Addressing HIV/AIDS Among Displaced Populations: Insights from Dr. Kaveh Khoshnood

World AIDS Day, observed annually on December 1, provides an opportunity to reflect on the strides made in the global fight against Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS). Yet, amidst the focus on progress, the plight of refugees is often overlooked. Facing unique challenges in accessing HIV prevention and care, this vulnerable group navigates a landscape marked by stigma, unpredictable mobility, and systemic neglect. Dr. Kaveh Khoshnood, Associate Professor of Epidemiology, Faculty Director for the Humanitarian Research Lab and Co-Lead of HIV/AIDS in Humanitarian Crises at Yale University, has led critical research at the intersection of global displacement and HIV/AIDS, offering valuable insights into what he calls a global health and human rights failure.

Displaced populations are often excluded from national and global HIV responses, leaving them especially vulnerable.[1] Dr. Khoshnood’s research, including a recently published scoping review of HIV risk factors in humanitarian settings, highlights the multidimensional vulnerabilities refugees face, spanning structural challenges and individual risk factors. The review, involving 49 studies conducted between 1990 and 2022—most of which were conducted in Sub Saharan Africa— revealed that modifiable risk factors—such as low HIV knowledge, lack of condom use, and trauma exposure—play a significant role in HIV acquisition among displaced populations. These factors, coupled with structural issues like disrupted health systems and socioeconomic instability, create a complex web of risk. The review also identified non-modifiable factors such as age and gender, showing higher HIV prevalence among certain subgroups, including younger women and men who have sex with men (MSM) in conflict zones.

One country that stood out in Dr. Khoshnood’s research is Lebanon, which hosts one of the world’s largest refugee populations, including millions of Syrians who fled the war starting in 2011. His findings reveal stark disparities: only 17% of refugees in certain regions reported ever being tested for HIV, compared to 58% of Lebanese nationals.[2] Refugees, particularly Syrians, face significant barriers to HIV care due to stigma and exclusion from the national healthcare system. As one Syrian refugee explained that there are, “no programs here [in camps] for drugs or anyone to talk to. You don’t really get helped if people know about you.”

Aside from stigma, refugees also face logistical challenges; frequent mobility between camps or areas disrupts continuity of care. Conflict settings compound these issues as overwhelmed humanitarian systems deprioritize HIV services in favor of basic needs. “Basic needs like food and shelter take precedence in humanitarian responses, while HIV care is often overlooked entirely,” Dr. Khoshnood explains. This neglect not only exacerbates health inequities but also undermines global health goals, such as ending HIV/AIDS by 2030.[3]

The scoping review also revealed that trauma-related events, such as sexual violence, are particularly significant in conflict-affected settings. Sexual violence is both a direct risk factor for HIV and a psychological barrier to seeking care. In South Sudan, for instance, displaced women reported alarmingly high rates of sexual violence, with studies indicating that up to 45% of women and girls in certain areas experienced sexual violence, correlating with increased HIV prevalence.[4]

A Path Forward: Bridging Policy Gaps and Building Solutions

As the world observes World AIDS Day, Dr. Khoshnood’s message is clear: the global fight against HIV/AIDS cannot succeed without addressing the needs of displaced populations. Refugees are among the most vulnerable groups, yet they remain an afterthought in global public health agendas. “This neglect is not just a public health failure—it’s a moral one,” he emphasizes.

Dr. Khoshnood stresses that addressing HIV/AIDS among displaced populations requires multilevel strategies that address individual behaviors, social networks, and structural barriers simultaneously. Policies that exclude refugees from national healthcare systems perpetuate inequities and violate basic human rights. “If I could make one policy change globally, it would be to ensure universal access to HIV prevention, testing, and treatment for refugees,” he says. Meanwhile there are opportunities for targeted interventions on a more localized level. These include integrating trauma-informed care into HIV services, provided by healthcare workers and humanitarian organizations, improving education around HIV prevention, and developing culturally sensitive and tailored outreach programs for refugees.[5]

Dr. Khoshnood also calls on academic institutions and humanitarian organizations to collaborate more effectively to understand and meet the needs of refugees. He cites the Middle East and North Africa Harm Reduction Association (MENAHRA) as an example of successful partnership-driven approaches. “Research must begin with the people on the ground,” he says. “Ask what support is needed and how your work can help. It’s about building trust and ensuring real-world impact.” As such, global HIV policies and programs should be designed, implemented, monitored, and evaluated with the participation of refugee voices, if possible. The findings from Dr. Khoshnood’s research and scoping review referenced above underline the urgency of prioritizing displaced populations in HIV responses. Refugees face extraordinary challenges in accessing care, but with targeted interventions, systemic reforms, and policy changes that address the HIV prevention, treatment, care, and support needs of refugees, these challenges can be overcome. By amplifying the critical needs of refugees and ensuring that their dignity and equity are at the center of our efforts, we can move closer to ending HIV/AIDS for everyone, everywhere.