HIV, AIDS and conflict in Africa: Why isn't it (even) worse?

Review of International Studies

Volumn 37, Issue 2, 2011, Pages 485-509

  McInnes, Colin ^a,b  

^a Centre for Health and International Relations   (United Kingdom)

^b ABERYSTWYTH UNIVERSITY   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 79953124053     PISSN: 02602105     EISSN: 14699044     Source Type: Journal    
DOI: 10.1017/S0260210510000574     Document Type: Article

References (254)

1. AIDS is a syndrome of infections and diseases which develops in human immune systems weakened by the virus HIV. Although often linked in the literature as one (typically 'HIV/AIDS'), for this article it is appropriate to separate them. It is HIV which is spread by human-to-human contact and the article is concerned with the potential for conflict to accelerate this spread; but it is AIDS which kills.
2. UNAIDS, 2008 AIDS Epidemic Update (Geneva: UNAIDS/WHO, 2008), pp. 32-3.
3. See also UNAIDS, 2009 Update Report, available at: {http://data.unaids. org/pub/Report/2009/JC1700-Epi-Update-2009-en.pdf}, which uses the 2008 data.
4. Stefan Elbe, 'HIV/AIDS and the changing landscape of war in Africa', International Security 27 (Autumn 2002).
5. On the link between conflict and HIV, see, Elbe, 'Changing landscape', p. 174;
6. Paul B. Spiegel, Anne Rygaard Bennedsen, Johanna Claas, Lauire Bruns, Njogu Patterson, Dieudonne Yiweza, Marian Schilperoord, 'Prevalence of HIV infection in conflict-affected and displaced people in seven sub-Saharan African countries', The Lancet, 369 (June 2007), pp. 2187 and 2191;
7. Jeff Gow, 'The HIV/AIDS epidemic in Africa: implications for US policy', Health Affairs, 21 (May/June 2002), p. 65;
8. Dennis Altman, 'AIDS and security', International Relations, 17 (December 2003), p. 421.
9. See, also for example, Duane Bratt, 'Blue condoms: the use of international peacekeepers in the fight against AIDS', International Peacekeeping, 9 (Autumn 2002), p. 72;
10. Peter Fourie and Martin Schonteich, 'Africa's new security threat: HIV/AIDS and human security in Africa', African Security Review, 10 (2001), p. 6, available at: {http://www.iss.co.za/Pubs/ASR/10No4/Fourie.html}, subsequent page references are to online version;
11. N. A. Betsi, B. G. Koudou, G. Cisse, A. B. Tschannen, A. M. Pignol, Y. Ouattara, Z. Madougou, M. Tanner and J. Utzinger, 'Effect of an armed conflict on human resources and health systems in Cote d'Ivoire', AIDS Care, 18 (May 2006), p. 36;
12. S. Verstegen, HIV/AIDS: Waking up to the Challenge, working document prepared by Conflict Research Unit, Clingendael Institute for the Netherlands Ministry of Foreign Affairs Special Ambassador for HIV/AIDS (March 2005), p. 24;
13. Vinh-Kim Nguyen and Katherine Stovel, The Social Science of HIV/AIDS: A Critical Review and Priorities for Action, report prepared by the Social Science Research Council Working Group on HIV/AIDS (October 2004), pp. 11-2;
14. Nancy B. Mock, Samba Duale, Lisanne F. Brown, Ellen Mathys, Heather C. O'Maonaigh, Nina K. L. Abul-Husn and Sterling Elliott, 'Conflict and HIV: A framework for risk assessment to prevent HIV in conflict-affected settings in Africa', Emerging Themes in Epidemiology, 1 (October 2004), available from BioMed Central, subsequent page references from the open access version;
15. Timothy Docking, AIDS and Violent Conflict in Africa, USIP Special Report 75 available at: {http://ww.usip.org}, p. 7.
16. High prevalence is defined as a rate above 3 per cent in the general population.
17. See UNAIDS, 2008 AIDS Epidemic Update, p. 34.
18. UN Security Council [UNSC] Press Release SC/6781 (10 January 2000). Available at: {http://www.un.org/News/Press/docs/2000/20000110.sc6781.doc.html}.
19. UNSC Resolution [UNSCR] 1308 (July 2000), p. 2. Available at: {http://www.un.org/Docs/sc/unsc-resolutions.html}.
20. Although more recent empirical evidence supports the case for a link. See Zaryab Iqbal and Chris Zorn, 'Violent conflict and the spread of HIV/AIDS in Africa', Journal of Politics (forthcoming, 2010). I am grateful to the editors of JOP for permission to make reference to this forthcoming article.
21. For a fuller discussion of these risk factors see Colin McInnes, 'Conflict, HIV and AIDS: a new dynamic in warfare?', Global Change, Peace and Security, 21 (February 2008), pp. 99-114.
22. International Crisis Group (ICG), HIV/AIDS as a Security Issue in Africa: Lessons from Uganda (Kampala/Brussels: ICG, 2004), p. 1.
23. For a more extensive discussion on this and the reasons behind it, see Colin McInnes, 'HIV/AIDS and security', International Affairs, 82:9 (March 2006), pp. 315-26
24. and 'HIV/AIDS and national security', in Nana K. Poku, Alan Whiteside and Bjorn Sandkjaer (eds), AIDS and Governance (Aldershot: Ashgate, 2007), pp. 93-114.
25. See also Eric G. Bing, Daniel Ortiz, Ricardo E. Ovalle-Bahamon, Karen G. Chen, Fannie H. Huang, Francisco Ernesto and Naihua Duan, 'HIV/AIDS behavioural surveillance among Angolan military men', AIDS Behaviour, accessed from PubMed PMID 17641966;
26. A. Pistorius, G. Gergen and B. Willershausen, 'Survey about the knowledge of the HIV infection amongst recruits of the German military', European Journal of Medical Research, 30 (April 2003), pp. 154-60;
27. E. van der Ryst, G. Joubert, F. Steyn, C. Heunis, J. le Roux, and C. Williamson, 'HIV/AIDS related knowledge, attitudes and practices among South African military recruits', South African Medical Journal, 91 (July 2001), pp. 587-91; (Pubitemid 32707862)
28. Harley Feldbaum, Kelley Lee and Preeti Patel, 'The national security implications of HIV/AIDS', PLoS, 3 (June 2006), p. e171;
29. Elbe, 'HIV/AIDS and the changing landscape of war';
30. UNAIDS, Uniformed Services Programming Guide (Geneva: UNAIDS, 2003), pp. 7-10;
31. US National Intelligence Council, The Global Infectious Disease Threat and Its Implications for the US, National Intelligence Estimate NIE99-17D (Washington: CIA, 2000). Available at: {http://www.cia.gov/cia/publications/nie/ report/nie99-17d.html};
32. International Crisis Group (ICG), HIV/AIDS as a Security Issue (Brussels: ICG, 2001), pp. 20-1;
33. Robert L. Ostergard Jr, 'Politics in the hot zone: AIDS and national security in Africa', Third World Quarterly, 23 (April 2002), p. 343;
34. Peter Chalk, 'Infectious disease and the threat to national security', Jane's Intelligence Review (September 2001), p. 49;
35. Alan du Pont, HIV/AIDS: A Major International Security Issue, Asia Pacific Ministerial Meeting (October 2001) (Canberra: Commonwealth of Australia, 2001), p. 7;
36. Verstegen, HIV/AIDS, p. 16;
37. Bratt, 'Blue condoms', p. 71;
38. Mark Schneider and Michael Moodie, The Destabilising Impact of HIV/AIDS (Washington: Center for Strategic and International Studies, 2002), p. 6;
39. Paolo Tripodi and Preeti Patel, 'The global impact of HIV/AIDS on peace support operations', International Peacekeeping, 9 (Autumn 2002), p. 164.
40. For example, UNAIDS, Technical Update: AIDS and the military, May 1998 (Geneva/New York, UNAIDS, 1998);
41. UNAIDS, HIV/AIDS Prevention and Care among Armed Forces and UN Peacekeepers: the Case of Eritrea (Geneva/New York: UNAIDS, 2003), p. 8.
42. UNAIDS, On the Front Line 1st edition (Geneva/New York: UNAIDS, 2003), pp. 5-6;
43. NIE 99-17D, The Global Infectious Disease Threat, available at: {http://www.cia.gov/cia/publications/nie/report/nie99-17d.html};
44. Lindy Heinecken, 'Facing a merciless enemy: HIV/AIDS and the South African armed forces', Armed Forces and Society, 29 (Winter 2003), p. 784;
45. Ostergard, 'Politics in the hot zone', p. 343;
46. ICG, HIV/AIDS as a Security Issue, p. ii
47. and Lessons from Uganda, pp. 2-3;
48. Schneider and Moodie, The Destabilising Impact, p. 2.
49. See, for example, Docking, AIDS and Violent Conflict, p. 7.
50. But in contrast see Alex de Waal, 'HIV/AIDS and the military', background paper to expert seminar and policy conference, AIDS, Security and Democracy, Clingendael Institute, The Hague (2-4 May 2005), p. 7.
51. See, for example, K. S. Subramanian, Impact of Conflict on HIV/AIDS in South Asia (2002), available at: {http://aidsportal.org/store/770.pdf}, p. 50.
52. See also PW Singer, 'AIDS and international security', Survival, 44 (Spring 2002), pp. 150-1.
53. Though Ciantia sounds a note of caution, Filippo Ciantia, 'HIV seroprevalence in northern Uganda', Journal of Medicine and the Person, 2 (December 2004), p. 174.
54. Oumar Ba, Christopher O'Regan, Jean Nachega, Curtis Cooper, Aranka Anema, Beth Rachlis and Edward J. Mills, 'HIV/AIDS in African militaries: an ecological analysis', Medicine, Conflict and Survival, 24:2 (May 2008), p. 88-100.
55. Bratt, 'Blue condoms', p. 71;
56. UNAIDS, 'AIDS and conflict: a growing problem worldwide', 2004 Report on the Global AIDS Epidemic (Geneva: UNAIDS/WHO, 2004). Available at: {http://www.unaids.org/bangkok2004/GAR2004-html/GAR2004-12-en.htm#P1704-379265};
57. Rene Bennett, The Correlation between Conflict and the Spread of HIV/AIDS to Women. Available at {http://www.sit-edu-geneva.ch/conflicthiv-and.htm}, p. 14.
58. Bennett, Correlation, p. 23.
59. Bennett, Correlation, p. 14.
60. See also below.
61. Global Coalition on Women and AIDS, 'Sexual violence in conflict settings and the risk of HIV', Violence Against Women and HIV/AIDS, Information Bulletin Series, 2 (2004), p. 1.
62. See also UNICEF, Children, Armed Conflict and HIV/AIDS (New York: UNICEF, 2003), pp. 2-3;
63. Mock et al., 'Conflict and HIV', p. 7;
64. Subramanian, Impact of Conflict on HIV/AIDS, p. 49;
65. Nguyen and Stovel, The Social Science of HIV/AIDS, p. 11;
66. Mbow and Webb, 'HIV/AIDS affected children', p. 50.
67. Human Rights Watch, The War within the War: Sexual Violence against Women and Girls in Eastern Congo (New York: Human Rights Watch, 2002).
68. Singer, 'AIDS and international security', pp. 152-3.
69. See also Dan Thomas, 'AIDS 2006: conflict makes girls and women even more vulnerable to HIV', available at {http://www.unicef.org/aids/index-35317.html}, accessed on 12 May 2008;
70. UNAIDS, 'AIDS and conflict';
71. Bennett, Correlation, p. 13;
72. Verstegen, HIV/AIDS, p. 4;
73. [No author] 'The Democratic Republic of Congo [DRC]: a country raped by all types of men', Women's World, 34 (1999), pp. 22-3.
74. UNICEF, Children, Armed Conflict.
75. But see also the case study on Rwanda below.
76. See for example Mock and others, 'Conflict and HIV';
77. Bennett, Correlation, p. 15;
78. Subramanian, Impact of Conflict, p. 51;
79. Anthony B. Zwi, Antonio Ulgalde and Patricia Roberts, 'Effect of war and political violence on health services', Encyclopedia of Violence, Peace and Conflict Vol. 1 (New York and London: Academic Press, 1999), pp. 683-5;
80. Bratt, 'Blue condoms', pp. 71-2;
81. Elbe, 'HIV/AIDS and the changing landscape of war', p. 172.
82. Tom Ellman, Heather Culbert and Victoria Torres-Feced, 'Treatment of AIDS in conflict-affected settings: a failure of imagination', The Lancet, 365 (January 2005), pp. 2 and 4, although the authors also point out that the movement of people living with HIV or AIDS to refugee camps may make anti-retroviral therapies (ARTs) easier to administer. See also Tony Barnett, 'Mapping the future of HIV/AIDS, Security and Conflict in Africa', paper presented to Justice Africa/LSE AIDS Joint NGO/Academic Seminar, King's College, London (6 December 2005), p. 1.
83. Betsi et al., 'Effect of armed conflict', pp. 359-64.
84. Mock et al., 'Conflict and HIV'.
85. Verstegen, HIV/AIDS, p. 5.
86. See also Fourie and Schonteich, 'Africa's new security threat', p. 7.
87. Bratt, 'Blue condoms', p. 68;
88. Schneider and Moodie, The Destabilising Impact, p. 8;
89. Chalk, 'Infectious disease', p. 49;
90. UNAIDS, On the Front Line, 1st edition, p. 6, Table 2.
91. UN, A Comprehensive Strategy to Eliminate Future Sexual Exploitation and Abuse in UN Peacekeeping Operations, Report A/59/710 (New York: UN, 2005), paras 3-10, 44 and 62.
92. See also UNSC Press Release SC/8400 (31 May 2005), available at {http://www.un.org/News/Press/docs/2005/sc8400.htm}. Ironically, the ready availability of condoms to peacekeepers - distributed as a means of protecting them against HIV - was seen by some soldiers as an unofficial endorsement of sexual exploitation.
93. See, for example, Paul B. Spiegel, 'HIV/AIDS among conflict-affected and displaced populations: dispelling myths and taking action', Disasters, 28 (September 2004), p. 323.
94. UNAIDS, On the Front Line, 3rd edition (Geneva: UNAIDS/WHO, 2005), p. 26.
95. Alex de Waal, 'HIV/AIDS and the military', p. 8.
96. De Waal's scepticism was reinforced by his doubt over the extent to which uniformed services experienced higher levels of HIV prevalence.
97. UNAIDS, On the Front Line, 3rd edition, p. 27;
98. Netherlands Ministry of Foreign Affairs (NMFA), HIV/AIDS, Security and Democracy, Seminar Report, Clingendael Institute (4 May 2005), p. 5.
99. On possible initiatives to prevent the spread of HIV/AIDS in militaries, see UNAIDS, Uniformed Services Programming Guide (Geneva: UNAIDS, 2003).
100. See also Martin Foreman, Combat AIDS: HIV and the World's Armed Forces (London: Healthlink Worldwide, 2002), pp. 37-48;
101. UNAIDS Initiative on HIV/AIDS and Security: Third Quarterly Report (2002), available at: {http://www.who.int/hac/techguidance/pht/UNAIDS- initiative-HIV-security/en/};
102. ICG, Lessons from Uganda, pp. 3, 8-9 and 14.
103. The UN's AIDS awareness card is available from {Awareness@unaids.org}.
104. For details on the card see UNAIDS Uniformed Services Programming Guide, p. 12.
105. Spiegel et al., 'Prevalence of HIV infection', p. 2007.
106. See also Richard Walker, 'UNHCR study challenges assumptions about refugees and HIV spread', AIDSPortal news, available at: {http://www.aidsportal. org/News-Details.aspx?id=5215&nex=51}, accessed on 12 May 2008; UNAIDS, 'AIDS and conflict'; de Waal, 'HIV/AIDS and the military', p. 8.
107. See also Richard Walker, 'UNHCR study challenges assumptions about refugees and HIV spread', AIDSPortal news, available at: {http://www.aidsportal. org/News-Details.aspx?id=5215&nex=51}, accessed on 12 May 2008; UNAIDS, 'AIDS and conflict'; de Waal, 'HIV/AIDS and the military', p. 2191.
108. Aranka Anema, Michael R. Joffres, Edward Mills and Paul B. Spiegel, 'Widespread rape does not directly appear to increase the overall HIV prevalence in conflict-affected countries: so now what?', Emerging Themes in Epidemiology, 5 (2008), available at: {http://www.ete-online.com/content/5/1/11}.
109. Zwi et al., 'Effect of war'.
110. Data for this comparison was taken from: UNAIDS' annual epidemic updates (see n. 2); UN DPKO, Background Note: 31 December 2005, available at: {http://www.un.org/Depts/dpko/bnote.htm#unmil}, last accessed on 26 January 2006;
111. US General Accounting Office, UN Peacekeeping: UN faces Challenges in Responding to the Impact of HIV/AIDS on Peacekeeping Operations, Report GAO-02-194 (Washington DC: US General Accounting Office, 2001).
112. Spiegel et al., 'Prevalence of HIV infection', p. 2193;
113. Iqbal and Zorn, 'Violent conflict'.
114. See, for example, Ciantia, 'HIV seroprevalence in northern Uganda', p. 173-4;
115. Mbow and Webb, 'HIV/AIDS affected children', p. 48;
116. Nguyen and Stovel, The Social Science of HIV/AIDS, p. 12;
117. Mock et al., 'Conflict and HIV', pp. 2-3.
118. These terms are adapted from the 'Jaipur paradigm' of Barnett and Whiteside, used to explain the relationship between HIV and state instability. Tony Barnett and Alan Whiteside, 'The Jaipur Paradigm: a conceptual framework for understanding social susceptibility and vulnerability to HIV', South African Medical Journal, 90 (2000), pp. 1098-101. (Pubitemid 32124216)
119. T. C. Quinn, 'Global burden of the HIV pandemic', The Lancet, 348 (July 1996), pp. 99-106; (Pubitemid 26234359)
120. Tuofu Zhu, Bette T. Korber, Andre J. Nahmias, Edward Hooper, Paul M Sharp and David D. Ho, 'An African HIV-1 sequence from 1959', Nature, 391 (February 1998), pp. 594-7.
121. Mock et al., 'Conflict and HIV', p. 11;
122. Quinn, 'Global burden'.
123. Note also that since refugee flows are changes caused by conflict they fall under vulnerability rather than susceptibility, and are considered below under dissasortive mixing.
124. UNAIDS, 2008 AIDS Epidemic Update, pp. 88-9;
125. Roger England, 'The writing is on the wall for UNAIDS', British Medical Journal, 336 (May 2008), p. 102.
126. Ostergard et al., 'The relationship between HIV/AIDS', p. 21.
127. Although evidence of malnutrition increasing the risk of acquiring HIV is limited there is a strong impact on the development of AIDS in people living with HIV. Mocketal, 'Conflict and HIV', 9;
128. UNAIDS, 'HIV, food security and nutrition', Policy Brief (May 2008), available at: {http://data.unaids.org/pub/Manual/2008/jc1515a-policybrief- nutrition-en.pdf}.
129. See, for example, Spiegel, 'HIV/AIDS among conflict-affected and displaced populations', p. 323;
130. Verstegen, HIV/AIDS, 25;
131. Mock et al., 'Conflict and HIV', pp. 4 and 7;
132. UNAIDS, 'AIDS and conflict'.
133. Robert L. Ostergard, Matthew R. Tubin and Erin Schweber, 'The relationship between HIV/AIDS and rape: evidence from South Africa', paper presented to annual ISA Conference, San Francisco, (March 2008), especially pp. 2 and 5;
134. Ciantia, 'HIV seroprevalence', p. 172;
135. Mock et al., 'Conflict and HIV', p. 7.
136. Though note that the UNAIDS methodology has evolved over the years to improve accuracy.
137. Much of the information on the conflict is taken from the UCDP entry on Sierra Leone, {http://www.ucdp. uu.se}, last accessed on 15 September 2008. Hereafter UCDP, Sierra Leone.
138. Sierra Leone: Country Report on Declaration Commitment to HIV and AIDS (2006-07), unpublished version of report prepared for the UN General Assembly on HIV and AIDS, p. 42. Hereafter UNGASS, Sierra Leone.
139. See also data in UNHCR, The state of the World's Refugees 2006, especially annexes 2 and 4-6, available at: {http://www.unhcr.org/static/publ/ sowr2006/toceng.htm}.
140. UN DPKO, UN Mission in Sierra Leone, available at: {http://www.un.org/ Depts/dpko/missions/unamsil/index.html} last accessed in 2004.
141. Reinhard Kaiser, Paul Spiegel, Peter Salama, William Brady, Elizabeth Bell, Kyle Bond and Marie Downer, HIV/AIDS Seroprevalence and Behavioral Risk Factor Survey in Sierra Leone, April 2002 (Atlanta, GA: Centers for Disease Control and Prevention, 2002), p. 5. Hereafter CDC, Sierra Leone.
142. Statement by HE Mr Allied Ibrahim Kanu to the 26th Special Session of the UN General Assembly, available at: {http://www.un.org/ga/aids/statements/docs/ sierrae.html}, last accessed on 19 September 2008; UNGASS, Sierra Leone, p. 7.
143. CDC, Sierra Leone, pp. 67-8;
144. WHO/UNAIDS, Epidemiological Fact Sheet on HIV and AIDS: Sierra Leone, July 2008 Update (Geneva: WHO/UNAIDS, 2008), p. 5;
145. WHO, Country Health System Fact Sheet 2006: Sierra Leone (Geneva: WHO, 2006).
146. UNGASS, Sierra Leone, pp. 4 and 6;
147. Mandi Larsen, Sara Casey, Moi-Tenga Sartie, Judith Tommy, Tamba Musa and Martha Saldinger, 'Changes in HIV/AIDS/STI knowledge, attitudes and practices among commercial sex workers and military forces in Port Loko, Sierra Leone', Disasters, 28:3 (2004), pp. 240-1.
148. UN Population Division, Word Population Prospects: The 2006 Revision Population Database Sierra Leone country profile, available at: {http://esa.un.org/unpp/p2k0data.asp}, last accessed on 17 October 2008.
149. See for example WHO/UNAIDS, Epidemiological Fact Sheet: Sierra Leone, p. 9.
150. Data from World Bank {http://ddp-ext.worldbank.org/ext/DDPQQ}, last accessed on 24 October 2008.
151. See for example UCDP, Sierra Leone;
152. Larsen et al., 'Changes', p. 240.
153. UNGASS, Sierra Leone, p. 5.
154. See annual UNDP Human Development Reports available from {http://hdr.undp.org}.
155. Respondents to the CDC survey suggested that only 10 per cent of displaced persons sought refuge outside Sierra Leone, mostly in Guinea and Liberia. CDC, Sierra Leone p. 8.
156. Larsen et al., 'Changes', pp. 242-3.
157. UNGASS, Sierra Leone, p. 12;
158. Larsen et al., 'Changes', p. 241.
159. CDC Sierra Leone, p. 62.
160. UCDP, Sierra Leone.
161. UNGASS, Sierra Leone, pp. 6, 18 and 45-62.
162. UNGASS, Sierra Leone, especially p. 13.
163. WHO, Country Health System: Sierra Leone;
164. UNGASS, Sierra Leone, p. 5.
165. Larsen et al., 'Changes', pp. 239, 246 and 251;
166. CDC, Sierra Leone, pp. 8 and 11.
167. Angola country page from UCDP database, available at: {http://www.ucdp. uu.se} last accessed on 6 October 2008. Hereafter UCDP, Angola.
168. See IISS Military Balance (various publishers) for period.
169. Eric G. Bing, Karen G. Cheng, Daniel J. Ortiz, Ricardo E. Ovalle-Bahamon, Francisco Ernesto, Robert E. Weiss and Cherrie B. Boyer, 'Evaluation of a prevention intervention to reduce HIV risk among Angolan soldiers', AIDS Behaviour, 12 (March 2008), p. 393.
170. UNAIDS, Epidemiological Fact Sheet on HIV and AIDS: Angola - 2008 Update (Geneva: UNAIDS/WHO, 2008), especially p. 9.
171. Data mined from {http://hdrstats.undp.org/buildtables/rc-report.cfm} and UNHCR State3 of the World's Refugees 2006.
172. UNAIDS, Epidemiological Fact Sheet: Angola - 2008, pp. 5, 8 and 11;
173. UNAIDS, Epidemiological Fact Sheet on HIV/AIDS and Sexually Transmitted Infections: Angola - 2004 Update (Geneva: UNAIDS/WHO/UNICEF, 2004), pp. 2 and 4;
174. UNAIDS, Fact sheet: Sub-Saharan Africa (Geneva: UNAIDS/WHO, 2007);
175. WHO, Country Health System Fact Sheet 2006: Angola (Geneva: WHO, 2006).
176. UN Population Division, Word Population Prospects: The 2006 Revision Population Database, Angola country profile, available at: {http://esa.un.org/ unpp/p2k0data.asp}.
177. For example, Eric G. Bing, Daniel Ortiz, Ricardo E. Ovalle-Bahamon, Karen G. Chen, Fannie H. Huang, Francisco Ernesto and Naihua Duan, 'HIV/AIDS behavioural surveillance among Angolan military men', AIDS Behaviour, accessed from PubMed PMID 17641966, p. 578.
178. Data from World Bank {http://ddp-ext.worldbank.org/ext/DDPQQ}, last accessed on 24 October 2008.
179. Data from UNDP Human Development Report various years, available at: {http://hdr.undp.org}.
180. UNAIDS, Epidemiological Fact Sheet: Angola - 2008, p. 15;
181. Bing et al., 'Evaluation of a prevention intervention', pp. 389 and 393;
182. Bing et al., 'HIV/AIDS behavioural surveillance', pp. 580 and 583;
183. UNAIDS, Epidemiological Fact Sheet: Angola - 2004 and 2008.
184. For example, Carmen Aceijas, Gerry V. Stimson, Matthew Hickman and Tim Rhodes, 'Global overview of injecting drug use and HIV infection among injecting drug users', AIDS: Official Journal of the International AIDS Society, 18 (19 November 2004);
185. Anne Buve, Kizito Bishikwabo-Nsarhaza and Gladys Mutangadura, 'The spread and effect of HIV-1 infection in sub-Saharan Africa', The Lancet, 359 (2002), pp. 2011;
186. UNAIDS, Angola: Progress towards universal access and the Declaration Commitment on HIV/AIDS, figures 8 and 10, available at: {http://cfs. indicatorregsitry.org/country-factsheet.aspx?ISO=ANG}, last accessed on 28 October 2008.
187. UNAIDS, Epidemiological Fact Sheet: Angola - 2008, p. 15;
188. UNDP, Human Development Report 2007 Data, available at: {http://hdrstats.undp.org/buildtables/rc-report.cfm}, last accessed on 20 October 2008;
189. WHO, Country Health System 2006: Angola.
190. Much of the information on the conflict is taken from the UCDP's country page, hereafter UCDP Rwanda, available at: {http://www.ucdp. uu.se}, last accessed on 15 September 2008.
191. UCDP, Rwanda.
192. See for example Donovan quotation below.
193. See UNHCR, The State of the World's Refugees 2000, pp. 245-73, available at: {http://www.unhcr.org/static/publ/sowr2000/toceng.htm}.
194. E. Kayirangwa, J. Hanson, L. Munyakazi and A. Kabeja, 'Current trends in Rwanda's HIV/AIDS epidemic', Sexually Transmitted Infections, 82 supplement 1 (2006), p. i29, available at: {www.sti-journal.com}, last accessed on 20 October 2008.
195. Komisiyo Y'Igihugu Ishinzwe Kurwanya, UN General Assembly Special Session on HIV/AIDS: Country Report - Rwanda hereafter UNGASS Rwanda (draft 2008), p. 14;
196. UN Population Division, Word Population Prospects: The 2006 Revision Population Database, Rwanda country profile, available at: {http://esa.un.org/ unpp/p2k0data.asp}, last accessed on 17 October 2008.
197. UNDP, Human Development Report 2007 Data, available at: {http://hdrstats.undp.org/buildtabls/rc-report.cfm}, last on accessed 3 October 2008.
198. See also, UNAIDS, Epidemiological Fact Sheet on HIV and AIDS: Rwanda - 2008 Update (Geneva: UNAIDS/WHO, 2008), p. 4;
199. World Health Organisation, Country Health Fact Sheet 2006: Rwanda (Geneva: World Health Organisation 2006);
200. UNGASS Rwanda, p. 14.
201. UCDP, Rwanda.
202. Data from the World Bank available at: {http://ddp-ext.worldbank.org/ext/ DDPQQ};
203. and from the Rwanda National Institute of Statistics at: {http://statistics.gov. rw}.
204. UNAIDS, Epidemiological Fact Sheet: Rwanda, p. 6.
205. See also Treatment and Research AIDS Center, HIV Sentinel Surveillance among Pregnant Women attending Antenatal Clinics, unpublished paper sponsored by Republic of Rwanda Ministry of Health and US Centers for Disease Control and Prevention (2002), pp. 11 and 14;
206. and Kayirangwa et al., 'Current trends', p. i28.
207. Kayirangwa and others, 'Current trends', p. i28-9;
208. Aisha Yousafzi and Karen Edwards, Double Burden: A Situation Analysis of HIV/AIDS and Young People with Disabilities in Rwanda and Uganda (London: Save the Children, 2004), pp. 57-8.
209. Paula Donovan, 'Rape and HIV/AIDS in Rwanda', The Lancet Supplement, 360 (December 2002), p. s17.
210. Kayirangwa and others, 'Current trends', p. i27.
211. Donovan, 'Rape and HIV/AIDS', p. s18.
212. UNAIDS, 2007 AIDS Epidemic Update, p. 18.
213. Aranka Anema, Michael R. Joffres, Edward Mills and Paul B. Spiegel, 'Widespread rape does not directly appear to increase the overall HIV prevalence in conflict-affected countries: so now what?', Emerging Themes in Epidemiology, 5 (2008), available at: {http://www.ete-online.com/content/5/1/11}.
214. UNGASS, Rwanda, pp. 13 and 16.
215. Kayirangwa et al., 'Current trends', p. i27.
216. Democratic Republic of Congo (Zaire) country page from UCDP database, available at: {http://www.ucdp. uu.se}, last accessed on 6 October 2008. Hereafter UCDP, DRC.
217. Congo Democratic Republic National Multisectoral Programme for the Response to HIV/AIDS, Report on the Implementation of the Declaration of Commitment of the heads of State and of Government for the Response to HIV/AIDS in the DRC Draft (31 December 2005), hereafter UNGASS, DRC 2005 (Kinshasa: PNMLS/UNAIDS, 2005), p. 3.
218. See also UNHCR State of the World's Refugees 2006 annexes 2 and 4-6, and State of the World's Refugees 2000, pp. 254-65 and pp. 268-71.
219. Initial data was available in 1984, but after 1993 this becomes much more sporadic until the early years of the new millennium.
220. Congo Democratic Republic National Multisectoral Programme for the Response to HIV/AIDS (PNMLS), Rapport National de suivi UNGASS, hereafter UNGASS, DRC 2007 (Kinshasa: PNMLS, 2007), p. 11;
221. WHO/UNAIDS, Epidemiological Fact Sheet on HIV and AIDS: Democratic Republic of Congo, 2008 Update (Geneva: WHO/UNAIDS/UNICEF, 2008), p. 5;
222. R. Kinoshita-Moleka, J. S. Smith, J. Atibu, A. Tshefu, J. Hemingway-Foday, M. Hobbs, J. Bartz, M. A. Koch, A. W. Rimoin and R. W. Ryder, 'Low prevalence of HIV and other selected sexually transmitted infections in 2004 in pregnant women from Kinshasa, the Democratic Republic of Congo', Epidemiology and Infection, 136 (2008), pp. 1290-6;
223. Claire Mulanga, Samuel Edidi Bazepo, Jeanne Kasali Mwamba, Christelle Butel, Jean-Willy Tshimpaka, Mulowayi Kashi, Francois Lepira, Michel Carael, Martine Peeters and Eric Delaporte, 'Political and socioeconomic instability: how does it affect HIV? A case study in the Democratic Republic of Congo', AIDS, 18:5 (March 2004), available at: {http://www.aidsonline.com}, last accessed on 28 October 2008, pp. 905-10;
224. WHO, Country Health System fact sheet 2006: DR Congo (Geneva: WHO, 2006).
225. WHO/UNAIDS, Epidemiological Fact Sheet on HIV and AIDS: Democratic Republic of Congo, 2004 Update (Geneva: WHO/UNAIDS, 2004), p. 2.
226. WHO/UNAIDS, Epidemiological Fact Sheet: DRC 2004, pp. 4-5.
227. Spiegel, 'HIV/AIDS among conflict-affected', p. 325.
228. Mulanga et al., 'Political and socioeconomic instability'.
229. UN Population Division, Word Population Prospects: The 2006 Revision Population Database, DRC country profile, available at: {http://esa.un.org/unpp/ p2k0data.asp}, last accessed on 17 October 2008;
230. UNGASS, DRC 2005, p. 3;
231. WHO/UNAIDS, Epidemiological Fact Sheet: DRC 2004, p. 3.
232. Data from the World Bank at: {http://ddp-ext.worldbank.org/ext/DDPQQ}.
233. Mulanga and others, 'Political and socioeconomic instability'.
234. UNDP, Human Development Report 2007 Data, available at: {http://hdrstats.undp.org/buildtabls/rc-report.cfm}, last accessed on 3 October 2008.
235. There are a number of examples of HIV prevalence reaching a plateau within communities. See, for example, K. R. Fowke, N. J. Nagelkerke, J. Kimani, J. A. Sominsen, A. O. Anzala, J. J. Bwayo, K. S. MacDonald, E. N. Ngugi and F. A. Plummer, 'Resistance to HIV-1 infection among persistently seronegative prostitutes in Nairobi, Kenya', The Lancet, 348 (November 1996), pp. 1347-51; (Pubitemid 26383775)
236. Tim Brown, Werasit Sittrai, Suphak Vanichseni and Usa Thisyakorn, 'The recent epidemiology of HIV and AIDS in Thailand', AIDS, 8 (1994), suppl 2 pp. S131-41;
237. Nicolas Meda, Ibra Ndoye, Soulemayne M'Boup, lpha Wade, Salif Ndiayee, Cheikh Niang, Fatou Sarr, Idrissa Diop and Michel Carael, 'Low and stable HIV infection rates in Senegal', AIDS, 13 (July 1999), pp. 1397-405.
238. WHO/UNAIDS, Epidemiological Fact Sheet: DRC 2008, pp. 12 and 15;
239. UNGASS, DRC 2005, pp. 14-15;
240. R. Kinoshita-Moleka et al., 'Low prevalence of HIV', pp. 1290-6;
241. Judith M. Vandepitte, Faustin Malele, Dieu-Merci Kivuvu, Samuel Edidi, Jeremie Muwonga, Francois Lepira, Said Abdellati, Joelle Kabamba, Catherine van Overloop, Anne Buve, 'HIV and other sexually transmitted infections among female sex workers in Kinshasa, Democratic Republic of Congo, in 2002', Sexually Transmitted Diseases, 34:4 (April 2007), available at: {http://www.stdjournal. com}, last accessed on 28 October 2008.
242. For example, Nadine Puechguirbal, 'Women and war in the Democratic Republic of Congo', Signs: Journal of Women in Culture and Society, 28:4 (Summer 2003), pp. 1271-81;
243. World Food Programme, 'War on women: rape legacy of DRC conflict', available at: {http://wfr.org/newsroom/in-depth/Africa/CongoDr/031107-WarWomen}, last accessed on 11 December 2008;
244. CBS News, 'War against women: the use of rape as a weapon in Congo's civil war' (17 August 2008), available at: {http://www.cbsnews.com}, last accessed on 11 December 2008.
245. Spiegel, 'HIV/AIDS among conflict-affected', p. 325.
246. Anema et al., 'Widespread rape'.
247. Mulanga et al., 'Political and socioeconomic instability'.
248. UNAIDS, Democratic Republic of Congo: Progress towards Universal Access and The Declaration Commitment on HIV/AIDS, available at: {http://cfs. indicatorregistry.org/country-factsheet.aspx}, last accessed on 30 October 2008.
249. WHO/UNAIDS, Epidemiological Fact Sheet 2004: DRC, p. 9;
250. R. Kinoshita-Moleka et al., 'Low prevalence of HIV';
251. WHO, Country Health System: DRC.
252. I am grateful to Julia Braxton for making this point to me. See Julia Buxton, 'Deconstructing the addiction to the war on drugs', paper presented to the annual BISA Conference, Exeter (December 2008).
253. See also UNAIDS, 2008 AIDS Epidemic Update, p. 43.
254. Elbe, 'HIV/AIDS and the changing landscape of war'.