Table 1 Impact of conflict on HIV and HBV outbreaks

Betsi et al., 2006 [9]

Armed conflict in Cote d’Ivoire (Central, North and West areas),

2001- early 2004

Key Informant survey (n = 165) among politicians, military leaders, health staff, members of organisations to address HIV, NGOs

• Population displacement (25-50%, depending on the part of the country)

• Decrease in healthcare personnel (75–88% reduction), especially medical doctors (91–98%)

• Reduction in functioning health facilities (72–80%)

• Healthcare delivery structures had been plundered or destroyed, laboratory equipment had been stolen and patient records and epidemiological monitoring and surveillance data had disappeared

• Lack of essential drugs and diagnostic kits for STIs

• Low compliance to diagnostic algorithms

• Lack of patient visitation

• Lack of awareness campaigns

• Interrupted condom distribution

• Interruption of existing antiretroviral therapy programmes

Implemented:

• An Increased number of active NGOs pursued education and sensitising programmes for the prevention and care of people living with HIV/AIDS.

Suggested:

• Awareness campaigns with emphasis on the age group 15–24 were suggested.

• Health facilities to be structurally and functionally rehabilitated to provide people living with HIV/AIDS antiretroviral treatment and other STIs in the long term.

Ali et al., 2012 [13]

Pakistan, conflict affected area in North Waziristan Pakistan,

2010–2011

Population of the conflict-affected area

• The prolonged armed conflicts caused a reported increase in poverty, medical deprivation, uncertainty and the breakdown of social structures that facilitated the transmission of HBV.

• Low socioeconomic status, and illiteracy were associated with HBV.

• High HBV prevalence was observed in areas with high frequency of military activities

• Transmission factors within this setting were the reuse of needles and syringes, sexual exposure, barbers’ shops, tattooing

Implemented:

Not mentioned

Suggested:

• Vaccination and awareness programmes are necessary to prevent the HBV epidemic

Vasylyeva et al., 2018 [11]

Ukraine, Earlier stages of the Ukraine conflict, 24 regional AIDS centres,

2012–2015

Patients from

Ukrainian AIDS centres

• The conflict internally displaced HIV-infected people

• In conflict areas, healthcare provision and harm-reduction services were interrupted

• The stress of the displacement might result in treatment failures for HIV-infected patients

• Patients who had to relocate because of the conflict may be more likely to reduce treatment adherence or drop out of treatment for some time

• Virus dissemination due to population movement was directed to the locations with the highest prevalence of people who inject drugs practising risky sexual behaviours

Implemented:

Not mentioned

Suggested:

• Enabling sustainable prevention services and treatment provision in locations where services have been physically disrupted.

• Proactive and routine integration of HIV testing for people who have relocated due to the war, or who frequently travel to the war zone.

• Scale-up of harm reduction services for people who inject drugs will be an important factor in preventing new local HIV outbreaks in Ukraine.

Katamba et al., 2020 [12]

Uganda, Post-conflict Northern Uganda,

November 2011 - March 2015

Conflict-affected population in three districts in Northern Uganda

• Conflict-affected participants who had experienced abduction and multiple traumas during the war were at greater risk of HIV infection.

Implemented:

Not mentioned

Suggested:

• Trauma-informed HIV prevention and treatment services, and culturally safe mental health initiatives are needed

Daw et al., 2022 [10]

Libya,

Libyan armed conflict,

2011–2020

People from four regions of Libya (East, West, North, and South)

• Healthcare services were continuously interrupted

• Internal population displacement (25%) leading to geographic spread of HIV virus from the regions involved in the armed conflict to the rest of the country.

• Population displacement may be reflected in the reduced treatment of HIV-infected individuals as patients who had to relocate because of the conflict may be more likely to reduce treatment adherence.

Implemented:

Not mentioned

Suggested:

• National intervention policies during and at post-conflict periods should be implemented

• Geographically tracing interventions should be introduced

• Viral treatment therapy to those infected should be introduced all over the country

• A national registry system for all infected patients to support access to care