A little-recognized side effect of the HIV/AIDS epidemic is its effect on military readiness as more and more people die in countries particularly hard-hit by the disease. The Pentagon is trying to help African militaries cope with defense readiness problems triggered by the devastating impact of the epidemic on troops.
Less than one-half of one percent of America's military personnel are infected with the HIV/AIDS virus.
But in Africa, the picture is far, far grimmer. In Botswana, for example, the rate is close to 40 percent. In some military units in South Africa, over a third of all troops are infected.
For the past three years, the Pentagon has been quietly running a program to assist African militaries with HIV/AIDS prevention. It is a modest effort, totaling just about $30 million thus far.
But the Defense Department has already assisted 27 sub-Saharan African countries in developing HIV/AIDS prevention programs. They have included Botswana and South Africa, as well as Angola, Ethiopia, Ghana and Kenya, along with Malawi, Mali, Mozambique, Rwanda, Uganda and Zambia. Although the focus is on military personnel, proponents say the programs can have a broader impact.
Rick Shaffer, a retired Navy commander and public health specialist who manages the HIV/AIDS prevention effort for the Pentagon, says that in many African countries, soldiers are an important core group who can set an example for the public at large.
"This is typically a group of 18-to-25-year-old men, who are usually sexually active," he explained. "They have money. They often travel. They often are in high esteem among their countrymen and their populations, and so working with that group is a way to help with the overall HIV epidemic."
The Pentagon's effort is multi-faceted. Educational training materials are provided to raise awareness about HIV/AIDS and how to prevent its spread. The emphasis is on training local trainers, so the effort can continue when U.S. military health experts depart. The work of defense officials is coordinated with local health experts and with other U.S. agencies, like the Agency for International Development and the Centers for Disease Control.
Mr. Shaffer says that in Botswana, Ethiopia and Tanzania, the local follow-on efforts have included radio dramas with military characters aimed at HIV/AIDS prevention - a concept he says is not only creative but, potentially, highly successful.
"People's behavior changes very slowly," he said. "So if you try to sit down and tell them in two hours to change their behavior, it often doesn't change in two hours. But if you spend months, or even years, with a radio soap opera that somebody can relate to, and the behavior of the characters changes slowly over time, that actually has more people following along with that behavior change."
The retired Navy commander says he has made frequent trips to Africa to oversee implementation of the program. He says there has been occasional resistance from officials who find it politically unpalatable to acknowledge their militaries have an HIV problem.
But Mr. Shaffer says he has repeatedly encountered situations where senior military leaders have realized the HIV/AIDS problem is having a direct impact on their country's defense readiness.
"We have a saying in our military that 'health is a readiness issue,' and unhealthy forces are often not ready to defend your country," said Mr. Shaffer. "And in sub-Saharan Africa, that's a lot due to HIV ... and watching the light-bulb go on in senior military members, when all of a sudden that concept of health as a readiness issue occurs to them, has really been a gratifying opportunity."
It is too early to say whether the Pentagon program is having an effect. Mr. Shaffer says very few African militaries had baselines three years ago, setting down how many of their troops were infected. That is now changing. He says about half a dozen are doing what he terms scientifically rigorous HIV testing, so that some time in the near future, he expects an assessment of the impact of prevention programs will be possible.
In the meantime, the Pentagon is preparing to expand the effort outside of Africa. India, Indonesia, Russia, Ukraine and Vietnam have already been identified as potential partners for HIV/AIDS security cooperation.