Colliding Wars: A Systematic Review on HIV Responses in Conflict-Affected Settings.

Abstract

Background: Armed conflicts are an escalating threat to public health, often marked by violence, poverty, displacement and weakened health systems-conditions that mirror the drivers of HIV transmission.

Aim: This review examines how armed conflict is associated with HIV vulnerability, disruptions to HIV services and how service delivery has adapted in these settings.

Methods: A systematic search of six databases (MEDLINE, Embase, Scopus, CENTRAL, OVID, CINAHL) was conducted up to June 2022. Six reviewers independently screened studies, resolving discrepancies through consensus.

Results: Of 7378 records, 17 met inclusion criteria. Studies revealed heightened HIV risk among adolescent girls, young women and displaced populations. Service interruptions-due to looting, supply chain breakdowns and population movement-led to treatment gaps and increased loss-to-follow-up. Adolescent girls, refugees, and those living in temporary shelters experienced consistently worse HIV risks and outcomes. Despite broad search terms, there was little-to-no evidence on some key populations, including prisoners, sex workers and people who inject drugs. Adaptive HIV prevention and response strategies-including hybrid delivery models, integrated medical supply chains and runaway bags (emergency stock packs)-were reported as promising but under-documented approaches.

Conclusions: Conflict-driven displacement and health system disruption are associated with heightened HIV vulnerability in some settings though effects vary by context. People living with HIV in conflict-affected areas face disproportionate risks and must be prioritized within humanitarian response plans and in host-country health systems.