HIV is a major challenge to humanitarian action. Disasters increase people's vulnerability to HIV, and HIV complicates work in zones of conflict and natural disasters. Humanitarian organisations must address many challenges, including reducing poverty, providing basic health care and managing the aftermath of disasters, all of which have an impact on the epidemic. The 2008 World Disasters Report analyses the enormous economic, social and intellectual toll of HIV and AIDS and also the vast challenges the epidemic presents to governments, humanitarian organisations and local communities.

'HIV is capable of quickly wiping out decades of national development gains, as we have seen in sub-Saharan Africa,' explains Red Cross HIV expert Bernard Gardiner. 'The cost of letting HIV get to epidemic proportions is so great that leaders often now understand they have to deal with this immediately even through the benefit of this leadership will not be seen for many years. That takes wisdom. The challenge now is to keep the promise, and sustain the effort.'

Marginalised groups the most vulnerable In countries in southern Africa, HIV has seriously disrupted the functioning of society. Prevalence rates are up to 20% and in some countries life expectancy has been halved.   Across the globe, HIV is a disaster for marginalised groups -- sex workers, injecting drug users, men who have sex with men and prisoners. They face stigma and criminalisation, and very few have access to the HIV prevention and treatment programs they need. An estimated 2.1 million people globally died of AIDS in 2007, bringing total deaths from HIV infection since 1981 to more than 25 million. Chapters in World Disasters Report 2008 cover the following topics:

Waiting at a Red Cross food centre in Malawi. The food shortage in southern Africa creates great difficulties, especially in households where woman are caring for orphans, the elderly and people living with HIV an AIDS. Image: B Mathisen/Federation

Chapter 3 - The humanitarian interface: using the HIV lens

Disaster relief and development organisations are increasingly accepting the need to integrate HIV and AIDS into all aspects of their humanitarian work. Whether distributing jerry cans or installing water pumps, examining what impact programs will have on those affected by the epidemic and what impact the epidemic will have on programs is vital.

Chapter 4 - HIV and population mobility: reality and myths

Vast numbers of people today are on the move between and within countries but the link between migration and HIV is complex. While HIV is often driven by poverty, it is also associated with inequality and economic transition. Economic growth and trade between neighbouring countries also increase labour migration, particularly of transport, mining, construction and other workers, and stimulate the sex industry along transport routes. Migrants are sometimes unfairly blamed for spreading HIV when the reality is that they are often the victims.

Chapter 5 - Refugees and the impact of war on HIV

Among countries with high rates of HIV, about half have been affected by major conflict between 2002 and 2005, with mass rape, forced displacement, breakdown in basic health care, disruption of social programmes and educational systems all increasing the risk of infection. When livelihoods are lost, both men and women can turn to sex work to survive. However, the link between conflict and HIV is complex. Women and children are often most vulnerable but armed personnel and even peacekeepers are also at risk both of acquiring and spreading HIV.

Chapter 6 - Natural disasters: the complex links with HIV

When natural disasters strike, certain problems affect HIV-positive people more than others. Disruption of medical supplies can cause resistance to treatment for those on anti-retroviral drugs. Malnutrition is likely to speed up progression of HIV. Lack of clean water for food preparation and personal hygiene is especially dangerous for those with advanced HIV. HIV prevention programmes are also often disrupted and populations at higher risk of HIV may get forgotten.

Chapter 7 - HIV and AIDS funding: where does the money go?

Spending on the response to HIV and AIDS in low- and middle income countries has significantly increased but is still well short of what is needed to provide universal access to prevention, treatment and support. Furthermore, what money that is available, too often fails to reach those most in need because of bureaucracy, ineffectual targeting and lack of coordination.

About the World Disasters Report

The World Disasters Report is the International Federation's flagship publication. Released annually since 1993, the report has an independent editor, contributors, and an editorial board composed of technical experts from academia, international and non-governmental organisations. It is a unique combination of critical humanitarian analysis and global disaster data.