HIV/AIDS in the military

http://www.nigeria-aids.org/

Col. Wale Egbewunmi Coordinator Armed Forces Programme on AIDS Control (AFPAC) Nigeria

Please allow me to make these few contributions on the issue of HIV/AIDS and the Nigerian military. I hope with this, a lot of people will be better informed on the efforts being taken by the military to combat the scourge from the program point of view and more importantly hope that this will generate comments and contributions on this topic.

I must however first apologize for this late entry.

The Nigerian military has been very active in the control of the scourge of HIV/AIDS. Even as far back as 1987 when the public awareness was virtually non-existent, the Armed Forces of Nigeria has been playing the vital role of raising awareness among its troops. Great thanks to the efforts of senior colleagues like Brig Gen SO Njoku and Col (Rtd) Ibojie, consultant haematologists in the Army whose efforts then culminated into the outfit that we have now, Armed Forces Programme on AIDS Control (AFPAC).

In the words of the Chief of Administration, Defence Headquarters in one of AFPAC's workshops recently "The combat readiness of members of the Armed Forces in any country is of paramount importance and must not be jeopardized. HIV/AIDS presents a great threat to the well being of our personnel with grave economic and security implications if left unchecked. The Defence Headquarters is therefore fully committed to eliminate all factors that could affect the combat readiness of our troops including HIV/AIDS. Towards the realization of this, we will continue to support and promote all meaningful programmes aimed at checking the HIV/AIDS scourge in all Military Barracks".

Introduction

HIV/AIDS control activities in the Nigerian Armed Forces date back to 1987 and these eventually led to the establishment of the Armed Forces Program on AIDS Control (AFPAC) in 1993. AFPAC has since inception been responsible for planning and implementing various programs aimed at controlling the HIV/AIDS scourge within the armed forces.

Overview of program

AFPAC's HIV/AIDS control activities reflect a multi-sectoral approach. HIV/AIDS is treated as a welfare issue and not just a health problem. Consequently all interest groups such as Officers' wives associations, PLWHAs, teachers, instructors, commanders and religious leaders in the military communities are involved in the prevention and care efforts.

AFPAC coordinates and monitors all HIV/AIDS control activities within the Armed Forces. It is involved in training of Armed Forces personnel through seminars and workshops. Each of the three services is represented in AFPAC by Service AIDS Control Coordinators thus ensuring a teamwork approach.

Where we are

Visible achievements have been made in the area of awareness, production of basic information, education and communication, routine surveillance and screening of troops, and the adoption of an approved Policy Guidelines on AIDS control within the Armed Forces of Nigeria. Studies have shown that the level of awareness among the troops is quite high but the behaviour they engage in are not in line with the level of knowledge. Hence, emphasis in HIV/AIDS control in the Armed Forces is now in the area of behaviour-change interventions.

Recently an Armed Forces Technical Advisory Committee on AIDS (AFTACA) was inaugurated with the mandate of policy formulation and giving technical support to the control program. AFTACA is made up of experts in the various fields of clinical management, laboratory services and preventive education.

An Armed Forces HIV/AIDS/STI Project funded by USAID with Family Health International, Nigeria as the Implementing Partner, is being implemented presently. Activities in the project are essentially behaviour-change interventions. Participants at activities of the project are drawn from the three services based on a ratio, which takes cognizance of the relative population of the three services. Civilian employees of Ministry of Defence including officers' wives are also involved in some of the activities that are relevant to them. In addition, Policy Project Nigeria is another Implementing Partner Agency of USAID and has been giving tremendous support to the control programme in the Armed Forces.

Principal elements of the program

1a. Formative research b. KAP/Prevalence study to be conducted by Policy Project Advocacy package will be developed from these and will be utilized for sensitization and advocacy meetings

2.Peer health educators curriculum development and training - For armed forces personnel and allied civilian - Students of Command Secondary Schools. Anti AIDS clubs will also be established in these schools

3. IPC & C training with establishment of counseling centers.

4. Condom logistics workshop with the establishment of condom outlets

5. Military training institutions -sensitization meetings -development of modules -HIV/AIDS/STIs integration into curricula -workshop for teachers

6. PLWHAs -training as peer counselors -outreach workers to be trained to conduct home visits -sharing of care and support experiences

7. Other activities include: -World AIDS Day campaign activities annually -IEC materials development, pre-testing and production -International Conferences

Armed Forces HIV/AIDS Week

The maiden edition of the Armed Forces HIV/AIDS Week in Nigeria took place in armed forces locations in the country from 20th to 25th March 2001. The control of HIV/AIDS is supposed to be a command responsibility; hence participation in the activities of the week was another way of assessing commitment on the part of the commanders.

The Armed Forces HIV/AIDS Week is designed to reinforce our awareness, with activities going on in all armed forces locations simultaneously during the period. It seeks to remind our leaders, commanders at all levels of their responsibilities. Incidentally this HIV/AIDS Week is the first of its type in any country's armed forces and with this, the Nigerian Armed Forces has set the pace for others to follow. It is designed to be an annual event henceforth until the chain of HIV transmission in our midst is completely broken. The last week of March 2002 has been fixed tentatively for this year's Armed Forces HIV/AIDS Week.

AFPAC-coordinated activities of the Armed Forces HIV/AIDS/STI Project

Implementation of the Armed Forces HIV/AIDS/STI Project funded by the USAID started in earnest in February 2001. Reports from the three services confirm their active participation and adequate representation in the following activities, which have been held so far. These include: (a) Uniformed Services Working Group Meeting held in Accra Ghana from February 26 to March 2, 2001 (b) Armed Forces HIV/AIDS Awareness Week held from 20-25 March 2001 (c) Project Management Training held between 18 and 20 April 2001 (d) Formative Research conducted in selected units of the three services between May and June 2001 (e) Study on Knowledge, attitudes, behaviour and practices (KABP) of Armed Forces personnel to HIV/AIDS/STI, which was sponsored by POLICY Project/Nigeria between 11 and 22 June 2001.

Other activities in the service

During the period under review, HIV/AIDS Control Committees were reconstituted in the Army and the Air Force. Lectures were arranged for secondary school students in schools of the three services in Lagos in collaboration with the Lagos State branch of the Retired Armed Forces and Police Officers Wives Association (RAFPOWA) and Officers' Wives Associations of the three services.

Counseling, screening and distribution of condoms to military personnel for foreign missions took place during the period under review. Preventive education was also provided for youths in some locations.

Training of peer health educators

48 personnel of the three services and the Ministry of Defence have been trained in July and August as trainers of Peer Health Educators. They were selected from military units in all the states of the federation, to replicate such training by training Peer Health Educators (PHEs) in armed forces units in the different states. It is estimated that not less than 3000 PHEs will be trained in turn by these trainers. The PHEs will include serving officers and men, officers' wives, other ranks wives, magajiyas, unit RSMs, youths etc. Training of PHEs is going on in military locations in about 10 states presently.

Media Materials Development Workshop

A workshop to develop information, education and communication materials specific to the military communities was held at AFPAC with representation from the three services, Ministry of Defence and Officers wives. Participants were drawn from education, public relations department and medical. The workshop lasted for 12 days. The materials developed have been pre tested and are being produced now.

Support from the Honourable Minister

The Honourable Minister of Defence made some pledges to AFPAC during the Armed Forces HIV/AIDS Week earlier this year. The utility vehicle and multimedia projector pledged have been issued to AFPAC. He also directed that video films of the SFH drama staged on the day be mass-produced and sent to all units. With these, AFPAC has created a mobile film unit that moves about from one barracks location to the other to project films on HIV/AIDS/STI and enlighten the barracks communities. More office accommodation has also been secured at the Ministry of Defence Annex at the present AFPAC location at Moloney Street, Lagos.

Future plans

In line with the national policy, plan is on to integrate Tuberculosis control into the Armed Forces HIV/AIDS Control Programme. The control of sexually transmitted diseases (STD) component of the programme will also be given the necessary attention it deserves. A workshop on syndromic management of STDs will soon be organized for our health care providers.

With the recent importation of generic forms of anti-retrovirals into the country, efforts are on to ensure armed forces personnel living with HIV benefit from the exercise especially as the cost is now more affordable. The modalities for management of this issue are presently being worked out and the armed forces will not be left behind.

It has been documented that peacekeeping soldiers worldwide have a higher probability of becoming infected with HIV than of being killed in military action. Peacekeepers therefore need to be adequately prepared before and after each mission. The Nigerian Armed Forces has been very active in peacekeeping operations over the past years and AFPAC will not relent in its effort in ensuring their adequate preparation for the missions.

Col Wale Egbewunmi Coordinator Armed Forces Program on AIDS Control (AFPAC) Defence Hq 17/27 Moloney St Lagos Nigeria Email: walegbewunmi@hyperia.com