Potential AIDS fallout from armed conflict

On the days that Alberis Guerrero Peralta doesn't make soup to sell in her neighbourhood of Arjona, an impoverished community outside Cartagena, a city on Colombia's northern coast, she and her four children don't eat.

Like many of the families living in Arjona, armed conflict between leftist rebel groups, government forces and right-wing paramilitary groups forced the Peraltas to abandon their home in the Department of Sucre, a province west of Cartagena.

"It was hard. My husband left his land behind and he wanted to go back, but I didn't want to put my girls at risk; I'm a single mother now," she told IRIN/PlusNews, perched on a plastic chair in her small, neatly constructed, mud-and-stick home.

Peralta said the haphazard, unpaved streets of her barrio [neighbourhood] were unsafe at night and she worried about her daughters, the oldest of whom is 14. "You can trust your kids, but you never know who they're going to meet in the streets. There's a lot of drug use here."

Colombia's interminable conflict has claimed countless lives and displaced nearly three million people from mainly rural areas to sprawling slums on the outskirts of cities like Cartagena, where they often live in miserable, overcrowded conditions and struggle to access basic services like health care.

The levels of domestic and gender-based violence are high in such communities, said Waldis Hurtado, who recently coordinated a World Food Programme (WFP) project aimed at raising awareness about and reducing the mostly unreported violence experienced by displaced women living in two cities on Colombia's southeastern, Pacific coast.

"Gender-based violence is a huge problem in Colombia generally, but it's worse among the internally displaced populations," she told IRIN/PlusNews. "In the urban context, gender roles become inverted - instead of men being the breadwinners, often it's the women, and in this macho culture that generates a lot of tension in the family."

Sexual violence has also been used as a weapon of war. Diana Peñarete,
a HIV/AIDS consultant with the UN Refugee Agency (UNHCR), said a survey had found that one out of every six displaced women had been victims of sexual violence.

Although Colombia's national HIV infection rate is under one percent, prevalence is higher among certain vulnerable groups, such as sex workers, and men who have sex with men.

No surveys have measured HIV rates among displaced populations, but they are thought to be another vulnerable group, partly as a result of the well-established links between sexual violence and the transmission of HIV, but also because displacement forces some of the women into sex work or having sexual relationships in exchange for financial support.

"Maybe you're worried about how you're going to get food for today," said Lina Ortega*, a single mother who has lived with her daughter in Nelson Mandela, another barrio outside Cartagena, since guerrillas killed her brother for refusing to join them and threatened the rest of her family. "Even myself, I thought about getting a man to help me, but I didn't because of my daughter; I didn't want to put her at risk."

Eduardo Pastrana, who works for a local non-governmental organisation (NGO), Amigos Positivos, which runs workshops on HIV and AIDS in Nelson Mandela, said displaced people often could not afford to buy condoms, or were ignorant of the dangers of unprotected sex. "Usually they come from rural areas and have low education levels."

The Amigos Positivos workshops are well attended; food parcels donated by the WFP are an incentive for participating, and women like Peralta and Ortega, who left their rural homes many years ago and have attended many such workshops, are well informed about HIV and AIDS. It is the lack of knowledge among the more recently displaced that is a major risk factor.

Diana Jesus, 19, belongs to an indigenous group from the Sinu region of northern Colombia, which moved to Arjona two years ago after an armed group drove them from their land. She and her nine family members now share a shack on a muddy patch of ground. "We don't know about HIV," she told IRIN/PlusNews, resting a naked baby on her hip. "I've heard of it, but honestly I don't know anything about it."

Various initiatives are redressing this awareness gap. In five municipalities of the southern Department of Putumayo, where a number of armed groups are still active, UNHCR has been running HIV prevention workshops and campaigns aimed at the displaced and the communities where they now live.

This family was displaced by Colombia's armed conflict and now live in Arjona, an imporverished community outside Cartagena on Colombia's northern coast

Photo: Kristy Siegfried/IRIN
A displaced family living in Arjona

Another focus has been to train local health care workers about the importance of keeping HIV test results confidential. "Health personnel don't always respect confidentiality," said Peñarete of UNHCR. "In some cases, HIV results have been filtered from health centres to local communities and members of armed groups have used this information to threaten people diagnosed HIV-positive."

The risk of HIV test results falling into the wrong hands is significant enough that UNHCR has postponed promoting testing in Putumayo. "We decided we couldn't guarantee the safety of people who tested positive," said Peñarete, citing the case of an NGO worker who had to leave the country because he and his family were threatened by a paramilitary group that wanted the HIV test results in his possession.

Armed groups also vulnerable

Members and former members of armed groups may also be at higher risk of HIV infection. Some are perpetrators of sexual violence; others are regular clients of sex workers as well as having multiple partners among the women living in nearby communities.

Some of the armed groups try to balance such practices with what could be described as an HIV/AIDS policy. "They taught us about using condoms. You had to take care of yourself because they didn't accept people who were HIV positive," David Gomez*, a former member of a paramilitary group, told IRIN/PlusNews.

"There was one time when the commander of our unit decided we all had to test for HIV. Fifteen men were infected and they shot them and burned the bodies." According to organisations that have worked with former combatants, the incident Gomez described is not an isolated one.

''I wasn't used to people treating me nicely, and treating others nicely. I started drinking a lot and going to prostitutes ''

Since 2002, the Colombian government has embarked on a policy of encouraging members of paramilitary groups to turn themselves over to the authorities in exchange for amnesty and entering a government programme of reintegration into society. By March 2008, over 40,000 people had demobilised.

Nastassia Kantorowicz of the Office of the Presidential High Counsellor for Reintegration, which is implementing the programme, said the period after demobilisation was often a very difficult time for these mostly young, poorly educated men, who have spent their entire adult lives - and in some cases also their teenage years - following orders.

"Sometimes when they're demobilised they have so much freedom they go a bit crazy with alcohol and prostitutes," she said.

Gomez recalled trying to adapt to civilian life after leaving his paramilitary group three years ago: "I wasn't used to people treating me nicely, and treating others nicely," he said. "I started drinking a lot and going to prostitutes; I think that's when I became infected [with HIV]."

The reintegration programme includes psychosocial support, such as help with recovering from alcohol and drug addiction and accessing free health care, and completing basic education and vocational training, but does not cover HIV/AIDS. Kantorowicz said a workshop on sexual and reproductive health would be introduced in 2009.

Gomez stopped drinking a year ago and shortly afterwards met the woman who is now his wife, but still struggles to understand how he became infected.

He often worries about his future. "I want to be a well-educated person so I can work," he said, "but I'm afraid that if people know I'm positive they won't give me a job."

*Not their real names