Colliding Wars: A Systematic Review on HIV Responses in Conflict-Affected Settings

Armed conflicts are an escalating threat to public health, often marked by violence, poverty, displacement and weakened health systems-conditions that mirror the drivers of HIV transmission.

This review examines how armed conflict is associated with HIV vulnerability, disruptions to HIV services and how service delivery has adapted in these settings.

A systematic search of six databases (MEDLINE, Embase, Scopus, CENTRAL, OVID, CINAHL) was conducted up to June 2022. Six reviewers independently screened studies, resolving discrepancies through consensus.

Of 7378 records, 17 met inclusion criteria. Studies revealed heightened HIV risk among adolescent girls, young women and displaced populations. Service interruptions-due to looting, supply chain breakdowns and population movement-led to treatment gaps and increased loss-to-follow-up. Adolescent girls, refugees, and those living in temporary shelters experienced consistently worse HIV risks and outcomes. Despite broad search terms, there was little-to-no evidence on some key populations, including prisoners, sex workers and people who inject drugs. Adaptive HIV prevention and response strategies-including hybrid delivery models, integrated medical supply chains and runaway bags (emergency stock packs)-were reported as promising but under-documented approaches.

Conflict-driven displacement and health system disruption are associated with heightened HIV vulnerability in some settings though effects vary by context. People living with HIV in conflict-affected areas face disproportionate risks and must be prioritized within humanitarian response plans and in host-country health systems.