HIV/AIDS, Security and Conflict, released Tuesday at The Hague, recommends ways to make peacekeeping, peace building and humanitarian efforts more in tune with the risks of the disease.
Alex de Waal is principle investigator for the AIDS, Security and Conflict Initiative and program director at the Social Science Research Council in New York.
"Ten years ago when the Clinton administration raised HIV/AIDS as a security issue, there were fears that the pandemic, particularly in the hardest hit countries in Africa, would bring about state crisis, state collapse, the collapse of armies, simply because so many individuals were infected," he says.
Those concerns, he says, were reinforced following the September 11th terrorist attacks on the United States. He says the Bush administration thought there would be "more ungoverned spaces on the planet in which terrorism and anarchy could foster."
The U.N. Security Council made HIV/AIDS a top priority in its first debate in the 21st Century in January 2000 "at the instigation of the United States."
Change of perception since then
"We know a lot more about HIV/AIDS and security. The epidemic has evolved and there have also been some very major responses to it, not the least the President's Emergency Plan for AIDS Relief, PEPFAR," he says.
Some of the worst fears failed to materialize.
"The alarmism of a decade ago has dissipated. States are not collapsing. Armies are not imploding. But there is a host of issues that we still need to be concerned about," he says.
These include violence against women in conflict situations, such as the many thousands of women who've been raped and sexually assaulted in the eastern DRC.
"Any woman who is exposed to acts of sexual violence is at a greater risk of receiving HIV. The act of violence itself is an increased risk factor. And very often the men who perpetrate these acts are themselves at high risk of being infected with HIV," he says.
Even the transition from war to peace can be a risk factor for countries. Many people that had been isolated in a refugee camp may not have been exposed as much to HIV as those in the general population. But with the end of the conflict, refugees and displaced people return home.
"You may see a lot of investment going into certain town. They may become boom towns. They may attract sex workers. They may attract impoverished young women, who get drawn into sex work," he says.
Soldiers returning home may bring HIV with them.
De Waal also says in some cases, HIV/AIDS is being "driven underground."
"In most countries of the world, we see that the epidemic is concentrated amongst groups that are on the margins of the law or beyond those margins -- people like injecting drugs users, like sex workers, like gay men in countries where homosexuality is illegal."
He says these populations are often stigmatized, marginalized and even criminalized.
"They rarely have interaction with the authorities that are straight forward and open. And therefore, they are difficult to access, difficult to gain the confidence," he says.
So, it's more difficult to provide them with care and treatment.
"One of our recommendations is for a greater focus on sexual and gender-based violence across the board. Another…is to do with the uniform services…. The most effective methods for controlling HIV and AIDS in armies and uniform services is when responsibility is vested, not so much in the medical services, but in the command of those institutions," he says.
This includes not only national armies, but peacekeeping forces and police, as well.
The report calls for support for local governments in countries hard hit by the epidemic.
"While states themselves may not be in crisis, very often…local government services are affected," he says.
The report is a joint project of the Social Science Research Council and the Clingendael Institute for International Relations at The Hague.