AIDS and Peacekeepers: Reason for Good Policy, Not Fear
In the early days of AMIS deployment, the Sudan government raised fears that peacekeepers from sub-Saharan Africa would be bringing HIV/AIDS into Darfur, and talked about screening incoming troops for HIV. At the time, Khartoum was opposed to increasing the AU peacekeeping presence, and these statements must be interpreted in that light. Nonetheless, there are genuine concerns over HIV/AIDS and international peacekeeping operations, including the fear that peacekeepers living with HIV may fall sick while on peacekeeping duty, or may transmit the virus to local people.
A recent article, drawing upon evidence about HIV prevalence, the HIV policies of troop-contributing countries, and modeling of transmission risks, suggests that the likelihood of peacekeeping troops contributing to HIV epidemics in host countries is very low. (Massimo Lowicki-Zucca, Sarah Karmin and Karl-Lorenz Dehne, “˜HIV among Peacekeepers and its Likely Impact on Prevalence on Host Countries’ HIV Epidemics,’ International Peacekeeping, 1743-906X, 16.3, 2009, 352-363.)
The authors’ argument has the following steps. First, fear that peacekeepers posed a public health risk was founded upon unfounded scares about ultra-high levels of HIV in African militaries. In fact, HIV prevalence in soldiers is often not dissimilar to their civilian peers. Of the 15 top troop-contributing countries, only two (Nigeria and South Africa) have HIV prevalence above 3%. Thus they are a small proportion of the overall number of people living with HIV in the host country.
Sudan has an estimated HIV prevalence of 1.4%. If the peacekeepers in UNMIS and UNAMID have HIV rates equivalent to the population prevalence in their countries of origin, between them they will have 483 HIV positive members (343 among 9,200 UNAMID troops, 140 among 9,950 UNMIS), just 0.17% of the estimated number of people living with HIV in Sudan. The proportion of UNAMID soldiers with HIV to the population of Darfur will be higher but still small””about 0.9% assuming Darfur’s HIV prevalence is the same as the national average. If we take a hypothetical worst-case scenario in which 26,000 UNAMID troops have an HIV rate four times as high as their national average, then there would be 3,877 HIV positive UNAMID troops, 7% of the total number of people living with HIV in Darfur. That would represent a significant contribution to Darfur’s HIV epidemic as well as a considerable medical burden on UNAMID’s already-stretched logistical capabilities.
Fortunately this is only a hypothetical projection–the reality is much less worrying.
To understand why this is so, the authors’ second point is important. They argue that in many cases HIV rates among militaries are in fact lower than the national average. Senegal and Ethiopia are examples. In addition, most troop-contributing countries test for HIV prior to deployment and do not send HIV positive soldiers on peacekeeping missions. So the figures given above are certainly overestimates.
Among the countries that undertake mandatory pre-deployment testing for HIV are Ethiopia, Nigeria, Rwanda and South Africa (though in May 2008 the South African courts ruled the policy an unconstitutional violation of soldiers’ rights to non-discrimination). Nigeria undertakes pre-deployment testing and does not deploy HIV positive soldiers if the host country so requests. The countries that contribute the vast majority of UNAMID’s troops are systematically screening out anyone who tests HIV positive.
Mandatory HIV testing and exclusion of those found positive is widely seen as a violation of individual human rights which does not bring appreciable public health benefits. International guidelines are strongly against it. However, the UN Department of Peacekeeping Operations and the African Union give troop-contributing countries the discretion to apply their own policies as they see fit. The case of UNAMID troop contributors may be a counter-example in which the international norm that opposes mandatory testing is less appropriate than the de facto practice of screening out soldiers who are HIV positive.
Third, there is the concern that even if the vast majority of peacekeepers are uninfected on deployment, they may become HIV positive while on mission, primarily through unsafe sexual practices. In this regard, after UN Security Council Resolution 1308 (July 2000) required UN peacekeeping operations to adopt strict HIV guidelines, and UN missions have taken on HIV/AIDS advisers and established close working relations with UNAIDS, all peacekeepers are provided with HIV counseling, testing, training and sensitization, as well as provision of condoms. These policies are implemented for the two international missions in Sudan.
Even though there is little reason to fear international peacekeepers contributing to an HIV epidemic in Sudan, this is no reason for complacency. HIV/AIDS programs among peacekeepers along with zero tolerance policies prohibiting sexual abuse and exploitation, remain important. The international agencies working on this issue, including UNAIDS and UNFPA, should be given every support.