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Colliding Wars: a Systematic Review on HIV Control in Conflict-Affected Settings

Published onJun 15, 2023
Colliding Wars: a Systematic Review on HIV Control in Conflict-Affected Settings

BACKGROUND: Armed conflicts are a serious problem in many regions of the world. Despite the global push for democracies and ceasefire, 56 active conflicts were reported in 2020 - the highest number reported outside the world wars. The increase in armed conflict is concerning, and poses serious threats to health security in the region affected and, eventually, those around it. There is a clear increase in population vulnerability, especially to infectious illnesses and preventable diseases like HIV.  People fleeing complex emergencies, for example, face a myriad of problems including food insecurity, unclean water, compromised housing, suspended education, and poor access to healthcare. These systems are likely to be collapsed, inaccessible, unaffordable, or discriminatory towards the populations targeted by the conflict. Often, breakdowns in health systems are worsened by shifts in national budgets towards the armed forces and defence - which, if chronic, can lead to long-term aid dependency. Conflict-driven HIV risk disproportionately affects key populations, children, girls and young women. Key populations who are affected by HIV, for example, may experience lapses in access to testing, care, treatment through war-like conditions. Further, the vulnerability of women and young girls - a group widely known to be at risk of contracting HIV -  can sharply rise as safety and security is weakened and violence, including sexual abuse, increase. This systematic review seeks to capture the heightened risks to HIV among key populations and other high-risk groups, acknowledging any reported interruptions or drawbacks in HIV programming in conflict settings. METHODS: A systematic scoping was conducted through the following databases: MEDLINE, Embase, Scopus, CENTRAL, and CINAHL to identify relevant publications, Relevant reports will also be screened for potentially pertinent evidence. Only records published after 2011 that meet the inclusion criteria were included in the systematic review. DISCUSSION: This review seeks to recognise the risks or drawbacks to HIV control in conflict-affected areas, considering outcome: increased risk of contracting HIV among key populations, children, girls and young women. Once analysed and summarised, the findings could assist in identifying literature gaps, and providing recommendations for HIV programmes targeting key populations and vulnerable groups.

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