Africa's armed forces find HIV a tough opponent

Kigali - If you are HIV-positive, you could be facing "career death", and unlikely to be deployed on peacekeeping missions or sent on training courses abroad, activists have argued.

Combat effectiveness versus the rights of soldiers is an issue many of Africa's armed forces are grappling with.

The impact of the epidemic on the military is well recognised: in two decades of war with the rebel Lord's Resistance Army, Uganda's defence force lost more soldiers to AIDS than to fighting; in Zimbabwe, AIDS-related illnesses are estimated to have killed more military personnel since 1983 than all its military operations combined, including the bloody independence struggle.

Rwanda, which has been excluding HIV-positive recruits since the early 1990s, views the high uptake of voluntary counselling and testing (VCT) services as a major achievement in its military AIDS programme.

Seventy percent of the country's armed forces have been tested for HIV, and prevalence currently stands at 4.5%, according to Dr Charles Murego, director of medical services in the ministry of defence. More than 1,000 HIV-positive personnel and their families are enrolled in the military's care and treatment programme.

But only 17% of Zambia's military personnel have come forward to be tested voluntarily. "VCT is not working in our military set-up; let's look at mandatory or routine testing," suggested Zambian Brig-Gen Joseph Banda at a conference on scaling up AIDS services, held in Kigali, Rwanda, this week.

Mandatory testing being considered

Banda told delegates at the gathering, organised by the US President's Emergency Plan for AIDS Relief (PEPFAR), that mandatory testing ahead of peacekeeping missions, or before troops were sent on foreign training courses when the host country demanded an HIV test, was a fact of life in the Zambian military.

Mandatory testing was also carried at the discretion of the service command, when considering promotion or assigning special duties. "Perhaps mandatory testing is not the right word ... It's too strong, maybe we should use the words routine testing, because it is more polite and more inviting, and soldiers can accept it," Banda told IRIN/PlusNews.

The Zambian Defence Force is in the process of drafting a new AIDS policy, which could include compulsory testing during the annual medical check-up.

"We can pick up on these people immediately, and then admit them quickly to management systems before they deteriorate; but if we just depend on VCT, very few people will come forward, they will only come forward when ill, when we can't even deploy them, therefore compromising the combat readiness of the defence force."

Combat readiness at all costs?

Combat readiness was a phrase Banda used often, and in his view was the bottom line when discussing the screening of HIV-positive recruits. "We just won't be combat ready if we compromise."

Analysts have argued that the policy of rejecting HIV-positive recruits has not been thoroughly considered by African militaries.

Martin Rupiya, of the defence sector programme at South Africa's Institute of Security Studies, noted in a recent study that the increasingly common policy was a "rough and ready practice" with serious shortcomings.

He argued that an HIV test could not be regarded as conclusive, as some potential members could be in the 'window period', while HIV-positive recruits could be deemed medically fit if their CD4 count - which measures the strength of the immune system - did not fall below 200.

A recruit would need to be tested repeatedly over a period of 180 days, and have a CD4 count of below 200, as well as viral load of over 100,000, before they could be deemed unable to serve in the armed forces, he pointed out.

However, Rupiya found that very few African security institutions "have the means, time and technical know-how to carry out such comprehensive tests".

"The scientific evidence on determining the HIV status of potential recruits makes nonsense of the current position adopted by states and institutions," he wrote.

But scientific evidence does not always make good business sense to a cash-strapped military like Zambia's.

"When you take on a [HIV-positive] recruit, right from the beginning you have to start looking after that recruit; you have to put systems in place for that recruit. You have to start testing them for CD4 counts at regular intervals; you have to start providing them with ARVs [antiretrovirals] when the time comes. You have to look at their diet, nutritional supplements, and also areas of deployment; you can't just deploy them anywhere," said Banda.

"So why inherit a problem when you can avoid that problem?"

Article by courtesy IRIN