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Risk of HIV for women and girls who escaped Boko Haram

May 8, 2015 — Last week, 234 Nigerian women and girls escaped from the violent terrorist group Boko Haram after a long and brutal period of captivity. With the assistance of the Nigerian army, they were evacuated from the Sambisa forest where they had been held hostage. A shocking 214 of these girls and women are now pregnant after being raped by their abductors. A report released by UNICEF just last month documented how children are deliberate targets of Boko Haram, “often subjected to extreme violence—from sexual abuse and forced marriage to kidnappings and brutal killings.”

UN agencies will, no doubt, start to come to the aid of these women and girls. Yet the media and the UN have not mentioned a major health concern that must be addressed: the risk of HIV transmission. Nigeria has an HIV prevalence rate of 3.2% among 15- to 49-year-olds. In 2013, there were 11,000 adolescent AIDS-related deaths in Nigeria, one of the highest rates in the world.

The number of rapes that each of these women and girls endured must have been incredibly high if 91% of them ended up pregnant. The high likelihood that they were raped by many different perpetrators further increases the chance that HIV was transmitted among and between them.

If they are not already doing so, we sincerely hope UNAIDS in Nigeria will immediately provide voluntary HIV counseling, testing, and treatment to all of these women and girls. We hope they will offer ARVs for the prevention of vertical transmission of HIV. The Nigerian health ministry is set up to provide these services, and UNAIDS, UNICEF, and others already on the ground are well-equipped to give counseling to pregnant adolescents and women and girls in the context of HIV.

UNFPA, who reported the high number of pregnancies, is already doing commendable work. They are providing prenatal services and clean delivery kits to the 214 women and girls, as well as preparing for cesarean sections where needed. (The assumption seems to be that all of them will carry their pregnancies to term. In Nigeria’s northern states, abortion is illegal unless it is performed to save the life of the mother, a condition that could very well apply in many of these cases.) Many of those who escaped are being treated for severe malnutrition with intravenous drips. There has also been a great deal of focus, rightly, on the severe trauma these women and girls have suffered and the critical need for them to receive psychiatric care. Yet we hope that the UN will also give priority to the possibility of HIV infection, and provide voluntary HIV testing, treatment, care, and prevention of vertical transmission when needed and requested. This will be no small task: currently only 27% of women and girls in Nigeria who need ARVs to prevent vertical transmission receive them. This low nationwide coverage will make it more difficult to properly attend to this group.

Nigeria is, however, one of the focus countries of the newly launched, and highly publicized, “All In” Campaign to End Adolescent AIDS, a joint effort between numerous UN agencies and other organizations. Now is the time to put that campaign into action.

Links:

International Business Times, Nigeria Boko Haram: 214 girls and women rescued from Sambisa forest 'visibly pregnant’. May 4, 2015.

BBC News, Boko Haram ‘captives’ arrive at Nigeria refugee camp, May 6, 2015.