Abstract

Armed conflict profoundly alters the epidemiology, prevention, and treatment of HIV by disrupting health 
systems, displacing populations, and exacerbating structural vulnerabilities. This narrative review synthesizes 
evidence from seven conflict-affected regions, including Sub-Saharan Africa, the Middle East and North Africa, 
Central and South Asia, Eastern Europe and the Caucasus, Afghanistan, the Democratic Republic of Congo, and 
Iraq, to examine how conflict dynamics shape HIV transmission risks, access to prevention and care, and the 
functionality of health systems. Findings indicate that while conflict can heighten exposure to HIV through sexual 
violence, population mobility, and weakened social protection systems, the relationship is neither linear nor 
uniform across contexts. Severe disruptions to testing, antiretroviral therapy (ART), and continuity of care 
emerge as recurrent challenges, compounded by limited surveillance, data scarcity, and humanitarian response 
gaps. Key populations, including displaced persons, women, adolescents, and people who inject drugs, face 
amplified risks due to stigma, insecurity, and exclusion from services. Methodological inconsistencies and 
contextual data gaps further hinder accurate assessment of epidemic trends. Strengthening ethical research 
practices, improving HIV data systems tailored to crisis settings, and expanding evidence-based, adaptable service 
delivery models are imperative for mitigating HIV-related vulnerabilities in conflict zones. The review highlights 
the urgent need for coordinated policies and sustainable investments that safeguard HIV services before, during, 
and after conflict.