HIV, AIDS and conflict in Africa: why isn't it (even) worse?

The causes and consequences of HIV and AIDS are social are well as biomedical. Given the scale of the pandemic, understanding the social dimensions of HIV and AIDS is vital. One key argument is that there is a link between conflict and the spread of HIV. This appears to be particularly the case for sub-Saharan Africa where high levels of HIV prevalence are matched by violent conflict and state instability. Recent evidence however suggests that HIV prevalence does not always increase in conflict and that in some instances it may even reduce. This article attempts to explain why HIV has not increased in some sub-Saharan conflicts. To do this it moves beyond the use of risk factors to offer a new explanation based on susceptibility and vulnerability. It uses this explanation to examine four cases – Sierra Leone, Angola, Rwanda and the Democratic Republic of the Congo (DRC) – where conflict did not lead to a significant increase in the prevalence of HIV. The article concludes that, despite the fears of a few years ago, conflict does not readily act as a vector for the spread of HIV, though the potential for this to occur does still exist under certain circumstances.