On 3/19/2009 12:36:15 PM Ray Kirkland wrote

The following blog by Ray Kirkland, director of programs for U.S. Africa Command's Strategies, Plans, and Programs directorate, refers to the Military HIV/AIDS Prevention Conference, March 2-5, 2009 in Gaborone, Botswana. For more information about the conference, see Military HIV/AIDS Prevention Conference Opens in Gaborone.

The conference was co-hosted by the Botswana Defense Force and the DOD HIV/AIDS Prevention Program. It brought together representatives of 26 African defense forces, and had representatives from the Joint United Nations Programme on HIV/AIDS (UNAIDS), the U.S. Agency for International Development (USAID), the United Nations Population Fund (UNFPA), non-governmental organizations, and the President's Emergency Plan for AIDS Relief (PEPFAR), as well as the South African Development Community (SADC). The principal purpose was to share best practices and to identify gaps in programs in order to make them more effective in the future.

This was an extremely well done conference, and the level of participation from African partners was tremendous. It was impressive to see what has actually been achieved to date by these militaries within the last ten years with quite limited resources. The defense force participants were equally impressive and very professional. Having worked in this field in Africa for many years myself, I felt that, in many ways, a number of these militaries were leading the way in their countries in how they were implementing their programs.

Still, there were major gaps identified which need support, both resources and leadership support. For example, less than half have policies related to program implementation and less than half have prevalence data and know exactly how bad their infection rate is. Most need (and I feel can effectively use) additional resources to expand the reach of their programs.

On the positive side, 100 percent now have testing and counseling services, and 90 percent test all potential recruits (only 5 percent will accept those that test positive). For those that deploy peacekeepers, only 16 percent said they would deploy positives outside their own countries. The topic of HIV/AIDS policy and peacekeeping was discussed at length, but no consensus was reached, although it appears that most militaries are moving towards similar policies with respect to how they deal with HIV/AIDS and peace keeping operations.

The South Africa Development Community (SADC) is in the process of developing a policy which lays out minimum standards for member country military HIV/AIDS Programs. Such a policy document could serve as a model for adoption by the other regional bodies, including the African Union.

One of the principal take-aways from the conference was that successful programs were successful not because of the level of material and financial support, but because of the support for the programs from senior leadership. This theme recurred throughout every aspect of the conference. This is an area where U.S. Africa Command can play an important role in its engagement with senior military leadership on the continent.

Another take-away was that the HIV/AIDS programs of the defense forces have an importance that exceeds the bounds of their respective militaries. In many African countries military health facilities are some of the best and in some cases the only facilities available in a geographical area. As a result, they tend to serve the local civilian population as well as the military. The same holds true for HIV/AIDS services. This is the case for 42 of the 44 African countries supported since 1999 by the Department of Defense HIV/AIDS Prevention Program (DHAPP). This is not to say that the militaries are providing services that should be provided by others, just that they are seen as part of the countries' overall health system and are expected to serve civilians in their catchment areas. This past year the Department of Defense HIV/AIDS program has served a half million African troops and family members alone, and supported 185 voluntary counseling and testing centers and 63 laboratories.

Following the HIV/AIDS conference, I also visited the Malawi Defense Force to review their HIV/AIDS program which the U.S. Department of Defense supports. The Malawi Defense Force reports a current HIV/AIDS prevalence of 14 percent and declining due to the success of its HIV/AIDS program. In discussions with the Deputy Commander, Lieutenant General Ntonya, he stressed that the program had top level support from the commander, and senior leadership understood the importance of this high level support.

When asked how he knew that the program was achieving success he stated, "In the past we had to pick up bodies and go to the cemetery almost every day to bury soldiers, their wives or their children. Now we don't go very often. That means the program is working." The U.S. Department of Defense will be providing the Malawi Defense Force with assistance in establishing two new clinic with labs in the far north of the country and in the south. This is expected to strengthen their program considerably.

One other take-away from the Malawi visit was the perception of both the Centers for Disease Control (CDC) representative and the USAID director and senior health officer. These individuals felt that because of their structure and greater discipline, the Defense Force could actually model particular HIV/AIDS interventions, especially those related to prevention, and show the kind of impact such interventions could have on a population. This information could then be used to expand these interventions to the larger civilian population. This refers to what I mentioned above about the militaries actually showing leadership in the fight against HIV/AIDS.

Ray Kirkland
Director of Programs

On 5/1/2009 10:47:23 AM Javier C. in Stuttgart wrote
Mr. Kirkland,

Simply put, why doesn't AFRICOM stay within it's lanes?
As a military organization within the US Department of Defense, it's bread and butter is, I assume, military related. While I am sure AFRICOM can bring many other capacities to bear in the fight against HIV/AIDS, it is a military organization. It breaks things, defends, it has ships and planes and tanks that shoot bullets, missiles and rounds. They do not and are probably not focused/highly skilled on solving humanitarian issues as opposed to the other wartime skills they have in great supply and to great degrees. Why divert money, people and other resources from fighting the other two wars currently in progress? Why not simply funnel money and people and resources to organizations whose purpose is to build up, such as USAID and other NGOs? We all want to make the world a better place, but if I am a doctor then I will practice medicine, a carpenter then build things and if I am a machine of war, well then...maybe using a hammer to solve all your problems regardless of if they need a hammer isn't the best way to go about it.