"When I was chased away from home, I thought I was going to die because I did not think that I could get anti-retrovirals (ARVs) from wherever I was going to end up." These are the words of a HIV-positive Kenyan woman who fled her country's post-election violence last year. She was speaking to The AIDS Support Organisation (TASO), a Ugandan HIV/AIDS service provider, from whom she eventually received the necessary drugs in the Mulanda refugee camp in southwest Uganda.

During a humanitarian emergency, livelihoods are disrupted, families are separated and health risks increase. Risks are particularly acute for those with HIV/AIDS and for those on a treatment programme for the disease. In light of this year's World Health Day theme - the safety of health facilities and the readiness of health workers to respond in emergencies - it's worth looking at the issues around HIV/AIDS in an emergency situation.

Part of the World Health Organisation's theme for 2009 is about not allowing emergencies to disrupt healthcare provision. A recent report by the Overseas Development Institute (ODI), a London-based think tank, found that emergencies don't disrupt ARV supplies as much as previously feared. This is thanks to strong contingency planning by medical providers, and the initiative of patients receiving treatment.

Currently, only around 31 percent of those living with HIV/AIDS around the world are on ARVs. If their treatment was disrupted, there would be serious consequences. Without the drugs, their health would rapidly deteriorate and they could develop resistance to the drug from lapsing on the medicines.

The woman's story from Kenya seems to support ODI's conclusion with organisations like TASO stepping in to deliver ARVs to displaced Kenyans. Similarly, in 2007, TASO responded to flooding in Uganda's eastern Soroti region by relocating community drug distribution points and using alternative modes of transport - including airlifts - to reach communities.

But ARVs also need to be taken with regular meals and clean water to be fully effective. People living with HIV/AIDS but not on a treatment programme need to keep their immune system strong through good nutrition. Although sudden-onset disasters pose their own set of risks, ODI concluded that food aid may arrive quickly in these types of emergencies meaning that long-term malnutrition is not as much of an issue. This is rarely the case in droughts and conflict-related emergencies, where food aid, if and when it materialises, is often too little, too late and poorly targeted.

As ARV treatment is only available to a fraction of those living with HIV/AIDS globally, there are other larger issues around responding to and preventing the spread of the disease in emergency situations. One of the most serious risks for those living with HIV/AIDS is the increased threat of other diseases such as malaria, tuberculosis, dysentery and cholera. These diseases can thrive in densely populated displaced communities and in areas without clean water and sanitation. Preying on a weakened immune system, they can kill those living with HIV/AIDS long before the disease itself would have.

With the breakdown of social structures and the separation of families in emergencies, women and children become more vulnerable to sexual violence and exploitation, increasing the risk of HIV transmission. Transactional sex is known to increase during emergencies and can become a survival mechanism for many women. The international aid response to some crises may do little to help this situation as an influx of foreign aid workers could likely fuel the local sex trade.

An interesting point made by ODI is that while they found no evidence of increased stigma against those with HIV/AIDS in emergencies, existing stigma plays an important role in the coping strategies of the affected population. In slow-onset disasters those with HIV may suffer because they're without social capital and community support. In a sudden-onset disaster, stigma may deter people from revealing their status and accessing the services that they need.

Narrowing down the World Health Day theme to issues around HIV/AIDS, health workers need to have plans in place for supporting those with HIV/AIDS during emergencies. There must be measures taken to prevent the transmission of HIV during situations characterised by breakdown - of community structures, safety precautions and healthcare infrastructure. Any emergency response needs to incorporate the specific risks posed to this population and provide for their needs, particularly around access to food aid, ARVs and medicines to treat opportunistic infections.

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