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: . Dealing with Disasters International Conference 2010 HIV: Threat to Stability and Security or a disaster averted? Hilary Homans www.abdn.ac.uk/sustainable-international-development. Overview. Background Progress International peacekeepers National militaries Current situation

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:

Dealing with Disasters International Conference 2010

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

Hilary Homans

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

overview
Overview
  • Background
  • Progress
    • International peacekeepers
    • National militaries
    • Current situation
    • New agenda
the 1990s
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
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
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
Related UN resolutions
  • October 2000 UNSC Resolution 1325Women, 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
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
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)
displaced persons
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
Progress made
  • Technical supported provided
  • Materials developed
  • Regional networks established
  • 2005 Progress report to UNSC
progress1
Progress
  • International peacekeepers

DPKO, photo

peacekeepers
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).
peacekeepers1
Peacekeepers

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

Source: DPKO, 2010

hiv prevalence rates for 2007 in 23 top troop contributing countries
HIV prevalence rates for 2007 in 23 top Troop Contributing Countries

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
UN Department for Peace Keeping Operations (DPKO)
  • DPKO has intensified training in HIV of international peacekeepers since 2000, & especially since 2004.

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 dpko1
UN Department for Peace Keeping Operations (DPKO)
  • DPKO training has led to an increase in peacekeeping staff seeking HIV testing.

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
Behaviour change:

A 2007 survey of peacekeepers in Haitifound 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.

progress2
Progress
  • National militaries

DoD photo by Fred W. Baker III

information
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
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
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
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
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.
slide26

Sub-Saharan Africa estimates 1990–2008

Number of people living with HIV

Adult (15–49) HIV prevalence (%)

25

10

20

8

Number(millions)

15

6

%

10

4

5

2

0

0

1990

1993

1996

1999

2002

2005

2008

1990

1993

1996

1999

2002

2005

2008

Number of people newly infected with HIV

Number of adult and child deaths due to AIDS

4

4

3

3

Number(millions)

Number(millions)

2

2

1

1

0

0

1990

1993

1996

1999

2002

2005

2008

1990

1993

1996

1999

2002

2005

2008

Estimate

High and low estimates

Source: UNAIDS/WHO

Figure 1

not known
Not known
  • HIV prevalence in many militaries
  • Effect of mandatory testing
  • Implications of circumcision
  • Role of militias
  • Disarmament, Demobilisation and Reintegration
policy implications
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
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
Recent UN resolutions
  • June 2008 UNSC Resolution 1820Women, 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 1889Gender, 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
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
Thank you for your attention

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