Armed forces break new ground in battle against HIV/AIDS

Soldiers whooped out a cheer as a trio of singers kitted out in combat fatigues crooned "Go for your VCCT test," and a back-up group dressed in purple satin broke into a routine. A pioneering information campaign, better health services and support from army wives are coming together to help Sierra Leone's armed forces fight HIV/AIDS. "Go for your VCCT test, go for your VCCT test, you go know your status" chanted the three lead singers on a stage decorated with posters advertising condoms. Last month's concert, dubbed "Combat Ready", in the capital Freetown, was the final leg of a month-long tour through the country's barracks and brigades by a team of army musicians determined to raise HIV/AIDS awareness among soldiers. "I've seen on a daily basis what HIV/AIDS does, how it kills commanders and troops," said one of the singers, Captain Penn-Trinity, who has been in the army for 14 years. "So many soldiers died during our war, we have to do all we can to curb the epidemic." In this small West African country emerging from a decade-long civil war, a 2005 population-based survey put the national HIV prevalence rate at 1.5 percent. While there are no official figures for prevalence within the armed and security forces, it is estimated as being three to five times higher than the general population, said James Samba, HIV/AIDS Coordinator for the armed forces. While working at Freetown's Wilberforce Military Hospital in 1995, at the height of the country's civil war, Samba said he noticed an alarming number of combatants arriving with similar symptoms of diarrhoea, weight loss and fever. He began to suspect HIV. "When we did a survey of all those hospitalised cases amongst the combatants, we saw almost 80 percent had HIV/AIDS," he said. Many thousands of troops were present in Sierra Leone during the country's 1991-2002 civil war, a murderous conflict in which rape and sexual exploitation were widespread. Among those deployed on the ground were 17,500 UN peacekeepers, the regular army, civil defence forces and the former Revolutionary United Front (RUF) rebels. ARMY BROKE GROUND WITH HIV/AIDS WORKPLACE POLICY The military are always a high risk group, said Leopold Zekeng, UNAIDS Country Coordinator in Sierra Leone. "They are mostly young, sexually active and risk takers, that's before you consider the social aspect - they receive regular pay for starters and in a country like Sierra Leone that counts for a lot in women's eyes - the military naturally attract the women." When the army kick-started its campaign to battle HIV/AIDS in 2002, the focus was placed on awareness raising, as many of the troops refused to admit that the virus existed. Now the message is starting to get through, said Abdul-Rahman Sessay, ministry coordinator at the National AIDS Secretariat and 50 counsellors, specialist nurses, doctors and peer educators have been trained to inform the troops. "Over 90 per cent of the troops are now aware of the disease and [the campaign] did help as gradually the stigma of the disease is decreasing. There is a wider acceptance amongst the armed forces." The Sierra Leone military were the first public sector group to establish an HIV/AIDS workplace policy. Under the policy, no personnel can be fired due to their HIV status and antiretroviral (ARV) drugs freely provided thanks to grants delivered by the World Bank and the Global Fund to Fight AIDS, Tuberculosis and Malaria. The army said the policy has encouraged more people to get tested and know their status without fear of being thrown out of the army. "We've had a few instances where we've moved soldiers into different jobs or to different locations so they can get better treatment. But no one would lose their job because of their status," Samba confirmed. SERVICES FOR HIV-POSITIVE SOLDIERS AND THEIR FAMILIES At the Voluntary Confidential Counselling and Testing (VCCT) centre at Wilberforce Barracks, Major Nellie Forde demonstrates how to put a condom onto a model penis for a young new recruit. The soldier, she said, came to the centre to gather information of his own volition before leaving the country on training. "When we started the centre people were afraid of coming here," she said. "But now, I'd say on average five people come per day just to ask questions, to watch HIV/AIDS programmes on TV or to get tested." The VCCT centre also provides free testing for civilians in the nearby community - a way of improving civilian-military relations in the surrounding area. Three more VCCT centres are planned in the provincial towns of Bo, Makeni and Kenema for troops stationed in the more remote areas of the country. Meanwhile, a People Living With AIDS (PLWA) Association has been set up for the 26 soldiers and their families infected or affected by HIV/AIDS. But, the weekly meeting is still held very firmly behind closed doors, Major Forde said. "Yes, it is still quite underground and people still won't come out in the open with their status," she said. "But in the PLWHA Association we have some success stories. For example, a healthy 2 year old with an HIV positive mother and we've got 17 soldiers on ARVs and making progress." "MAMMY QUEEN" ARMY WIVES PLAY A VITAL ROLE While working on awareness, the armed forces gradually came to realise the vital role that army wives could play. "When we started with the road shows, the wives were refusing that their husbands accept condoms", said Samba. "They were saying it was a gateway to promiscuity. So we brought them into the programme and we trained them." Sarah Conteh is the head "Mammy Queen" in Freetown's Wilberforce Barracks, home to over 2,000 soldiers and their families. She was elected by and represents the other wives and women in the barracks and was trained to educate those around her on HIV/AIDS. "People feel they can come to me with their problems so I'm also in a good position to go to them, to raise awareness about HIV/AIDS and to encourage people to get condoms or to be faithful to their husbands and wives," she said from her cramped home in the barracks. One of her roles, she said, was to act as a condom vendor to get the troops and their wives using condoms. "I normally do demonstrations for the women and show them the female condoms as well as for the men. The supplies always run out and people do use them", she added. The Sierra Leone army’s pioneering approach has won international praise. "The uniformed services recognised there was a problem and they started to address it," Zekeng said. But he was quick to caution that all the ingredients were still in Sierra Leone for an explosive epidemic - high risk sexual behaviour, low levels of knowledge partnered with high illiteracy and low levels of condom use. Only when all troops have been tested and all are aware of their status, will real progress would have been made, he said. "We've not reached the stage where we make an order for everyone to be tested."