Patricia Nell Warren

War and AIDS

Filed By Patricia Nell Warren | January 31, 2013 11:00 AM | comments

Filed in: Living, Marriage Equality
Tags: civil war, HIV transmission, HIV/AIDS, human rights abuses, Nigeria, rape, Uganda, UN

The UN News Center just aired this headline: "Rape and torture among serious rights violations spawned by Mali crisis." According to UN reports -- in northern Mali, where radical Islamist rebels have established sharia law, bigstock-War-4718998.jpgwomen are suffering violent sexual punishments for now-outlawed behaviour like riding a motorbike or not being totally veiled. A UN spokesperson just told the press: "Rapes of women and girls, at times in front of family members ... have been repeatedly used in the North to intimidate people and break any form of resistance."

Till now, Mali had a relatively low rate of HIV transmission. But with civil-war rape now exploding, those figures may rise.

Most Americans think of HIV transmission as taking place in peacetime situations. Examples: among sex workers, or mutually consenting heterosexuals or MSMs, or even porn stars who didn't wear a condom. U.S. prevention programs are definitely tailored to peacetime. Yet as far back as the 1990s, civil wars around the world have been identified as a major factor in the spread of AIDS.

Few people talk about this ugliest form of HIV transmission--atrocities against civilians, and war rape. It's not even mentioned in the standard list of transmission routes. But we have to ask ourselves how many of the estimated two million-plus new infections around the world every year are the result of war rape. From there, we have to consider how treatment in these cases has to reach way beyond routine HIV testing and ARV drugs. For each woman, child and man who is raped, there may be lasting effects of internal injury, not to mention the extreme psychological trauma.

According to, the last hundred years have seen a huge shift in the percentage of civilian deaths during warfare. "During World War I," says this military-oriented NGO, "civilians made up fewer than 5 percent of all casualties. Today, 75 percent or more of those killed or wounded in wars are non-combatants."

Africa -- Afflicted by War

Global Security goes on to comment, "Africa, to a greater extent than any other continent, is afflicted by war. Africa has been marred by more than 20 major civil wars since 1960. Rwanda, Somalia, Angola, Sudan, Liberia, and Burundi are among those countries that have recently suffered serious armed conflict....Billions of dollars of development assistance have been virtually wasted in [these] war-ravaged countries." Indeed, any map of Africa showing the war zones is literally pockmarked with them.

Today the U.S. AIDS establishment has a big focus on getting testing and treatment into every African country where AIDS exists. These tasks are difficult enough in regions lacking in the most minimal public-health delivery systems. But the tasks can be more difficult, sometimes impossible, in regions where fierce civil fighting is going on, or where tens of thousands of refugees are living piled up in huge camps.

Says UNICEF: "We are very much aware of the hostilities and human suffering that are deeply connected with conflicts across the African continent. Yet the situation is far worse than what we see, read and feel sitting thousands of miles away from the conflict zones. UNICEF has warned that rape and sexual violence in some of the conflicts of Africa have taken the form of an epidemic....While sexual violence is common in war-zones, women and children are now being raped in displacement camps, during aid distribution and even after conflicts have ended."

Worse yet--according to Amnesty International, war rape has evolved beyond the historic pattern of victorious soldiers gratifying themselves sexually while looting. Today it often is a key element of military strategy. In countries where traditional societies still reign, victims of war rape can find themselves shunned by spouses, families, and society generally. So a sheer mass of these crimes, directed at civilian "enemies," can swiftly contribute to the collapse of morale and social order on that other side.

Just a year ago, Doctors Without Borders reported on widespread rapes during fighting between government troops and rebel bands in the Democratic Republic of the Congo. According to agency representative Annemarie Loof, who was speaking with CNN World, "Women had been restrained with ropes or beaten unconscious with the butt of a gun before being attacked, some in front of their children." In 2012, the Journal of the American Medical Association did a study in Eastern Congo, revealing that an estimated thirty percent of the region's women and twenty-two percent of its men had been subjected to rape by soldiers.

In 2004, the UN News Center reported on a similar epidemic of rapes in the Darfur region of Sudan. The news service stated: "Armed militias in Sudan's strife-torn Darfur region are continuing to rape women and girls with impunity, an expert from the United Nations children's agency said today on her return from a mission to the region. Pamela Shifman, the UN Children's Fund (UNICEF) adviser on violence and sexual exploitation, said she heard dozens of harrowing accounts of sexual assaults."

Uganda's Example

Uganda is a case in point, since it has been ballyhooed as the first African country to introduce the faith-based ABC prevention program teaching "Abstinence before marriage; Be faithful; Condoms." Ironically this program could only have succeeded in a peacetime setting. Yet from 1981 on, Uganda's northern reaches have been consumed with chronic civil war against a rebel army, and reports of sexual atrocities against civilians have been rife. Not surprisingly, later surveys showed that the ABC program was not very successful.

The spread of AIDS in Uganda was analyzed through the lens of civil war by the British science journal Epidemiology and Infection in its August 1991 issue. Authors Smallman-Raynor and Cliff commented, "The classic association of war and disease substantially accounts for the presently observed geographical distribution of reported clinical AIDS cases in Uganda. Both the spread of HIV 1 infection in the 1980s, and the subsequent development of AIDS to its 1990 spatial pattern, are shown to be significantly and positively correlated with ethnic patterns of recruitment into the Ugandan National Liberation Army (UNLA)....This correlation reflects the estimated mean incubation period of 8-10 years for HIV 1 and underlines the need for cognizance of historical factors which may have influenced current patterns of AIDS seen in Central Africa. The findings may have important implications for AIDS forecasting and control in African countries which have recently experienced war."

As further irony, Uganda makes news with its ongoing determination to pass the notorious "anti-gay" law. One clause applies to people with HIV, stating, "A person commits the offense of aggravated homosexuality where the offender is a person living with HIV." In the most recent version of the bill I've seen, the punishment for an HIV-positive offender is life imprisonment. But some observers continue to insist that the bill, in its final form, will contain the death penalty. Either way...what injustice might befall an HIV-positive Ugandan man caught in the toils of such a prosecution, whose status is the result of war rape? Who might not have known he was positive till he was forcibly tested? How does he defend himself?

With Muslim/Christian civil conflict continuing in Uganda, it's no wonder that many observers say enforcement of this law will greatly complicate the war on AIDS in Uganda.

Americans Often Oblivious

Here in the U.S., the AIDS establishment is gearing up to pump new ARVs into Africa, in the wake of all those recent pronouncements that "treatment must be made available to more millions." AIDS Healthcare Foundation just announced: "Dr. Salami Olawale, the Nigerian Country Director for the AIDS Healthcare Foundation (AHF), has announced that about 300,000 Nigerians have been infected with HIV since the start of 2012. Olawale announced this sobering fact during a call to action encouraging members of Nigerian communities to get tested for HIV--something only about 20% of the country's population has done."

Yet Nigeria has just experienced a new flare-up of civil war. In northern Nigeria this past summer, heavy fighting broke out between Christians and Muslims, who are retaliating on each other with widespread killings and burnings of property. Government troops raced in to restore peace. But according to Amnesty International, reports of atrocities against civilians by both sides have reached Western media. Given the fierce hatreds between the two religious factions, sexual violence was a given. Yet little is said that some of these 300,000 new Nigerian cases of HIV may be the tragic result of war rape.

Americans are often oblivious to the way in which war-time sexual violence will cut across their ARV efforts in Africa.

Shortly after I published this commentary in A & U Magazine, civil war broke out in the West African nation of Mali. And a new name was added to the list of countries where this problem may now become endemic.

How to ensure that these casualties of war are treated with respect, once their HIV status becomes known to their families and their local societies? Once it is known that their infection resulted from war rape? How can governments take AIDS aid without making efforts to change old attitudes that shun and stigmatize these victims of war crimes? Without a change in attitudes, any adult victim might understandably do everything possible to avoid being tested or treated, for fear of the social consequences.

Today, in the U.S. media, the air is full of grand statements about how "global AIDS can be ended in our lifetime" if only enough test kits and doses of drugs are pumped out there.

But the fact is--war everywhere on our planet will have to end before we can even talk about "ending AIDS."

A shorter version of this commentary originally appeared in the December 2012 issue of A & U Magazine. This new version is updated with mention of the Mali conflict. New version is copyright 2013 by Patricia Nell Warren. All rights reserved. War graphic via Bigstock.

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