:

Dealing with Disasters International Conference 2010

HIV: Threat to Stability and Security or a disaster averted?

Hilary Homanswww.abdn.ac.uk/sustainable-international-development

Overview

• Background• Progress

– International peacekeepers– National militaries

• Current situation• New agenda

The 1990s

• In the 1980s and early 1990s, Thailand experienced an alarming spread of HIV infection. By 1993, 1 in 25 (4%) new recruits to the Royal Thai Army were HIV-positive, leading national authorities to conclude that the epidemic was undermining military readiness and threatening national security.

Source: UNAIDS, HIV/AIDS Prevention and Control, an experience of the Royal Thai Army in Thailand, Case study 3.

Concern amongst Defence Forces and Governments

• Namibian deputy Defence Minister “[AIDS] is inflicting misery in the region and affecting military and security establishments to the core.”

• “The HIV/AIDS pandemic constitutes the most immediate challenge to humanity and to the security and stability of our world.”

Nigerian Ambassador to the UN Arthur Mbanefo, Proceedings of the UN Security Council, 19 January 2001

Global threat

• In July 2000 the United Nations Security Council (UNSC) acknowledged the extent of the HIV pandemic worldwide and the severity of the crisis in Africa in particular.

• The UNSC stressed that the HIV epidemic, if unchecked, may pose a risk to stability and security and unanimously adopted UNSC Resolution 1308.

Related UN resolutions

• October 2000 UNSC Resolution 1325 Women, Peace and Security recognized the impact of armed conflict on women and girls and called for effective institutional arrangements to guarantee their protection and full participation in the peace process (S/RES/1325).

Contribution to HIV transmission• Uniformed personnel (including peacekeepers)

playing a significant role in HIV transmission.• According to the AIDS, Security Conflict Initiative

(ASCI), HIV prevalence in uniformed service personnel is related to a range of factors including:– Age, rank, length of service– command structures– maturity of the epidemic– repertoires of violence – military sexual trauma– operational mandates – HIV prevalence in deployment areas– military and medical policies (ASCI, 2009).

Impact on the MDGs• The MDGs recognize:

– the interdependence between growth, poverty reduction and sustainable development

– that development rests on the foundations of democratic governance, the rule of law, respect for human rights, and peace and security.

• Conflict situations undermine the development process and achievement of the MDGs. “Armed conflict remains a major threat to human security and to hard-won MDG gains. Large populations of refugees remain in camps with limited opportunities to improve their lives. In 2009, 42 million people had been displaced by conflict or persecution, four-fifths of them in developing countries.” (UN, 2010)

Correct knowledge of HIV preventionArmenia BBS 2007

IDUs SW MSM Prisoners Migrants Refugees Youth0

1020304050607080

AdultsAdolescents

Displaced persons

• Humanitarian populations should be included in national HIV and AIDS programmes and evidence-informed gender sensitive interventions targeted to areas where risk behaviour occurs.

• HIV data should be disaggregated by displacement, and access to prevention and treatment services for displaced persons monitored to improve universal access.

Progress made

• Technical supported provided • Materials developed• Regional networks established• 2005 Progress report to UNSC

Progress

Progress

• International peacekeepers

DPKO, photo

Peacekeepers• Since 2000 a growing number of unstable political

situations has led to an increase in the number of peacekeeping missions and the number of peacekeepers deployed.

• In 2000 the number of peacekeepers (including military observers and police) worldwide was 36,858.

• By the end of 2009 that number had almost tripled to 98,187.

• The number of missions had grown to fifteen (eight African countries and seven in other regions of the world).

Peacekeepers

Pakistan

IndiaEgyp

t

JordanGhana

Italy

South Afri

caChina

France

Spain

Malaysia

Zambia

0

2,000

4,000

6,000

8,000

10,000

12,000

Figure 1: Top twenty three troop contributing countries, December 2009Source: DPKO, 2010

HIV prevalence rates for 2007 in 23 top Troop Contributing Countries

Pakista

n

Bangla

desh India

Nigeria

Egypt

Nepal

Jordan

Rwanda

Ghana

Uruguay Ita

ly

Senega

l

South Afric

a

Ethiopia

China

IndonesiaFra

nce

Morocco Sp

ain

Sri La

nka

Malaysi

a

Philippines

Zambia

0

2

4

6

8

10

12

14

16

18

20

Sources: European Centre for Disease Prevention and Control/WHO Regional Office for Europe (2009) HIV/AIDS surveillance in Europe 2008

UNAIDS, 2008. Fact Sheet on HIV and AIDS, 2008: Epidemiological Update, UNAIDS, Geneva. www.unaids.org

UN Department for Peace Keeping Operations (DPKO)

• DPKO has intensified training in HIV of international peacekeepers since 2000, & especially since 2004.

2004 2005 2006 2007 2008 2009*0

10000

20000

30000

40000

50000

60000

3075

7776 9529

16044

22394

53613

Military Police Civilian

TOTAL trained

Figure 1: Total number of peacekeeping officers receiving HIV Induction training by category of staff and year 2004 to 2009

Source: DPKO data base, 2010

UN Department for Peace Keeping Operations (DPKO)

• DPKO training has led to an increase in peacekeeping staff seeking HIV testing.

2005 2006 2007 2008 2009*0

2000

4000

6000

8000

10000

12000

14000

16000

1833

6306

74367373

13881

Military Police Civilian

TOTAL

Figure 2: Number of peacekeepers seeking HIV testing each year by type of staff 2005 to end 2009

Source: DPKO data base, 2010

Behaviour change:

A 2007 survey of peacekeepers in Haiti found that 29% had sex whilst on leave/compulsory time off (CTO). Of these, 43% did not use a condom with their last sexual partner. Other surveys indicate the need to increase condom use with casual/paid sexual partners.

Progress

• National militaries

DoD photo by Fred W. Baker III  

Information

• Information of HIV in national militaries is not always available. Recent data on HIV prevalence rates amongst national militaries from 33 countries show that information was publicly available in less than half (42%) of the countries.

• Where data were available, HIV prevalence data varied from a low of 0.64% amongst recruits in Vietnam to 10.1% in Equatorial Guinea.

Progress made in Thailand

• Thai response was for the Army to implement a comprehensive AIDS response, emphasizing HIV prevention models tailored to the specific needs of military settings.

• HIV prevalence in the Thai Army:– halved by 2000 – declined by more than 75% – to less than 1% in

2003 (UNAIDS, 2005)– further reduced to 0.5% at the end of 2008

(Tassie, 2010).

.

Case study of the national military in Mozambique

HIV counselling and testing amongst military personnel launched in 2004. By the end of 2009:• eight static military HIV

counselling & testing facilities had been opened

• 10,000 military personnel, their sexual partners and families tested for HIV.

HIV counselling and testing campaigns have reached the largest number of soldiers in barracks through example by the military leadership.

Mozambique (continued)

• Community counselling & testing in residential areas near barracks and in neighbouring military units has helped to reach soldier’s partners & families.

• Promotion & provision of services coordinated with clinical treatment of partners & involves trained military counsellors & health care providers.

• Attention paid to female soldiers on the dangers of unprotected sex.

“Now I travel protected because I know my HIV test result.”

Source: Felix, 2010

Status of the epidemic

• In 2008, 71% of new HIV infections were estimated to have occurred in Sub-Saharan Africa.

• The epidemic appears to have peaked by 2008 with a reduction in the number of people living with HIV to 33.4 million and 2.7 million new infections during 2008.

Sub-Saharan Africa estimates 1990–2008Number of people living with HIV Adult (15–49) HIV prevalence (%)

Number of people newly infected with HIVNumber of adult and child deaths due to AIDS

Figure 1

Estimate High and low estimates

1990 1993 1996 1999 2002 2005 2008

25

20

15

10

5

0

Num

ber

(milli

ons)

1990 1993 1996 1999 2002 2005 2008

10

8

6

4

2

0

%

1990 1993 1996 1999 2002 2005 2008

4

3

2

1

0

Num

ber

(milli

ons)

1990 1993 1996 1999 2002 2005 2008

4

3

2

1

0

Num

ber

(milli

ons)

Source: UNAIDS/WHO

Not known

• HIV prevalence in many militaries• Effect of mandatory testing• Implications of circumcision• Role of militias• Disarmament, Demobilisation and

Reintegration

Policy implications

• Align policies & practices of national, regional and UN peace support missions to attain universal standards of HIV prevention, treatment & care across all TCCs, in line with the global goal of universal access (ASCI, 2009).

• Align HIV prevention strategies with sexual violence prevention and response, calling on the command structure wherever appropriate.

• Establish synergies with related issues (health, gender).

Practice implications

• Intensify efforts to reduce HIV risk behaviour amongst uniformed service personnel.

• Increase coverage of HIV prevention and AIDS treatment, care and support interventions amongst uniformed service personnel, their sexual partners and families.

• Pay more attention to men’s use of violence (especially sexual violence), and the specific needs of female combatants and women associated with armed forces in Disarmament, Demobilization and Reintegration (DDR) programmes.

Recent UN resolutions • June 2008 UNSC Resolution 1820 Women, Peace and Security

urged troop and police contributing countries to take appropriate preventative action to strengthen efforts to implement the policy of zero tolerance of sexual exploitation and abuse in UN peacekeeping operations and military sexual trauma among their personnel as a way of reducing HIV risk (S/RES/1820: 7).

• September 2009 UNSC Resolution 1888 specifically mandates peacekeeping missions to protect women and children from rampant sexual violence during armed conflict

• October 2009 UNSC Resolution 1889 Gender, women and sexual violence called for measures to strengthen the participation of women at all stages of peace processes, focusing on the period after peace agreements have been reached.

New agenda

• Create a policy environment in which uniformed service personnel are supported to be “agents of change” in HIV prevention and are seen as key players in protecting vulnerable and at-risk populations from HIV, sexual violence and exploitation.

Thank you for your attention

www.abdn.ac.uk/sustainable-international-development