A number of converging factors make conflict and post-conflict settings high-risk environments for the spread of HIV. The age range, mobility and risk-taking attitudes of former members of armed forces and groups place them at a heightened risk of contracting HIV. Female ex-combatants, women associated with armed forces and groups, dependants and abductees are frequently at a high risk of HIV and other STIs, as sexual violence and abuse is often widespread in these settings.
The shift in social norms around sex and violence during conflict impacts behaviour and gender roles, norms and identities. When conflict ceases, violence as a sanctioned expression of masculinity is often no longer socially acceptable. The “crisis of masculinity” experienced by some men post-conflict and during the DDR process when their weapons are surrendered and their role in a society at peace is unclear, can fuel violence among men and particularly sexual violence against women. Additionally, social norms around gender-based violence shift during conflict, normalizing some forms of violence and contributing to impunity, which creates an enabling environment and increases the risk of rape and exposure to HIV.
Further, when women associated with conflict return home, they often face stigma, challenging reintegration efforts and leaving them with few income-generation options. This is also true for children who have missed their childhood and education. Participation in the DDR process confirms their role in conflict, labels them as ex-combatants and increases social isolation. Lack of viable employment options and a social safety net for women and girls fuels their participation in sex work and sex for trade. Further, children associated with conflict have earlier sexual debut -increasing their risk to HIV and early pregnancy.
DDR is an entry point for addressing the specific HIV needs of returning male and female ex-combatants and host communities. Understanding the different needs of men and women, and targeting both men and women through public information campaigns on HIV, is the first step. DDR programmes can identify HIV vulnerabilities and priorities through several strategies. Ensuring that family planning services, including emergency contraception and post-exposure prophylaxis, are in place, is one such strategy. Maternal and newborn health services - including antenatal care, management of delivery by skilled personnel, access to emergency obstetric and neonatal care, newborn care, and post-natal care - are a critical opportunity for HIV detection, treatment and prevention of mother to child transmission. DDR is also an opportunity to support the establishment of confidential HIV testing, prevention, treatment and care programmes. By linking with national development partners, these services can be sustained through the development process. Over the long term, DDR programmes can also actively discourage harmful traditional practices like female genital mutilation, early marriage and selective abortion, all of which present major health risks for women and girls and violate their human rights.