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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

   

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

  1. Basic and In-Service Training Module: HIV/AIDS and Behavior Change in the Uniformed Services, Uniformed Services Task Force [forthcoming].
  2. 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].
  3. 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.
  4. 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].