AIDS and global insecurity co-exist in a vicious cycle. Civil and international conflicts can expand the spread of HIV as populations are destabilized, and armies move across new territories. At the same time, the epidemic contributes to national and international insecurity through high levels of HIV infection among military and peacekeeping personnel. 

During armed conflict, people are often subjected to mass displacement and human rights abuses, including sexual violence, and are left in conditions of poverty and powerlessness that might force some individuals to sell sex to survive. In addition, infrastructure may be destroyed, and prevention and curative health services disrupted. Such conditions put populations at increased risk of HIV infection, and women and children are especially vulnerable. 

The relationship between conflict and the spread of HIV is complex, unpredictable and poorly understood. It is influenced by such factors as population mobility, existing prevalence of HIV infection, and level of sexual interaction. 

In regions where HIV prevalence rates are high, the epidemic destroys the very fabric of what constitutes a state: individuals, families, communities and political institutions. AIDS affects and eventually breaks down community structures. Public administration, governance and social services become unsustainable in the process, and both coping capacity and policing capacity are reduced. As a result, communal conflict is likely to increase, which is particularly true for areas with a history of violence and armed conflict. 

AIDS also has a direct impact on military capacity. Among male population groups, military and police report the highest risk behaviour and number of partners. Sexually transmitted infection rates among military personnel are two to five times greater than those in civilian populations in peacetime. These figures increase dramatically during conflict. In some countries with adult HIV prevalence rates of 20%, as many as 50% of military personnel could be HIV positive. 

The potential loss of experience, skills, and training capacity within the uniformed services can seriously affect military readiness. As the impact of HIV grows, tensions may increase within and between states in many regions. Diminished readiness in the security sector, and particularly in defense forces, can thus be considered a threat to international peace. 

Recognizing the security implications of AIDS, the UN Security Council made history in January 2000 when for the first time it debated a health issue. By subsequently adopting Resolution 1308 (2000), it highlighted the potential threat the epidemic poses for international security, particularly in conflict and peacekeeping settings. 

The increased international attention on AIDS in the context of security signals a shift from the traditional understanding of security as the absence of armed conflict to a wider definition of human security, which encompasses the fundamental conditions for people to live safe, secure, healthy and productive lives. 

Emergencies 

An emergency is a situation that threatens the lives and well-being of large numbers of people and requires extraordinary action to ensure their survival, protection and adaptation. Emergency situations are caused by both natural disasters such as earthquakes and droughts and human conflict such as warfare and civil unrest. A complex emergency is a humanitarian crisis with a significant breakdown of authority and security, requiring an international response beyond the mandate of one single agency. In such situations, people in all sectors – soldiers, rebels, humanitarian workers, displaced persons and others – are at greater risk of exposure to HIV. Women and children are often the most vulnerable. 

Emergencies, particularly those involving displacement, increase HIV risk by reducing access to HIV prevention services, disrupting social support networks, increasing exposure to sexual violence, encouraging sex in return for food, shelter and other necessities, or simply by movement occurring to a higher HIV prevalence location. 

The risk of HIV transmission through transfusion of contaminated blood and other medical procedures may be particularly high as health services are disrupted and demand for such procedures increased by the emergency. The post-conflict period of reconstruction is also a period of heightened vulnerability to infection. AIDS prevention needs to be an integral part of all humanitarian programmes to assist populations caught up in conflict. 

Acknowledging the potential for conflicts and disasters to increase HIV risk and contribute to the spread of HIV, the 2001 Declaration of Commitment on HIV/AIDS by the United Nations General Assembly calls on countries to integrate HIV activities into programmes and action plans for emergency situations. Humanitarian relief efforts now routinely integrate HIV prevention into their work. In the wake of the 2004 Asian tsunami, for example, governmental, non governmental and inter-governmental organizations from the outset integrated and prioritized HIV prevention into their response.