HIV, AIDS and Conflict in Africa: Why Isn’t It (Even) Worse?

Abstract

The argument that there is a link between conflict and the spread of HIV has become commonplace in both the academic and policy world. This is particularly so for sub-Saharan Africa given the combination of an HIV pandemic in the region and high levels of violent conflict and state instability. However the link is not straightforward. Crucially, despite significant risk factors indicating a relationship between conflict and the spread of HIV, empirical evidence exists that HIV does not always increase in times of conflict, and that in some conflicts prevalence has decreased. This suggests a more complex relationship than originally envisaged. This paper does four things. First, it examines the risk factors identified in the early years of this decade which indicated a relationship between conflict and the spread of HIV. Second, it discusses how empirical evidence began to emerge suggesting a more complex relationship and how a number of conflicts demonstrated reduced HIV prevalence despite these risk factors. The third section moves beyond risk factors to suggest a framework based on susceptibility and vulnerability which explains under what circumstances HIV might - and might not - be spread, despite the presence of risk factors. The final section examines four cases - Sierra Leone, Angola, Rwanda and the DRC - where conflict did not lead to a significant increase in the prevalence of HIV, using the previous framework as the basis to explain this phenomenon. The paper concludes that, despite the fears of a few years ago, conflict does not readily act as a vector for HIV, though the potential for this to occur does still exist under certain circumstances.