INTERNATIONAL: Mass Rape During Armed Conflict Increases HIV Infections

Mass rape could be causing thousands or even tens of thousands of HIV infections annually among women and girls in conflict-afflicted countries in Africa, according to mathematical modelling by Virginie Supervie and Sally Blower of UCLA and Yasmin Halima of the Global Campaign for Microbicides.

The researchers assessed the impact of mass rape during armed conflict, especially as many of those conflicts have taken place in sub-Saharan Africa where the HIV pandemic has hit hardest. They found that mass rape could significantly affect HIV incidence, contributing to a median annual increase in infections of 6 to 7 percent.

“War, women, and violence—it's a tragic combination,” said co-author Yasmin Halima. “The UN has long proclaimed that it is more dangerous to be a woman in an armed conflict setting than a soldier.”

Modelling the epidemiological processes, the authors analyzed direct infections caused by rapes during war time. They noted that the high rates of HIV prevalence in these countries, the above-average rates among soldiers in combat, and the efficiency of transmission due to violent or coercive sex, are all factors leading to the large numbers of new infections for women in these situations. The far-reaching effects of mass rape extend to sexually transmitted infections, unwanted pregnancies, and transmission of HIV to male partners or to children (through birth or breastfeeding).

The authors encourage future studies to explore these and other issues, including the effects of long-term suffering and psychological scarring, and the stigmatization and rejection by victims' partners, families, and communities. The researchers recommend that prevention, care, and treatment interventions—such as the offering of post-exposure prophylaxis and emergency contraception—be implemented for rape survivors during armed conflicts to reduce HIV incidence and unwanted pregnancies. They point to the need for stronger surveillance and protection systems for women in refugee camps. They assert that policy changes, additional research, and greater support for women in conflict zones should be implemented on the basis of both human rights and public health.

“We felt it was important to show the impact of mass rape on new HIV infections and to not only consider the longer-term implications for prevalence,” notes Dr. Virginie Supervie, lead-author and modeller. “We hope that our study will go some way towards informing policies and services that can help women who are caught in situations of armed conflict.”

“Coercive sex is just one of many motivators for the development of new HIV-prevention products—like microbicides, pre-exposure prophylaxis, and vaccines—whose usage could be controlled by women,” said Halima. “We at the Global Campaign for Microbicides urge governments and the donor community to support research and development of more methods that could help vulnerable people protect themselves against HIV infection.”