War and HIV Prevalence

In this article we examine the hypothesis that armed conflict increases HIV prevalence, using the case study of the Ethiopian Defence Forces and the civilian population of Tigray region of Ethiopia during the Ethio-Eritrean war of 1998–2000. The study utilises data sets for HIV prevalence in the region, before, during and after the conflict. These include HIV screening conducted among the military during mobilisation and demobilisation, ANC surveillance data, blood donor screening data, and voluntary counselling and testing (VCT) data. The datasets are severely limited in both quality and quantity. They do not show clear evidence of an increase in HIV prevalence associated with the war. Data from the screening of conscripts and demobilising soldiers indicate a 76% increase in HIV prevalence during the war period, but this increase does not appear to be larger than would have occurred among a similar cohort of young men in civilian life. The ante-natal clinic (ANC) and blood donor data show a decline in HIV prevalence since the end of the war. The robustness of this finding is uncertain. It can be concluded that there is no evidence of a general increase in HIV prevalence associated with the war in either civilian or military populations. There are indications of a post-conflict decline in prevalence. Better quality HIV surveillance is needed in Tigray to ascertain the trajectory of the HIV/AIDS epidemic in the region.