For years, international efforts to combat AIDS have focused on preventing the spread of HIV within civilian populations. But the 22 million people who serve in armed forces around the world are a group particularly vulnerable to contracting and spreading the disease. The United States and the United Nations are reaching out to military commanders in Africa and elsewhere to develop effective HIV prevention programs.
The HIV infection rates for armed forces personnel in certain regions of the developing world are staggering, as high as 60-percent in some sub-Saharan African nations, according to the U.N. Program on HIV/AIDS.
At a recent AIDS conference in Washington, retired Marine General Carlton Fulford described the gravity of the situation. General Fulford, who directs the Africa Center for Strategic Studies for the U.S. National Defense University, says AIDS-stricken militaries lose their effectiveness as a fighting force, putting the nations they serve on a possible path to failed state-status.
He says governments around the globe have no choice but to confront the problem. "There is intense concern about a nation's military, and an awareness that the strength or weakness of that military can impact the survival of not only a regime, but the nation as a whole," he says.
Most soldiers are sexually-active young males aged 18-to-24. In developing countries, soldiers often enjoy a privileged status, as well as disposable income greater than the average civilian. In addition, they are immersed in a military culture that tends to encourage aggressive behavior and risk-taking.
According to U.N.-AIDS, these factors add up to HIV infection rates for armed services personnel that are often double or triple that of the general population.
Most international efforts to fight HIV / AIDS are designed with civilians in mind. But Rick Shaffer, a former U.S. Navy commander and public health specialist, says civilian programs rarely lend themselves to an effective military application.
Mr. Shaffer, who heads the Pentagon's HIV / AIDS prevention program, says targeted strategies are required, and that these strategies must be embraced by military commanders. "It is not just a medical issue. It is not just for the physicians and the public health people to worry about. It is for everybody from the ministry of defense (of a nation) down (to the soldiers). And, often, just by bringing the issue to the table, coming in and offering to talk about it with their military, it brings the issue to a different level than it would have been [otherwise]," he says.
Since 1999, the Pentagon has operated an HIV / AIDS outreach program to assist the armed forces of developing nations, focusing primarily on Africa, where partnerships with 27 nations have been forged. Mr. Shaffer says the goal is to help other militaries develop targeted programs for containing the spread of HIV. "One of the goals in some of these countries is to help them get their (HIV) testing up and going. One of the keys in the prevention area is not just providing the education. Individuals have to know what their status is in order to effectively bring on board the [transmission] prevention methods. And that is one of the things we are trying to push in a number of countries," he says.
The HIV / AIDS dilemma becomes particularly acute in the context of international peacekeeping operations, when troops from high AIDS-prevalence nations are deployed to low-prevalence regions, or vice-versa.
Retired General Carlton Fulford tells this story from a visit to Africa. "I had a leader of an African country tell me that he would rather deal with insurgents than deal with peacekeepers who brought HIV into his country. That [example] is anecdotal, but it came from the leader of a nation. And I think it expresses part of the difficulty we are challenged with here," he says.
The U.N. Department of Peacekeeping Operations does not require troops be tested for HIV. But according to HIV / AIDS policy advisor Roxanne Bazergan, the United Nations acknowledges the need to prevent the spread of the virus. "On the one hand, we encourage abstinence. But, on the other hand, as a reality check, we do provide condoms. The recommended issue is five condoms per peacekeeper per week. We are also building up voluntary counseling and testing facilities within mission. East Timor was the first to do this last year, [but] we want to have it across the board [universal]," she says.
Ms. Bazergan says the challenge of containing HIV is far from easy. Some obstacles are medical; others, she says, are human. "Sometimes we find troops coming in, and they know very little about HIV. Also, another problem is mainstreaming HIV [prevention techniques]. We have had consignments of condoms burned by commanding officers who did not want their troops to be given condoms. And I must stress, it is [always] up to the commanding officer as to whether the troops get condoms or not," she says.
At present, it is difficult to judge the efficacy of U.S. and U.N. initiatives, since many developing countries have only begun to keep statistics on HIV infection rates for their personnel in uniform.
But, speaking in Washington recently, Chad's Army Chief of Staff, Colonel Idriss Dokony Adiker, said his nation's armed forces have benefited from contact with their U.S. counterparts:
The colonel said, with the help of the U.S. Defense Department, Chad's military doctors have been able to attend a few seminars, and that the effort has helped heighten awareness of HIV / AIDS. He says the goal here is not to eradicate the disease, which is impossible, but to curb the spread of the virus.