This report compares the impact of El Niño-induced climate events in Southern Africa during the 2015/2016 and 2023/2024 cycles, with a focused lens on HIV, sexual and reproductive health and rights (SRHR) and related vulnerabilities including gender-based violence (GBV), food insecurity and displacement. The analysis highlights how climate shocks intensified existing HIV and SRHR challenges, despite specific improvements and applied learnings between the two time periods.
Although the 2023/2024 El Niño event was climatically less severe than that of 2015/2016, its impact was more widespread, affecting 61 million people compared to 32 million previously. The report documents improvements in preparedness, including earlier risk communication and innovative service delivery models such as multi-month dispensing of antiretroviral therapy (ART) and mobile outreach clinics. These approaches contributed to improved retention in HIV care, especially in remote and drought-affected areas.
Despite these advances, the integration of HIV and SRHR into drought responses remained limited. Participants consistently reported a lack of clear guidance, inadequate resources and weak prioritization of HIV in humanitarian settings. Drought exposure was associated with an increase in HIV infection rates, alongside declines in HIV testing and increases in high-risk sexual behaviors, including transactional and intergenerational sex. Key populations—such as LGBTQ+ individuals, sex workers, and people who inject drugs—remained underserved in emergency planning and response.
The report also identifies gaps in addressing SRHR and GBV during climate-related emergencies. While there were examples of community health workers being trained as GBV monitors and increased emphasis on GBV in 2023/2024, referral and reporting systems remained underdeveloped. Community engagement improved, with examples of youth-led and community-driven actions, but their involvement was often too late in the planning cycle.
Key recommendations include:
• Systematic integration of HIV and SRHR into climate and disaster risk response plans.
• Tailored strategies for reaching key populations during emergencies.
• Strengthened community engagement, especially youth participation.
• Enhanced GBV prevention and response mechanisms.
• Investments in data systems that capture the intersections of HIV, SRHR and climate-related risks.
These findings and recommendations underscore the need for a comprehensive, integrated approach to drought and flood responses that address the complex interplay between HIV, climate change and humanitarian emergencies. Future preparedness and responses should prioritize building resilient systems, enhancing community engagement and ensuring targeted support for the most vulnerable populations affected by both HIV and climate-related crises.
