Reproductive Health Response in Conflict (RHRC) Reproductive Health Response in Conflict (RHRC)

Conflict, Post-Conflict, and HIV/AIDS — The Gender Connections

Women, War and HIV/AIDS: West Africa and the Great Lakes

Remarks by Judy A. Benjamin, Senior Technical Advisor,
Women's Commission for Refugee Women and Children

Presented at the World Bank, International Women's Day, March 8, 2001

Today's wars are more likely to be fought within borders rather than against invading forces or across borders. The civil war in Sierra Leone has created a population of nearly one million internally displaced people. Over 300,000 are refugees in Guinea and in other neighboring countries.
The often-cited percentage of women and children who make up refugee and internally displaced populations is from 70 to 80 percent of the estimated forty to fifty million uprooted. Why, because the men are either fighting in the conflict, have been killed in action, taken prisoner, or they live in exile away from the conflict.

My presentation addresses violence against women as a cofactor of HIV/AIDS. Two African countries, Rwanda and Sierra Leone, illustrate how war affects men and women differently. The material is drawn from my field research in those countries.

Humanitarians, politicians, governments, and the media discuss the link between conflict and the spread of HIV/AIDS, however, quantifying that link is difficult because reliable statistical data are not readily available. Military forces do not publicize HIV infection rates of their troops even when statistics exist.

Conflict affects everyone in its path. Today 75 percent or more of people killed or injured in wars are civilians. In World War I fewer than 5 percent of all casualties were noncombatants. More men die in battle than women. But women and girls are deliberately targeted for rape, torture, sexual slavery, trafficking, and forced marriages and pregnancies.

Conflict and post-conflict situations force changes in gender roles. As traditional caretakers of family members, women adopt coping mechanisms to secure basic human necessities for the survival of their families. Short-term strategies may result in tragic outcomes.

I directed an HIV/AIDS prevention program in Ngara Tanzania from 1994 until 1996 for Rwandan refugees. At that time it was the world's largest AIDS prevention effort for refugees. CARE was the lead agency with support from Population Services International and John Snow Inc.

The project initially targeted 67,000 refugees but because of the enormous influx of refugees that figure grew to nearly 200,000. The project used a community-based approach and a system of outreach by AIDS educators selected and trained from the refugee population. At start-up the project conducted a baseline survey to establish the knowledge, attitudes, practices and beliefs regarding HIV/AIDS. After 12 months the same survey was administered to measure the impact of the program.
The baseline survey revealed a high level of AIDS awareness-87 percent of respondents knew at least two ways to prevent HIV infection, one of which was condom use. Yet condom use was only 16 percent for men during their most recent sexual encounter. More than 50 percent perceived themselves to be at moderate or high risk for HIV infection. Given the high resistance to using condoms, other strategies were adopted like promoting fewer sexual partners and loyalty to one partner. Probably the most effective strategy was promoting an aggressive sexually transmitted infections (STIs) treatment and follow-up.

Rwandan women on both sides of the conflict were beaten, raped and tortured. The violence did not end when the women arrived at the refugee camps. Rapes occurred frequently in and around the refugee camps. Women without adult men in their households were the most vulnerable. A number of women became pregnant as a result of rape during the conflict or in flight. Those who gave birth in the camps became pariahs. With no one to stand up for them, the unmarried mothers were easy targets for sexual abuse. They reported that men walked into their huts at will, raped them and left.
The structural design of the camps led to gender violence when latrines and water taps were situated a distance from the dwellings. Women and girls were raped when they visited the latrine or fetched water. Self-appointed guards at the water taps demanded sexual favors from women seeking water.
The project addressed gender violence by offering counseling, through focus group discussions with men in the community, and by helping organize multi-agency crisis intervention teams (CIT) to assist rape victims.

The findings of the 12-month KABP survey revealed that condom use did not increase, however, knowledge about HIV transmission modes improved. More people sought treatment and counseling for STIs after 12 months.

At the 12-month evaluation survey, women respondents were more sexually active than a year before (87 percent versus 79 percent), and more women had multiple partners during the previous two months (16 percent as compared to 2 percent during baseline.) These troubling behavior changes, despite the aggressive AIDS prevention program, suggest that as the population in the camps increased and food supplies decreased women resorted to more sexual partners. Other analyses for this finding are also possible; the topic needs more research.

Internally displaced in Sierra Leone

In many respects internally displaced persons (IDPs) are more at risk than refugees because they are not protected under the mandate of a specific UN agency. In addition to the protection of the UN High Commissioner for Refugees (UNHCR), refugees also have legal recourse under International refugee law. Women in IDP camps face the same problems refugees do. Male food distributors cheat women on their food allocations and demand sexual favors in exchange for entitlements of food. Male hegemony prevails in camps through the UN system of appointing men leaders and decision-makers. Even though a few women leaders may attend meetings, the power is decidedly in the hands of men. The gender imbalance-significantly fewer women employed by the UN and NGOs-perpetuates the disempowerment of refugee and displaced women and provides few opportunities for their voices to be heard.

Gender violence in the camps, including domestic violence within households, is a major problem. The rebels and other military units inflict brutalities on civilians in their paths. The rebels destroy villages and capture young people. Boys are forced to fight and are given drugs that induce them to commit atrocities. If they refuse they are killed. Girls become sexual slaves or servants to the combatants and sometimes fighters.

The girls who have either escaped or been released by the rebels suffer extensive psychological trauma and multiple physical problems. Nearly one hundred percent exhibit one or more STIs. In Bo, the YWCA assists former girl captives by providing counseling, one meal a day, and skills training. On arrival the girls are taken to a clinic for a reproductive health checkup and treatments. Of the 99 participants present when I visited the facility, all 99 tested positive for STIs; most had multiple infections. Testing for HIV was not available but the caretakers suspected several cases based on symptoms.

Many women believe the long conflict engendered a culture of violence that permeates Sierra Leonean society. Rwandan women refugees expressed the same sentiment. War erodes traditional practices that promote respect and gender balance in societies.

Time limits an extensive review in this presentation, but the following are some of the crucial issues facing refugee and internally displaced war-affected women and girls:

  • Inequitable distribution of resources within camps despite having gender guidelines in place
    · Women without adequate access to resources-particularly food-resort to coping strategies that put them at greater risk of HIV/AIDS
  • UN agencies, governments, and religious institutions have been unsuccessful in protecting individual women and children in conflict settings.
  • Forced migration caused by conflict increases the vulnerability of women in every regard but especially to gender based violence-rape, torture, abduction, forced marriage, slavery, trafficking and forced pregnancies.
  • UNHCR's mandate does not provide for the protection of individual refugees even though their policies describe various modalities for ensuring that the rights of women are protected. In practice, the institutional mechanism for operationalizing these policies is lacking.
  • Humanitarian assistance agencies do not see protection as part of their role. NGOs make assumptions that someone else will handle the problem.
  • Peace Keepers' Role in Gender Violence and HIV Transmission
  • Men dominate the UN. The skewed gender balance affects overall UN behavior and decisions throughout their operations. UN programs and implementation reflect the male perspective. Women's needs in peacekeeping and peace making are given low priority.

The UN needs to come to grips with the behavior of its soldiers in peacekeeping operations in relation to gender violence and prostitution. In 1951 the UN adopted the "Convention for the Suppression of Traffic in Persons and the Exploitation of the Prostitution of others" that prescribes punishment of any person who procures or entices another into prostitution. Despite this effort, prostitution and trafficking of persons has increased. The UNTAC mission to Cambodia depicted many of the negative aspects of peacekeeping. According to a BRIDGE report from 1995, in Phnom Penh from 1992 to 1993 the number of commercial sex workers increased from 6,000 to 20,000. Moreover, the countries contributing troops did not provide HIV/AIDS prevention education to the troops prior to deployment. While statistics of HIV infection in the military are rarely available, it is probable that UNTAC troops, as well as the local population, experienced an increase in the number of HIV positive persons.


  • All peacekeeping and peace enforcement soldiers must be trained in international human rights laws, gender awareness and preventing gender violence, and HIV/AIDS safeguards
  • UN mission staff must be gender balanced
  • Violations and gender abuse must be exposed and those responsible prosecuted to the extent possible
  • Condoms and treatment for STIs musts be available to troops, refugees, war displaced, and to local populations
  • Donors should provide more funding to combat gender violence and HIV/AIDS