ISHASHA, 18 November 2008 (IRIN) - Violence in the eastern Democratic Republic of Congo (DRC) has forced thousands of people to flee across the border into neighbouring countries, but relief workers in Uganda admit that HIV is low on the list of priorities.

"[NGOs] are prioritising water, sanitation, basic health; they are doing a broad intervention," said Innocent Asiimwe, a repatriation officer at the United Nations refugee agency, UNHCR. "They might do immunisations next week, but until that's sorted, they won't have time for HIV. We need a health partner to target HIV on the ground."

So far, no refugees have asked for antiretroviral (ARV) drugs or Septrin - an antibiotic commonly prescribed to avoid opportunistic infections associated with HIV - and it was unlikely they would do so unless there was an organisation specifically sensitising the community to HIV, he said.

According to UNHCR, the violence in eastern DRC has displaced an estimated 250,000 people. About 12,000 have crossed into Uganda, with around 7,000 passing through the transit site at Ishasha, near the border of DRC's North Kivu Province. Although some returned to DRC after only a few days, others have gone to a permanent refugee settlement area in western Uganda called Nakivale.

There are approximately 4,000 refugees in Ishasha, but the transit site is not equipped to provide such a large influx of people with water, sanitation, food, condoms, and health care.

There are only three latrines for this large population, and no garbage disposal pit or system, but Médecins Sans Frontières (MSF), the international medical charity, is building a water-filtering system.

"[The need for] sanitation is immediate, but health care is needed in the long term. We need a more permanent intervention because people will keep coming," Steven Sebudda, the district health official at Ishasha, told IRIN/PlusNews.

"The population is at risk of HIV, but it is not useful to do VCT [voluntary counselling and testing] if we can't provide condoms or medicine afterward, and we can't provide condoms until there is somewhere to dispose of them." He feared that small children would get hold of used condoms and play with them or use them as water containers, creating a huge public health risk.

UNHCR is encouraging the refugees at Ishasha to go to Nakivale, where there are well-stocked health centres, plenty of medication, and trained counsellors and doctors who can assist people living with HIV.

The Inter Agency Standing Committee - a mechanism for coordinating humanitarian assistance by key UN and non-UN partners - notes in its guidelines on HIV interventions in emergency settings that it is crucial to incorporate HIV into the overall emergency response.

The guidelines state: "If not addressed, the impacts of HIV/AIDS will persist and expand beyond the crisis event itself, influencing the outcome of the response and shaping future prospects for rehabilitation and recovery."

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