Belinda Beresford
South Africa’s military forces are recording a decline in the levels of HIV infection among soldiers used for international missions, although it is still not prepared to give anti-retroviral treatment to affected troops .
Testing of about 11 000 South African National Defence Force (SANDF) members initially revealed 17% had HIV. The selected units are tested every six months as part of an overall health check-up three such surveys have been done.
Sources within the SANDF say the later results show a small decline, although it is too early to present the data. This indicates that soldiers coming into the units are less likely to have HIV now than when the research started. The army hopes this is a sign that its anti-Aids campaign is starting to work, although other factors such as self-selection could be playing a part. About 95% of the soldiers in the units agreed to be tested.
The SANDF this week upped the intensity of its anti-HIV/Aids education and prevention strategy by launching the Masibambisane (working together) campaign. As part of Masibambisane, all willing military personnel are expected to be tested for HIV by the end of next year. Before being sent on operations SANDF members have to agree to and pass a full health check-up, which includes HIV testing.
By the end of next year all medical service staff will be trained to care for HIV-positive soldiers, while the army hopes to have a minimum of 6000 peer educators. An official involved in the programme said already more soldiers are volunteering for HIV tests.
The initiative to combat HIV/Aids in the military is being assisted by the United States Department of Defence. A programme run through the US navy is helping 11 countries manage HIV in their military and South Africa was the first country to participate.
The US has declared HIV/Aids a matter of strategic importance. The first HIV-positive member of the SANDF was identified in 1991.
The focus of the Masibambisane campaign is on prevention through behavioural changes and not treatment. Given its regimented nature and comprehensive health services, the army is considered one of the arms of the state that could easily provide anti-retroviral care to members.
However, the Surgeon General, Lieutenant General Rinus Jansen van Rensburg, is adamant that the army will comply with the national Aids plan, which does not include the provision of anti-retroviral drugs. He also says he has reservations about the feasibility of such a treatment programme, despite the exhaustive training programme being undertaken.
Others involved in the SANDF Aids initiative say army doctors are being trained to give anti-retroviral drugs, in part because they have to care for soldiers who buy the medicines privately.
The US military gives its members such treatment and includes in its ranks soldiers, on anti-retroviral drugs, who have been HIV-positive for 14 years. Within the South African military, stresses appear to mean survival of HIV-infected soldiers is shorter on average than among civilians.
SANDF members who have occupational exposure to HIV can receive treatment with anti-retroviral drugs to reduce their chances of infection.
Armies are regarded as vectors of disease. As a rule of thumb the US government estimates that African armies have twice the prevalence of HIV than the countries’ general population.
Another factor suggesting that the original 17% figure may be on the low side is that, by their nature, the rapid deployment units used outside South Africa’s borders tend to be the healthiest and fittest. In addition the survey did not include soldiers from all the provinces the army says that the civilian provincial patterns of infection are mirrored in the military.
An SANDF release on Masibambisane admits that “the military community is considered to be a high-risk environment for HIV transmission”. Soldiers tend to be young, sexually active, away from home and surrounded by opportunities for sex .
Sexually transmitted diseases facilitate the spread of HIV, and in peacetime such infections among military are found to be between twice and five times that of the civili-an rates. In war, the United Nations estimates, the military risk of acquiring a sexually transmitted infection can be 100 times that of civilians.
Despite their limitations, the SANDF figures probably represent the only large-scale survey of African men. South Africa’s national estimates come from pregnant women attending public antenatal care facilities.
The SANDF is in the process of creating an HIV database. There are no estimates on prevalence in the army prior to the initial 17% study. The army already tests all new recruits: it is the only employer allowed to consider HIV status when assessing potential employees.