|
Developing
a Comprehensive HIV/AIDS/STIs Program for Uniformed Services
The armed forces, police, and other uniformed services around
the world face a serious risk of HIV and other sexually
transmitted infections (STIs), and can serve as a core
transmission group for these infections to the general
population. HIV prevalence rates among the services are
significantly higher than among the general population. To
understand this situation, one must consider the circumstances
of those who serve in uniform. Often they are posted or
required to travel for extended periods away from home, or
must await proper housing before sending for their families.
Confronting risk daily inspires other risky behaviors, and the
sense of invincibility the services promote sometimes carries
over into personal behavior. These groups also tend to have
more frequent contact with sex workers.
Because of their command and control hierarchical structures,
uniformed services permit sustainable integration of HIV/AIDS/STI/Tuberculosis
(TB) prevention and care into the systems already in place. To
reach this goal, a Task Force on Uniformed Services evolved
under the guidance of USAID. This task force–coordinated by
Family Health International, and comprised of USAID, DOD Life
Initiative, Family Health International, Naval Health Research
Center, Civil-Military Alliance, The Futures Group
International and UNAIDS–has given itself a mandate to build
on the networks of participating organizations to develop
tools to support the integration of HIV/AIDS into existing
systems and structures of the Uniformed Services.
In consultation with Uniformed Services representatives from
Ghana, Nigeria, Zambia, South Africa, Kenya and Eritrea, the
elements necessary to develop a comprehensive package were
identified:
·
Advocacy
at the highest levels to mandate vital policies
such as ensuring that STI treatment at the clinic is kept off
an individual’s records. Others mandate inclusion of condoms
in travel kits, adequate supplies of STI drugs, and continued
service if HIV-positive.
·
Qualitative
assessment to find out how officers and the ranks perceive
risk
and risky behavior, where they seek treatment for STIs, when
they use condoms, what they do for recreation, whom they
listen to for information about HIV/AIDS/STI/TB, and what they
value.
·
Strategic
planning
based on an assessment of the potential for integrating
HIV/AIDS programming into existing systems and structures.
·
Behavior
change communication (BCC), based on the assessment, to develop a peer educator network,
interpersonal and group communication strategies, and use
local mass media.
·
Basic
and in-service training on HIV/AIDS for all recruits and personnel.
·
Condom
distribution
and policies, including the promotion of 100 percent
condom use policies in surrounding communities and garrison
towns.
·
Strengthened
STI services within
health delivery systems used by the uniformed services.
·
Quality
HIV voluntary counseling and testing (VCT) services.
·
Care
and support for those affected, including quality clinical services and support groups for
people living with HIV/AIDS (PLWHA) and their families.
·
Monitoring
and evaluating impact.
In addition, a number of other issues unique to the Uniformed
Services have emerged:
·
Demobilization.
A number of militaries around the world are demobilizing
troops in large numbers. This presents both a challenge and an
opportunity. The challenge is to reach troops prior to
demobilization with HIV/AIDS prevention and care education and
information, before they function as bridge populations to the
general community. This presents an opportunity to take
advantage of this process to create a cadre of change agents
to release back into the general community. A number of
organizations are working on this issue, including USAID and
UNAIDS.
·
Peacekeeping
Operations.
Working with the UN to link national efforts to global
peacekeeping efforts.
·
Women
in Uniformed Services. More and more women are members of the uniformed services. Efforts are
needed to ensure their needs are met.
·
Prisons.
Specific tools need to be developed to meet the needs of
uniformed services working in prisons and for prisoners.
Activities of the Uniformed Services Task Force to date: In
addition to a number of Task Force planning meetings, there
was a regional meeting in Accra, Ghana, in February 2001. The
goal was to reach consensus on the overall concept of the
comprehensive guide; examine and further develop peer
education, basic and in-service training manuals; design a
guide for developing behavior change communications; and
create a manual on monitoring and evaluation. The materials
are now being pre-tested in Ghana and Nigeria under the USAID
IMPACT project, and with the Eritrean Defense Forces with
technical support from IMPACT and UNAIDS. Plans are underway
for a workshop to develop specific policy and advocacy tools
and strategic planning and assessment tools.
There are examples of work with the Uniformed Services in
many countries, including Cambodia, Thailand, Cameroon,
Eritrea, Ghana, Rwanda, South Africa, Zambia and Zimbabwe. The
Task Force will make an effort to ensure that opportunities
are captured to further develop and build upon existing work
and tools for the Uniformed Services. The Task Force will also
begin to identify other partners to ensure greater outreach
and consistency in international support to Uniformed Services
for HIV/AIDS programming.
Resources
- Basic and In-Service Training Module:
HIV/AIDS and Behavior Change in the Uniformed Services,
Uniformed Services Task Force [forthcoming].
- Developing a Comprehensive Monitoring and
Evaluation Workplan for HIV/AIDS and STI Programs: A
Facilitator's Training Manual. Comprehensive Package on
HIV/AIDS/STI for Uniformed Services, Uniformed Services
Task Force [forthcoming].
- O’Grady M, Miller NN. In The
Civil-Military Project on HIV/AIDS: An International Joint
Venture for HIV/AIDS Prevention. Edited by Bunmi Makinwa
and Mary O’Grady. FHI/UNAIDS Best Practices in HIV/AIDS
Prevention Collection. UNAIDS and Family Health
International, 2001.
- UNAIDS Key Materials on Military
including:
- Briefing
note on the Civil-Military Alliance to Combat HIV and
AIDS. Hanover, NH, Civil-Military Alliance, 1996.
- Kingma
SJ. AIDS prevention is a priority military mission.
Address presented to the IXth International Conference
on AIDS and STD in Africa, Kampala, Uganda, 10-14
December 1995.
- Miller
NN, ed. Alliance Our Sponsors (newsletter of the
Civil-Military Alliance to Combat HIV and AIDS).
- Protect
yourself against HIV/AIDS. A briefing document for
police and armed forces personnel. Report of the
regional policy workshop for Eastern and Southern Africa
on AIDS prevention in the civil-military environment,
Mangochi, Malawi, 23-26 April 1996.
- Yeager
R. AIDS brief on military populations: for sectoral
planners and managers. Morgantown, WV, West Virginia
University, 1995.
Uniformed
Services HIV/AIDS Peer Leadership Guide, Uniformed Services
Task Force [forthcoming].
|
