Educating peacekeepers about AIDS.

When soldiers from Eritrea put on their uniform belts, they not only carry with them hand grenades, ammunition cases and canteens but, since 2003, also a leather pouch that holds four-pack condoms. With distribution ongoing, these pouches are now standard military issue equipment of the Eritrean Defense Force and thus a weapon against HIV/AIDS, which in the last twenty years has claimed more lives in sub-Saharan Africa than all wars on that continent in the last century.

More than twenty years since the disease was first identified, the Joint United Nations Programme on HIV/AIDS (UNAIDS) said that it has continued to spread not only in Africa but also in many parts of the world, killing some 8,000 people each day, while another 14,000 are infected, adding to some 42 million living with the virus. While the fight against the pandemic is pursued on many levels and in many sectors, efforts in recent years of the United Nations and its Member States have begun to specifically target the role that military and police personnel--the so-called "uniformed services"--play in the spread of the infection. The initial focus will be on peacekeepers. With many of them young and sexually active, often deployed to or from regions with high HIV/AIDS prevalence, and by profession inclined to risky behaviour, some consider the peacekeepers to be "more likely to contract or transmit the virus than the average population", Roxanne Bazergan, HIV/AIDS Policy Adviser with UNAIDS and the UN Department of Peacekeeping Operations (DPKO), told the UN Chronicle.

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HIV/AIDS deeply affects the life of every individual who contracts it. At the same time, it has broader implications, as it has the potential for destroying entire societies and thereby creating conditions that further facilitate the spread of the virus--reason enough for the UN Security Council to adopt unanimously in 2000 its first-ever resolution dealing with a health issue. In resolution 1308 (2000), the Council called HIV/AIDS a risk to stability and security, expressed concern at its impact on international peacekeeping personnel and called for action against the infection. That call was taken up by the General Assembly in 2001 in its Declaration of Commitment on HIV/AIDS, which extended this concern to uniformed services and further specified action to be taken by the United Nations and its Member States.

The use of pouches for condoms as a new standard issue equipment in Eritrea is only one illustration of how the commitments of resolution 1308 and the Declaration can be put into concrete action. Although just a small detail in a broader picture of various approaches pursued by different countries and institutions, this could serve as an example for countries contributing troops and civilian personnel to the UN peacekeeping missions, said Michael Munywoki, HIV/AIDS Policy Officer with the UN Mission in Ethiopia and Eritrea (UNMEE). Thus far, these uniform belts only include the more familiar military equipment, but Mr. Munywoki wants to ensure that their pockets contain what is necessary to protect the peacekeepers and others from HIV/AIDS. When new peacekeepers arrive in the mission area, they are offered an induction training during which HIV/AIDS awareness cards are distributed. Slightly bigger than a credit card and made from flexible plastic, they contain basic facts about HIV/AIDS and are available in eleven languages, so that most peacekeepers do not need an interpreter to learn how to protect themselves and others. And Mr. Munywoki does his best to ensure that they make this card a vital part of their personal belongings. "The pouch has a pocket and when I promote carrying the cards, I tell them that the pocket can be used to put not only a condom but also photos of loved ones."

UNAIDS has produced such awareness cards since 2001 and distributes approximately 50,000 per year to peacekeepers, while DPKO provides the condoms.

Pursuing this policy, the United Nations faces a classic dilemma, as Ms. Bazergan explains: "On the one hand, we want to encourage abstinence in the field But you are dealing with people. If you are talking about uniformed peacekeepers, they might be deployed for between four to six months or a year; if you are talking about civilians, they might be out there for a number of years. And so you give out condoms at the same time. You've got this dual message which seems to contradict itself, but it's more like a reality check."

Condoms are an important factor in addressing HIV/AIDS, but certainly not sufficient. Mr. Munywoki's way of promoting the cards by suggesting that personal photos can also be put in them exemplifies what the United Nations has recognized: there are no technical solutions to the disease but, as Ms. Bazergan told the Chronicle, the main challenge in addressing the pandemic is achieving behavioural change.

UNAIDS and DPKO work closely together in order to reach this goal. This collaboration was formalized in a 2001 cooperation framework and is symbolized by the creation by DPKO of the position of HIV/AIDS Policy Adviser at UN Headquarters. Ms. Bazergan's job is to develop DPKO policy and guide the strategic response in peacekeeping operations.

Jean-Marie Guehenno, Under-Secretary-General for Peacekeeping Operations, in November 2003 informed the Security Council of his intention to "deploy HIV/AIDS policy advisers in all major peacekeeping operations" As of February 2004, four of the thirteen UN Missions each have one of these full-time Policy Advisers placed directly in the mission area: (UNMEE), the Democratic Republic of the Congo (MONUC), Sierra Leone (UNAMSIL) and Timor-Leste (UNMISET). One will be introduced in Liberia late this year. The remaining Missions have "HIV/AIDS focal points", who deal with the issue in addition to their regular tasks.

This job keeps Col. Joyce Ng'wane Puta, Policy Adviser in Timor-Leste, and her colleagues in other Missions rather busy. When new peacekeepers arrive at the Mission area, she offers them induction training, consisting of basic facts about HIV/AIDS. More important, she has developed a module that attempts to relate abstract information about the infection to the personal experiences of those who will serve in the Mission. "There are personal risk assessment questions which I give to everyone so that each can assess his or her possibility of having been exposed to catching the virus", she said. After the assessment has sensitized these newly-arrived peacekeepers, they are provided with the strategies on how to prevent contracting or transmitting the deadly virus.

As dozens of countries participate in peacekeeping missions, language is a major obstacle to effective education about HIV/AIDS. In a wider sense, teaching becomes even more complex when it comes to culture. Traditions, beliefs and habits of communication may differ between cultures--this affects the way information can be delivered.

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Yet, while cultural specificities are an obstacle to a generic educational approach, when incorporated into an educational strategy they can also offer opportunities for effectively communicating the message about HIV/AIDS, as Mr. Munywoki recounts from his experience among Eritreans. "They have what they refer to as a coffee ceremony, and during that traditional ceremony they usually have biscuits, sweets and popcorn. And they mix them with condoms so that condoms become accepted by the community." Such culturally specific approaches can also be utilized for the training of uniformed services personnel. This is one reason that UNAIDS and DPKO emphasize the "training of trainers" in their overall policy on HIV/AIDS. This not only multiplies the number of people who can be reached but also facilitates a culturally sensitive approach, thereby increasing the depth of learning.

Awareness and knowledge about HIV/AIDS and its prevention are crucial, but the most important for most individuals is whether or not they are infected with the virus. In Timor-Leste, peacekeepers can get this information by visiting the Voluntary Confidential Counseling and Testing (VCCT) centre. Learning about one's HIV-status involves more than just receiving medical information, as Ms. Ng'wane Puta told the Chronicle: "Once someone has gone through a test, HIV actually comes at a personal level. When these individuals are waiting for results, they are very apprehensive--most of them--even if they haven't been promiscuous." Because of this emotional stress and the implications that the information about their HIV-status may have on their lives, the testing is embedded into personal confidential counselling, before and after the test, even if the result is negative, Ms. Ng'wane Puta said. "During my post-test counselling, I emphasize, especially to those who test negative: 'don't take your HIV-negative status for granted, but guard it zealously'. "For her and UNMISET, VCCT is a cornerstone of their HIV/AIDS policy, although limited resources make optimal implementation rather difficult.

The challenges with respect to regular voluntary counselling and testing are even greater for the other Missions, for example in the Democratic Republic of the Congo, where VCCT did not exist. However, according to the UNAIDS Annual Update 2003, VCCT is planned to be introduced in all major missions by the end of 2004.

With the initial spotlight on the risks of peacekeepers, the United Nations has recognized that most of their characteristics is shared by the uniformed services in their respective home countries, as mentioned in Council resolution 1308 (2000) and particularly stressed in the Declaration of Commitment. According to UNAIDS, sexually transmitted infections in peacetime are generally higher among uniformed services than in the average local population. Aside from their professional ethos of risk-taking and their young age, uniformed personnel also have more opportunities to purchase sexual services. Sinead Ryan, technical officer with the UNAIDS Office on AIDS, Security and Humanitarian Response, told the Chronicle: "In many communities, the people in the army and the police are the only ones who are getting a salary. They are the ones who have money, and this is why in many instances you will have sex workers and brothels built up around garrisons."

UNAIDS currently supports approximately fifty countries in developing and implementing comprehensive programmes that incorporate the HIV/AIDS aspects into the training of uniformed services and into an overall national strategy on the disease. Since many countries are willing to launch such programmes but not sure of how to do it, UNAIDS has also developed a programming guide to help them design a comprehensive HIV/AIDS policy, as well as a peer education kit that focuses on spreading the message and adapting it to the needs of the specific group being addressed. Furthermore, UNAIDS has established HIV/AIDS focal points in different parts of the world and in late 2003 adapted the awareness cards to national uniformed services in general. Yet, considering this strong emphasis on uniformed services, Sinead Ryan is careful to point out that this does not mean that extra blame is to be put on them. Clear data are scarce with respect to the general problems and their solutions. Another UN goal therefore is to acquire better information on the topic. Moreover, "since the national Declaration of Commitment, there is a recognition of the need to work with uniformed services, both as a high-risk and a highly functional group, as well as being agents of change. They hold this position often within their society and if they themselves become advocates in the fight against AIDS, they can have a strong impact on their peers in preventing HIV/AIDS" Ms Ryan said.

If successful, comprehensive national programmes make the uniformed services powerful agents of change in the fight against the epidemic, not only in their own community but also as peacekeepers in the host community where they are deployed. Partnerships with local communities and institutions are therefore an important part of the work of the peacekeeping missions, "because the HIV programme is better delivered by the locals themselves", as Ms. Ng'wane Puta of UNMISET told the Chronicle.

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Thus, successful HIV/AIDS education of uniformed services has the potential of yielding multiple benefits, which supports the United Nations decision to focus on this specific professional group in the struggle against the pandemic.

Even a simple act by responsible uniformed personnel in their everyday lives may have considerable impact, but a dedicated individual can also make a great difference, as demonstrated by Capt. Stephen Talugende. In 1994, as a young aspiring officer in the Ugandan People's Defense Forces, he was selected for professional training in the United Kingdom that would further his career in the military. As a requirement, he had to take an HIV test before departure, which he did in May that year, and learnt that he was HIV-positive: "From that day, I saw myself as having lost out on my professional career as a soldier and thought that maybe I could do something different or something more than just taking my path on to being a soldier." Ten years later, Mr. Talugende is the National Coordinator for the National Forum of People Living with HIV/AIDS Networks in Uganda. For the past few years, he has travelled all over the world participating in conferences, making presentations in workshops and teaching in trainings on HIV/AIDS.

In autumn 2003, he went to the UN Mission in Timor-Leste to give a "personal testimony" of his experience to peacekeepers and the local population. Having been trained as a soldier and lived through a period of fighting and conflict, Mr. Talugende had many commonalities with and thus a unique access to his audience. He told them about his personal experience with HIV, how he chose to take the test, handled the results and what he did to maintain himself as a person living with HIV He contrasted his healthy looks with the dangerous virus in his body, making people rethink about their risk perceptions with regard to HIV.

HIV/AIDS Policy Adviser Ng'wane Puta, who watched Mr. Talugende's presentation, told the Chronicle that it was so captivating that "after the presentation, people just sit there--they don't want to leave. And I believe that for most of them: their behaviour changed." Soon after his personal testimony, the number of people who wanted to be tested dramatically increased.

For more information, visit www.unaids.org

By Tobias Kuhlmann, for the Chronicle