HIV/AIDS as a Security Issue in Africa: Lessons from Uganda

EXECUTIVE SUMMARY AND RECOMMENDATIONS

HIV/AIDS prevention and conflict prevention should go hand in hand. They are the two blades of the scissors required to cut the strangler's cord choking Africa. Some 2.5 million Africans will die of AIDS in 2004. One in four African countries presently suffers from the effects of armed conflict.

The correlation of HIV/AIDS and war is difficult to calculate with precision because the data are less than complete, and numerous interacting factors are at play. Nevertheless, the evidence available demonstrates that war can lead to increased risks of HIV/AIDS and suggests that HIV/AIDS can make conflicts worse. While the relationship between these two scourges is too complex to be expressed in simple cause-and-effect terms, it is important to consider how the HIV/AIDS pandemic in Africa contributes to further instability and conflict on the continent and how violent conflict in turn creates conditions favourable to the spread of the virus.

HIV/AIDS, moreover, can make it harder to bring conflict to an end. To ensure a sustainable and lasting peace, it is not enough simply to halt the fighting and implement disarmament and reintegration programs (DR). Law and order and governance have to be re-established quickly, regional and local administrations set up, schools and clinics opened. However, AIDS thins the ranks of trained and experienced personnel required to fill these posts and adds to the complexity of demobilising combatants. Hence, how successfully a country resolves internal conflict may depend in part on how well it incorporates HIV/AIDS into its DR programs and on how successfully it manages national response to the AIDS pandemic.

Too many African governments still fail to recognize that AIDS is more than a public health issue but also threatens their states' stability and potential security. The New Partnership for Africa's Development (NEPAD) pays too little attention, particularly to the pandemic's impact on economic development, stability and conflict. Uganda's more comprehensive approach, which makes the security sector and specifically the army an important focus of its overall AIDS strategy, demonstrates a more integrated response.

Although it is widely accepted that HIV/AIDS has been shown, in most countries, to be more prevalent among uniformed services than the general population, this is not fully reflected in programs and allocation of funding and resources by governments, the UN or NGOs. As a result, opportunities for reducing the disease's spread in the controlled environment of organised militaries are lost. HIV/AIDS technical and financial cooperation programs for militaries in Africa remain limited by inadequate bilateral and multilateral support. Implementation of comprehensive awareness, testing, prevention, counselling and treatment programs for UN peacekeeping forces similarly suffers from lack of resources. Mandatory HIV/AIDS testing and screening should be encouraged for all participants in UN peacekeeping missions and backed up with confidentiality, counselling, access to condoms and treatment to the extent possible. All soldiers in conflict areas should be issued condoms as standard equipment, as some governments do, and given awareness and sensitisation training.

HIV/AIDS should be addressed during a conflict rather than waiting until it has ended. Humanitarian pauses and ceasefires should incorporate the opportunity for prevention education, distribution of condoms and voluntary testing. Negotiations for peace agreements should include the possibility for the full range of prevention, testing, counselling and, to the extent feasible, treatment programs for all combatants, whether regular or irregular forces, as well as among displaced civilians. It should be on the agenda during peace negotiations, which would require including public health officials on negotiating teams or at least among those providing facilitation. Consideration should be given to offering assistance, as an inducement to stop fighting, to combatants with HIV/AIDS, including treatment for diseases like pneumonia and tuberculosis that attack those whose immune systems have been weakened (so-called opportunistic infections) and, when they are medically indicated and can be sustained, anti-retroviral (ARV) medicines.

For both militaries and populations in the African countries most affected by the pandemic, the greater availability of ARV drugs will lead to a substantial increase in people living with AIDS. It also will require an effective health delivery system to insure proper management of the ARV regimen. It will mean larger numbers dependent upon health care facilities, so that greater priority should be given in DR programs to expanding health infrastructure along with widespread dissemination of the "ABC" package of prevention - abstinence, being faithful to a partner, and using condoms.

This report is the third in a series on HIV/AIDS as a security issue, and draws particularly on the policy experience of Uganda.

RECOMMENDATIONS

To the Donor Community:

1. Allocate a larger percentage of technical and financial assistance programs for militaries to HIV/AIDS prevention and treatment.
   
   
2. Provide additional resources to the Global Fund to Fight AIDS, Tuberculosis & Malaria in order to include local militaries in prevention and treatment programs.
   
   
3. Provide more funding to the UNAIDS program on AIDS, Security and Humanitarian Response (SHR) to assist national government design and implementation of testing, screening, prevention, counselling and treatment programs for their military and police forces, as part of their comprehensive programs.
   
   
4. Provide more funding to the UN Department of Peacekeeping Operations (UNDPKO) so it can significantly expand its capacity for testing, screening, prevention, counselling and, as appropriate, treatment programs for peacekeeping forces.
   
   
5. Assure as a condition of support that disarmament and reintegration (DR) programs and reconstruction programs take appropriate consideration of HIV/AIDS, including voluntary testing, counselling and treatment for ex-combatants, internally displaced persons (IDPs), and returned refugees, and provide increased funding for those programs.
   
   
6. Incorporate more support for HIV/AIDS prevention and treatment within cooperation assistance to NEPAD development programs, particularly in relation to AIDS and conflict resolution.

To the United Nations:

7. Direct all UN agencies to cooperate more closely with UNAIDS on its AIDS, Security and Humanitarian Response (SHR) program.
   
   
8. Provide adequate funding within peace operations budgets to incorporate HIV/AIDS awareness, prevention and treatment programs for all military forces and, at a minimum, enforce and monitor current DPKO policy that all members of peacekeeping forces, including civilian police, should be offered Voluntary Confidential Counselling and Testing (VCCT) prior to deployment.
   
   
9. Change current policy to encourage, through DPKO and UNAIDS, all countries contributing troops to UN peacekeeping missions to carry out mandatory HIV/AIDS testing and screening prior to deployment and on return from conflict areas, and require those countries to notify the UN whether this has been done and whether HIV/AIDS awareness training has been given to these troops.
   
   
10. Introduce, through DPKO, condom pouches as part of the standard military equipment for all members of UN peacekeeping missions.
    
    
11. Ensure that HIV/AIDS prevention and conflict prevention activities go hand in hand, including by:
    
    
1. exploring with the governments of the affected countries how all those engaged in fighting in conflict areas, including rebels, can benefit from HIV/AIDS awareness and sensitisation programs; and
   
   
2. ensuring that HIV/AIDS is fully taken into consideration as part of humanitarian accords, peace negotiations, and DR programs.

To the Governments of Affected Countries:

12. Collect and provide more statistical information regarding the prevalence of HIV/AIDS within their military and security forces.
    
    
13. Adopt a multi-sectoral approach to tackling HIV/AIDS, including the security and defence sectors, in order to take full account of the impact of AIDS upon security and conflict.
    
    
14. Allocate more resources to HIV/AIDS programs that benefit members of their military and other uniformed services, including provision of ARVs.
    
    
15. Provide condoms as part of the standard equipment for all members of the armed forces, and accompany this with HIV/AIDS awareness and sensitisation programs.
    
    
16. Encourage, where this is not already the case, mandatory AIDS testing and screening for all members of the military and other uniformed forces before and after deployment to conflict areas.

To NGOs and Other International Organisations:

17. More NGOs involved with HIV/AIDS programs should, with the agreement of the host authorities, work with the uniformed security services.
    
    
18. International bodies and other organisations able to work in conflict zones, in particular those with access to "rebel-held" areas such as the International Committee of the Red Cross (ICRC), should include HIV/AIDS awareness and sensitisation programs in their activities.

Kampala/Brussels, 16 April 2004