1. SECOND DESK REVIEW Women and Girls, HIV/AIDS and Conflicts: Situation Analysis of 11 Selected Conflict and Post- conflict Countries in Africa

2. SELECTED COUNTRIES Angola Burundi Cote d’Ivoire Congo(DRC) Liberia Mozambique Rwanda Sierra Leone Somalia Sudan Uganda South Sudan

3. OBJECTIVES To assess the progress made in the implementation of the recommendations of the first desk review. To strengthen the coordination of implementation of UN Resolution 1325, as well as AU regional and national legal instruments that derive from it. To strengthen routine collection of gender disaggregated data on the situation of women and children, especially girls, in relation to HIV and AIDS, and sexual and reproductive health and rights in conflict-affected countries. To strengthen the delivery of key interventions for women and children, especially girls, in relation to HIV and AIDS, and sexual and reproductive health and rights in conflict-affected countries

4. GENERAL FINDINGS Information on the 11 selected countries was very difficult to come by and that which was available did not necessarily reflect on the situation of the whole country. For instance national data for Sudan does not necessarily reflect on the situation in South Sudan or that of the Darfur Region. 1 2 Politically, most of the 11 countries have been able to sustain peace, they have signed peace agreements or are making progress to signing.

5. KEY FINDINGS

6. CONFLICTS IN AFRICA There has been a steady decline in the number of conflicts recorded in Africa however most contemporary wars are of protracted duration, intrastate, fought by irregular armed groups, and fuelled by economic opportunities and ethnic rivalry. 1 2 3 There is increased occurrence of transactional sex among populations affected by conflicts and studies report higher rates of HIV among sex workers than in the general population (Iqbal Z 2010; ). Rape is used as a weapon of war, in form of ethnic humiliation, to denigrate the enemy, terrorize civilian populations and as a form of gratification for the fighting forces.

7. CONFLICTS IN AFRICA Perpetrators of sexual violence and/or initiators of transactional sex are often armed personnel, whether national armies, armed rebels or even peace keeping forces Evidence shows that migrants, refugees or internally displaced populations, as well as military and peacekeeping personnel tend to have more sexual partners and are thus more at risk for HIV. HIV rates for the refugee populations move towards rates of the host populations. An example is rates of HIV in South Sudan, which are very low compared to the South Sudanese refugees who went to northern Uganda where HIV rates were higher in the host population 5 6 7

8. REFUGGES AND IDPs The region with the largest total number of IDPs is sub-Saharan Africa, which is currently hosting 10.4 million, an increase of 7.5 per cent from the year before (UNHCR 2012). The 11 countries contribute 21% of the global refugee total and 24% to the global IDP totals.

9. REFUGEES AND IDPs REFUGEES AND IDPS Table 1 Refugees IDPs

10. IMPACT OF CONFLICT ON HEALTH AND REPRODUCTIVE HEALTH SERVICES Populations affected by conflict often do not have access to adequate health services, leading to a higher prevalence of untreated Sexually Transmitted Illnesses (STIs) which in turn increase the likelihood of HIV transmission. Women may also find it difficult to seek care from male health care workers, especially women who have experienced rape. Yet in conflict or acute post-conflict situations, studies indicate that UN staff in peace-keeping operations are overwhelmingly male dominated, with on average 3% average female staff out of 100,000 soldiers and only about 30% of the international civilian personnel being female (CSS 2012) 1 2

11. HEALTH CARE SERVICES AND PREVENTION, TREATMENT AND CARE OF HIV IN CONFLICT-AFFECTED POPULATIONS Present priorities and practices for health-care provision in conflict settings are still broadly based on a model of humanitarian relief that was developed during the last two decades of the Cold War. An analysis of current HIV and malaria National Strategic Plans (NSPs) and Global Fund approved proposals from rounds 1-8 for countries in Africa hosting populations with refugees and/or IDPs found that a majority of countries did not mention IDPs (57%) compared with 48% for refugees in their HIV NSPs. 1 2

12. HIV/AIDS AND WOMEN AND GIRLS SRHR, WOMEN AND GIRLS AND HIV TRANSMISSION Reproductive Health and related needs during conflict and post-conflict situations are massive, acute, and complex to meet. In all countries, the rates of HIV among young females are higher than for the young males. Generally fewer females than males had used a condom at the last risky sexual contact, except for Uganda. Sexual and reproductive health and rights and gender issues are often not taken into account in the planning and implementation of humanitarian responses both during acute emergencies and recovery periods. Contraceptive use rates in the conflict- affected countries are lower than the regional averages. Skilled attendants at delivery as well as institutional delivery rates are fairly poor for almost all countries except for Sudan that has 87% followed by DRC at 61%.

13. SOCIO-CULTURAL DYNAMICS, POVERTY, CONFLICTS AND WOMEN AND GIRLS Although women make up a part of the fighting forces, including in leadership positions, when it comes to Disarmament, Demobilisation and Reintegration (DDR), they are often not catered for.

14. HIV PREVALENCE, INCOME, ACCESS TO TREATMENT AND QUALITY OF CARE. Out of the eleven countries nine have very low GDP per capita, all below US $ 1,000. Despite having the highest GDP per capita Angola has the lowest percentage (6%) in relation to access to care while Uganda has the highest at 51%. People living with HIV per physician and nurse ratios are higher in the DRC, this however reflects on the concentration of qualified health care professionals in the urban areas, especially for Angola, DRC, Sierra Leone and Sudan. 1 2 3

15. HIV PREVALENCE, INCOME, ACCESS TO TREATMENT AND QUALITY OF HEALTH CARE Country GDP per capita (US$) HIV Prevalence 15-49 yrs. (%) Access to care (%) Pop. Per Physician Pop. per Nurse PLWH per Physician PLWH per Nurse Angola1,8732.3612,99387136324 Burundi1071.31435,3405,243750111 Cote d'Ivoire8503.2178,1201,66036074 DRC1191.149,3391,89017235 Mozambique34611.1937,3194,8513,502455 Rwanda2422.93921,1502,36047453 Sierra Leone2191.5230,7622,80728626 South Sudan7832.71n.a Somalia6000.5 Uganda3267.25144,1312,7291,21775 n.a data is not available

16. ACTIVITIES African Union Commission to convene a regional meeting of key partners, implementing the different aspects such as WHO-AFRO, UNFPA, UNICEF, UN Women to discuss coordination mechanisms; Formulate a research strategic plan for the Africa Region on women and girls, HIV and AIDS and conflicts; Development and dissemination of an “Integrated approach to SRHR and HIV/AIDS programming for conflict-affected women and girls” toolkit; Monitoring and evaluating implementation of SRHR and HIV/AIDS programming for conflict affected women and girls. OBJECTIVES To strengthen coordination of implementation of UN Resolution 1325 and AU and national legal instruments. To strengthen routine collection of gender disaggregated data on the situation of women and children, especially girls, in relation to AIDS, sexual and reproductive health and rights in conflict-affected countries. To strengthen the delivery of key interventions for women and children, especially girls in relation to AIDS and sexual and reproductive health and rights in conflict-affected countries. GOAL To strengthen the operationalization of AU and UN instruments and protocols that provide for women and children, especially girls in conflict-affected situations. PLAN OF ACTION

17. 1 2 Launch of the preliminary report of the 2nd Desk Review in Juba during the 2013 WAD. Launch of the Desk Review to 11 Member States. AU ROLLOUT PLAN

18. THANK YOU FOR YOUR KIND ATTENTION