Sexually transmitted infections and HIV spread fastest where there is poverty, powerlessness and social instability characteristic of refugee and internally displaced populations. The disturbance of community and family life among displaced populations may disrupt social norms governing sexual behavior. Adolescents may start sexual relations at an earlier age, take sexual risks, such as having sexual intercourse without using a condom, and face exploitation in the absence of traditional socio-cultural constraints. During civil strife and flight, displaced persons, especially women and girls, are at increased risk of sexual violence, including rape. Women and children may be coerced into having sex to obtain their survival needs.
In refugee settings, populations from low HIV prevalence areas may now be living close to a population with high prevalence. Peace-keeping forces, military and police may also be susceptible to infection and facilitating the spread of HIV in refugee situations.7