of the relationship between war and HIV.
“What our paper points to is that we need to better understand the precipitating factors that drive conflict precisely because we’ve identified that as a period of vulnerability where HIV incidence is likely to be increased,” Lurie said in the release. – by John Schoen
Disclosure: The researchers report no relevant financial disclosures.