It is now widely accepted that the HIV/AIDS pandemic is “the most formidable development challenge of our time”, as Secretary-General Kofi Annan asserted in his report on AIDS to the General Assembly special session. Globally there is an increased call on a “war” against this deadly infection.

But there is strong evidence now, that war itself is a factor in the rapid spread of the virus. Conflict brings economic and social dislocation, notes the Joint UN Programme on AIDS (UNAIDS), including the forced movement of refugees and internally displaced people and resulting loss of livelihoods, separation of families, collapse of health and education services, and dramatically increased instances of rape and prostitution.

All this contributes to conditions for the rapid spread of HIV and other infectious diseases. Doug Webb, HIV/AIDS Advisor at Save the Children UK says, “Millions of children whose lives were already difficult have been further devastated by the direct and indirect effects of HIV/AIDS in conflict and post conflict situations.”

Throughout the world, military personnel are among the most susceptible populations to HIV and AIDS. Military and peacekeeping service often includes lengthy periods spent away from home, with the result that personnel are often looking for ways to relieve loneliness, stress and their sexual needs. The military’s professional ethos tends to excuse or even encourage risk-taking.

Most personnel are in the age group at greatest risk for HIV infection – the sexually active 15-24 year age group. Deployment to unsettled areas increases their chances of acquiring HIV, as they are exposed not only to socially disrupted settings where STIs may abound, but also to the possibility of infection through wounding and contaminated blood.

This issue has grown in significance amid concerns that the UN itself may be an unwitting agent for the spread of the virus around the world. “I regret to say,” the former US Ambassador to the UN, Richard Holbrooke, told the Security Council in January 2000, “that AIDS is being spread, among other people, by peacekeepers.”

A study of Nigerian troops returning from peacekeeping operations in West Africa, for example, conducted by the non-governmental Civil-Military Alliance to Combat HIV/AIDS (CMA), found infection rates more than double that of the country overall. Significantly, the study also found that a soldier’s risk of infection doubled for each year spent on deployment in conflict regions, suggesting a direct link between duty in the war zone and HIV transmission.

With 18 violent conflicts, tens of thousands of troops in the field and some 8 million refugees and internally displaced people, UN Department of Peacekeeping Operations (DPKO) Medical Unit head Dr. Christen Halle noted, it would be surprising if war were not a major factor in the spread of HIV in Africa.

“There is a whole context [in combat areas] which contributes to the spread of infectious diseases, including sexually transmitted diseases like HIV.”

Lydia Temoshok of the World Health Organization presented disturbing data from the US military: During the six months prior to Temoshok’s study, 43% of HIV-infected servicemen surveyed reported having at least one HIV-negative sexual partner and not always using a condom during vaginal or anal sex.

A study of Dutch soldiers on a five-month peacekeeping mission in Cambodia found that 45% had sexual contact with prostitutes or other members of the local population during their deployment.

In Cameroon, HIV seroprevalence rates in 1994 were at a relatively low 3.2% for the general population, but 6.3% for the military. Mpoudi Ngolle Eitel, Service de lutte contre le SIDA, lamented, “Some soldiers still do not believe in the existence of AIDS.” Eitel utilises compulsory courses in STI prevention, weekly radio programs on STI/AIDS, and use of peer educators to further HIV/AIDS education.

Major Rubaramira Ruranga of the Joint Clinical Research Center in Uganda, pointed out ways in which the military is a largely untapped resource that can be actively used to prevent HIV infection. Ruranga noted that members of the military are readily accessible for training and networking. The Vietnamese military, for example, has the most aggressive HIV education program in the country.

The military has a high sense of self-preservation, which can be used to promote prevention efforts. Ruranga is living with HIV and supports testing efforts in Uganda. He remarked, “Any good commander would never take his forces anywhere without first doing reconnaissance.”

The plan of action provides for reducing the rate of new infections among soldiers by 5% annually through educational and preventive measures; ensuring that new recruits are HIV-negative; voluntary, anonymous and confidential testing of military personnel; and counseling and the provision of generic medications to ill soldiers.

HIV/AIDS is the leading cause of death in Sub-Saharan Africa: a region suffering from both poverty and instability. The majority of those infected are women (55%). Half of the HIV infections occur in people under the age of 25. Soldiers are said to have up to five times higher rates of infection than the population at large.

The interaction between these three groups should be emphasized. According to Graça Machel’s report to the United Nations, “Impact of armed conflict on children,” “Adolescents are at extreme risk during armed conflict. They are targets for recruitment into armed forces and armed groups; they are targets for sexual exploitation and abuse; and they are at great risk of STDs, including HIV/AIDS.”

All soldiers, even peacekeepers, must receive proper training in how to deal with noncombatants, especially women and children.

Soldiers are a high-risk group both during peacetime and during conflicts. The military (and other uniformed services such as peacekeepers, peace observers, police, etc) must incorporate a gender sensitive approach to training and education on HIV/AIDS. This should be integrated in a code of conduct promoting respect for women and young girls.

Good examples of addressing risk behavior with soldiers exist in Botswana, Chile, the Philippines, Thailand and Zambia. They provide prevention education, condom distribution, STD treatment and voluntary testing along with counseling services.

Efforts should be directed towards reducing attitudes of aggression and power and emphasis should be put on notions of controlling conflicts and protecting people. It is crucial for soldiers and peacekeepers to re-think their role as responsible individuals and as important advocates in the prevention of the spread of HIV/AIDS.

AIDS 2002 Conference News produced by Health & Development Networks/Key Correspondent Team