Report on Refugees and Internally Displaced Persons - The President's Emergency Plan for AIDS Relief (February 2006) PDF version House Report 109-152, accompanying H.R. 3057, called upon the Office of the United States Global AIDS Coordinator to report as follows: The Committee requests the Global HIV/AIDS Coordinator, in consultation with USAID, the Bureau of Population, Refugees, and Migration, and other stakeholders, to develop a comprehensive approach to addressing the special HIV/AIDS needs of refugees and internally displaced persons (IDPs). The Committee notes that refugees and IDPs are especially vulnerable to HIV/AIDS, due to fragmentation of families, frequent movement, increased sexual violence, and greater socio-economic vulnerability. Many countries in Africa face a double burden of HIV/AIDS and large numbers of refugees or IDPs. Nine such countries—Cote D’Ivoire, Ethiopia, Kenya, Namibia, Rwanda, South Africa, Tanzania, Uganda, and Zambia—are also Emergency Plan focus countries. The Committee urges the Office of the U.S. Global AIDS Coordinator, in coordination with others in the State Department and USAID that have special expertise on refugees, to develop a comprehensive approach to addressing the special HIV/AIDS needs of refugees and IDPs. Report to Congress Mandated by House Report 109-152 Submitted by the Office of the U.S. Global AIDS Coordinator February 2006 I. EXECUTIVE SUMMARY Extended displacement and the disruption of refugees’ lives can put them at increased risk for HIV/AIDS, due to factors such as exposure to sexual violence, economic vulnerability, and increased contact with surrounding populations with higher HIV prevalence. The United Nations High Commissioner for Refugees (UNHCR) reports that, on average, refugees will spend seventeen years outside of their home country.1 Approximately eighty percent of refugees are women and children. Considering the economic, social, and health risks that accompany displacement, HIV/AIDS services are important in order to protect refugees as well as people in host communities and countries of return. The United States (U.S.) recognizes the particular responsibility of the international community for refugee welfare and the need for adequate services to be provided to refugees. In Fiscal Year (FY) 2005, the U.S. Government, through the Department of State’s Bureau of Population, Refugees, and Migration (PRM), provided nearly $1 billion to support international efforts to protect and assist refugees, conflict victims, and vulnerable migrants. No single international organization is exclusively devoted to addressing the protection and assistance needs of IDPs. Although there is less available data about displaced populations, they often face similar risk factors for HIV/AIDS as refugees. However, addressing the protection and assistance of IDPs may require overcoming other barriers as well. In FY 2005, USAID’s Food For Peace program provided almost $600 million in food and program support resources to refugees and IDPs through the World Food Program (WFP) and other partners. These resources included approximately $400 million for IDPs. Many of the countries that receive funding from the President’s Emergency Plan for AIDS Relief (the Emergency Plan), including some focus countries, have significant refugee and/or displaced populations.2 In FY 2005, the Emergency Plan supported HIV/AIDS prevention, treatment and care interventions for some refugee populations, including programs supported through PRM. In FY 2005, planned funding for activities targeting refugees or IDPs was $27 million; in FY2006, $53.7 million is planned for these activities. It is the Emergency Plan’s goal that refugee populations in focus countries have access to the same level of prevention, treatment, and care as nationals of those countries. In some cases, host governments (with or without Emergency Plan funds), UNHCR, and other international partners have adequate resources to provide this level of access. In most cases, however, host governments do not incorporate refugees into their HIV/AIDS programs. Resource constraints limit the ability of UNHCR and its partner organizations to provide the same level of HIV/AIDS services enjoyed by host nationals. The Emergency Plan encourages country teams in focus countries to make a determined effort to consider the particular needs of refugees and IDPs, to make them eligible on an equal basis for Emergency Plan programs, and to make special arrangements where necessary to reach refugee and displaced populations that are not adequately served by other means. The Emergency Plan aims to implement international HIV/AIDS programs so that refugees and IDPs are not discriminated against in access to prevention, treatment, and care services. The Emergency Plan will continue to emphasize prevention to protect refugee, displaced, and host populations. The Emergency Plan will work along with international partners to identify unmet HIV/AIDS needs of refugees and IDPs, in order to ensure that they are adequately addressed. II. REFUGEES and IDPs: CURRENT POPULATIONS At the beginning of 2005, there were 13.4 million refugees recognized by the UN (9.2 under UNHCR3 and 4.2 under UNRWA4) or governments that have signed the various UN or regional instruments relating to the status of refugees. Over twenty percent of the global refugee population is in Africa. Though the overall number of refugees worldwide has decreased in recent years, increases have occurred in Central Africa and the Great Lakes Region, East and Horn of Africa, as well as Asia and the Pacific. Together, women and children make up approximately 80% of the refugee population.5 In many countries, refugee women and children are vulnerable to gender-based violence, abuse, and exploitation. In partnership with the UN, other international and non-governmental organizations, the U.S. Government (through PRM) has programmed resources to prevent and respond to these vulnerabilities. In 2004, the Internal Displacement Monitoring Center estimated that there were approximately 25,000,000 IDPs displaced by conflict in 48 countries.6 More than half of the world’s displaced people live in Africa, and nearly half live in countries experiencing ongoing conflict. The displaced may have needs distinct from those of refugee populations; as such, emphasis is being placed on gathering data about, and advocacy for, the displaced. III. The Challenge of HIV/AIDS and Refugees and IDPs
HIV Prevalence Among Refugee Populations: Although refugees may have higher or lower HIV prevalence rates than their host communities, they often suffer from the perception that they “bring HIV/AIDS” with them.9 Studies have documented that despite their displacement and disruption of their normal lives, HIV prevalence in several refugee communities was actually lower than the surrounding population. A 2002 UNHCR surveillance study among pregnant women in more than 20 camps housing 800,000 refugees in Kenya, Rwanda, Tanzania and Sudan found low HIV prevalence among refugees compared to the surrounding local population.10 Table 5: HIV Prevalence in Refugee Camps* More recently, preliminary results from a 2005 HIV and syphilis sentinel surveillance survey conducted in Mwange and Kala camps, Zambia, found an HIV prevalence rate of 2.4% among pregnant women who were attending antenatal care for the first time during their current pregnancy.11 These rates were much lower than the general population prevalence rate in Zambia. Considering the refugees’ vulnerability and the length of time they may remain in Zambia, this is a critical opportunity to implement prevention programs to maintain low prevalence among the refugee population. The focus of UNHCR’s HIV/AIDS activities is prevention, to ensure that those who are HIV-negative remain so. UNHCR’s 2005-2007 strategic plan for HIV/AIDS in refugee populations stresses the need for: integrating refugees into HIV/AIDS policies, funding proposals, and programs of countries of asylum; addressing the needs of refugee women and children, the most vulnerable of an at-risk population; developing sub-regional approaches that reflect the cycle of displacement; and eliminating HIV-related discrimination against refugees and other persons of concern to UNHCR. Obstacles to Meeting HIV/AIDS Needs of Refugees and IDPS
Internally displaced persons, since they remain inside their own countries, may face additional challenges because:
IV. EMERGENCY PLAN STRATEGY AND PRIORITIES
Emphasis on Prevention Coordination and Cooperation with International Partners Service Integration Building on Existing Health Infrastructure IDPs who are not served by established camps present special challenges for service provision. Those who reside with relatives may have access to existing HIV/AIDS services in their host communities. However, IDPs often settle in urban slums or squatter settlements that are under-served by the formal health sector. Therefore, a key challenge is to improve access to HIV/AIDS prevention, treatment, and care services to those living in such marginal settlements. Integration of Services for Refugees, IDPs, and Host Communities: Continuity of Care Upon return to their countries of origin, regular monitoring and follow-up to ensure continuity of care to refugees is a particular challenge. Whether refugees qualify for ART and how treatment can be maintained is a judgment that must be made based on the overall situation of each population. The U.S. Government intends to maximize the ability of refugees to benefit from ART, but is not in a position to be responsible for on-going treatment in the case of repatriation to countries such as Angola, Sudan, Somalia or Liberia, which are not focus countries and where conditions do not presently exist that would allow widespread ART. The Emergency Plan will encourage open dialogue among international partners, host countries, and countries of origin to ensure the continuation of ART and other services for repatriated refugees. The Emergency Plan works with partners to strengthen regional initiatives that serve refugees. V. HIV/AIDS SERVICES TO REFUGEES AND IDPS: U.S. LEADERSHIP In FY 2005, 61 Emergency Plan activities in focus countries, with total funding of $27 million, were specifically aimed at refugees and IDPs. In FY 2006, refugees and IDPs are referenced as target populations in 83 planned activities. Planned Emergency Plan funding for these activities is $53.7 million. In a number of Emergency Plan focus countries, activities focused solely on service provision in refugee camps are underway or scheduled for implementation in FY2006:
Also in FY 2005, PRM funding for HIV/AIDS interventions included supporting access to PMTCT services for women in all of Tanzania’s camps. These figures and examples, however, tell only part of the story, since it has long been U.S. policy to encourage host governments to integrate refugees into nationally-provided services. Thus, some Emergency Plan activities benefit refugees, even if refugees are not the target population. For example, in Uganda, prevention of mother-to-child-transmission services intended for host country nationals are also accessed by refugees at the Kyangwali and Palorinya settlements, which host 220,000 refugees.12 The U.S. Government supports HIV/AIDS services to refugees and IDPs through several funding channels. PRM contributes to UNHCR, other international organizations, and NGOs for the care of refugees, conflict victims, IDPs, and vulnerable migrants. In 2005, PRM made significant contributions to UNHCR. USAID’s Food For Peace program, through WFP and other organizations, provides resources for refugees and IDPs. WFP has incorporated HIV/AIDS prevention into the majority of its food distribution programs supported by USAID. USAID’s Office of Foreign Disaster Assistance (OFDA) has a mandate to work with displaced populations in emergency settings and has prioritized the provision of HIV/AIDS prevention messages as part of primary health care provision. USAID’s Displaced Children and Orphans Fund also supports projects to protect especially vulnerable children among internally displaced populations. The existing health and social services that the UN and other entities provide to refugees, such as education, water, and sanitation, can serve as a platform for extending the reach of HIV/AIDS services. In other circumstances, the Emergency Plan funds PRM or one of the implementing partners working with PRM and/or UNHCR. At Kenya’s Kakuma camp, home to about 90,000 refugees, the Emergency Plan is collaborating with the International Rescue Committee to build HIV/AIDS counseling and testing, treatment, prevention, and palliative care services into existing health infrastructure. ART was initiated in FY 2005 on a pilot basis, with the aim to expand in FY 2006. Addressing gender issues is central to all Emergency Plan activities. The U.S. Government aims to implement programs addressing gender issues in refugee and displaced populations, which benefit not only women, but also their children, whose risk factors for vulnerability increase through the illness or death of a parent or caretaker. The Emergency Plan is specifically addressing these issues, with initiative to increase gender equity in HIV/AIDS programs and services, reduce violence and coercion, and address male norms. 1Spiegel, B.; A. Miller, A., M. Schilperoord. Best Practice Strategies to Support the HIV-related Needs of Refugees and Host Populations. UNHCR/UNAIDS. (2005). |
 | |||
|
