HIV-testing row in the military

A recent row in South Africa over the deployment of HIV-positive soldiers on peacekeeping missions has turned the spotlight on the issue of HIV testing and the exclusion of HIV-positive individuals from the army. South Africa's Minister of Defence Mosiuoa Lekota sparked controversy earlier this month when news reports quoted him as saying: "Anybody with the condition [HIV/AIDS] cannot be recruited [into the defence force]." Activists said the policy was unconstitutional, and threatened to take the defence department to court. The South African cabinet distanced itself from Lekota's comments, saying there was no policy to prevent the recruitment of HIV-positive personnel into the South African National Defence Force (SANDF) merely because they were HIV-positive. Lekota attributed his position to the United Nations peacekeeping regulations, which recommend that countries should not deploy HIV-positive individuals on peacekeeping missions. Although the UN's Department of Peacekeeping Operations (DPKO) maintains that it does not prescribe mandatory testing prior to deployment, it nevertheless issued guidelines recommending that countries should not second HIV-positive individuals to peacekeeping duties. According to DPKO, available medical treatment may not be adequate to meet the requirements of those living with HIV when they are sent on mission. Peacekeepers may also have to undergo pre-deployment vaccinations, and they may be exposed to diseases during deployment, posing additional risks to their health. But an expert panel, convened by UNAIDS and DPKO in 2001, revised this policy and agreed that HIV should no longer be a criterion for exclusion from peacekeeping missions, Gael Lescornec, UNAIDS humanitarian programme advisor, told PlusNews. "The revised policy is not yet binding between member states, but it has been handed to member states ... they are all aware of it - even the SANDF," she said. "SANDF has always done mandatory testing before deployment - there's no reason to now use UN regulations as a decision to exclude HIV-positive people." Defence ministry spokesman Sam Mkhwanazi admitted that army recruits had to undergo a "comprehensive assessment", including HIV testing. "But they are not compelled to join - it would be unconstitutional. You can obviously refuse to go for a medical," he commented. According to Robyn Pharoah, senior researcher at the AIDS and Security project of the Pretoria-based Institute for Security Studies (ISS), this was still "completely contrary" to UN guidelines. Despite the cabinet's statements that there was no government policy to exclude individuals from the SANDF solely on the basis of their HIV status, "the SANDF continues to practice a blanket policy of excluding job applicants with HIV," the AIDS Law Project (ALP) said in a statement. According to the ALP, SANDF's official policy on sexually transmitted diseases, including HIV, "explicitly states that sero-positive cases are, by definition, unfit for employment as uniformed members". The ALP was currently dealing with a number of cases where this had happened, the statement added. While the SANDF may ban the recruitment of HIV-positive personnel, it does try to care for those already in uniform and living with the virus. The SANDF's 'Masibambisane' Campaign (www.mil.za) was "quite a good workplace programme", which offered peer education, prevention projects, and care and support for employees living with HIV/AIDS, observed Richard Delate, co-author of a review of HIV/AIDS policies and programmes among peacekeepers. "We don't just provide prevention and education ... we have treatment for opportunistic infections and counselling services. Our programme is in line with the national policy on HIV/AIDS," Mkhwanazi said. With South Africa now playing a key peacekeeping role on the continent, the issue of deploying HIV-positive troops on missions remains a contentious one. The UNAIDS review - prepared for the UN General Assembly Special Session in September this year - found that establishing guidelines on HIV testing and peacekeeping operations was still an uphill battle. Most countries required mandatory testing prior to deployment, but "various interpretations of the protocol regarding permission to test" had been reported. "There is also a lack of care and support for peacekeepers living with HIV," it added. "A lot of debate" about HIV/AIDS in the military that went beyond testing policies was still taking place, Delate said. "There is no information in the public domain around AIDS in the military. Prevalence levels are still an area of contestation." According to the review, data on HIV prevalence in the uniformed services was limited, as prevalence studies were seldom conducted. Authorities were also reluctant to release data that could imply strategic weaknesses within their services. Delate called for a shift in public perceptions about HIV/AIDS in the armed forces. "Let's not apportion blame, but rather look at how peacekeepers can be seen as agents of change in the fight against HIV/AIDS."