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.

Kampala/Brussels, 16 April 2004