HIV/AIDS prevention strategies in the armed forces in sub-Saharan Africa: A critical review

Armed Forces and Society

Volumn 34, Issue 2, 2008, Pages 292-313

  Sagala, John Kemoli ^a  

^a NORTHERN ARIZONA UNIVERSITY   (United States)

Author keywords

African militaries; military effectiveness; military HIV AIDS prevention and education

Indexed keywords

EID: 36549034278     PISSN: 0095327X     EISSN: None     Source Type: Journal    
DOI: 10.1177/0095327X07302976     Document Type: Review

References (147)

1. L. Heinecken, "Facing a Merciless Enemy: HIV/AIDS and the South African Armed Forces," Armed Forces & Society 29 (Winter 2003): 281-300.
2. M. Fleshman, "AIDS Prevention in the Ranks: UN Targets Peacekeepers, Combatants in War against Disease," Africa Recovery 15, 1-2 (June 2001): 16-18.
3. A. Whiteside, A. De Waal, and T. Gebre-Tensae, "AIDS, Security and the Military in Africa: A Sober Appraisal," African Affairs 105, 419 (2006): 201-18.
4. S. Elbe, "HIV/AIDS and the Changing Landscape of War in Africa," International Security 27, 2 (2002): 159-77.
5. P. Tripodi and P. Patel, "The Global Impact of HIV/AIDS on Peace Support Operations," International Peacekeeping 9, 3 (2002): 51-66;
6. see also P. Tripodi and P. Patel, "HIV/AIDS, Peacekeeping and Conflict Crises in Africa," Medicine, Conflict and Survival 20, 3 (2004): 195-208.
7. L. Heinecken, "Facing a Merciless Enemy"; R. Ostergard Jr., "Politics in the Hot Zone: AIDS and National Security in Africa," Third World Quarterly 23, 2 (2002): 333-50;
8. P. Singer, "AIDS and International Security," Survival 44, 1 (2002): 145-58.
9. S. C. Kalichman, K. J. Sikkema, and A. Somlai, "Assessing Persons with Immunodeficiency Virus (HIV) Infection Using the Beck Depression Inventory: Disease Processes and Other Potential Confounds," Journal of Personality Assessment 64, 1 (1995): 86-100.
10. T. Beehr and J. E. Newman, "Job Stress, Employee Health, and Organizational Effectiveness: A Facet Analysis, Model, and Literature Review," Personnel Psychology 31 (1978): 665-99;
11. P. E. Spector, "Organizational Frustration: A Model and Review of the Literature," Personnel Psychology 31 (1978): 815-29.
12. R. Sarin, "A New Security Threat: HIV/AIDS in the Military," World Watch Institute (March/April 2003): 17-22.
13. Healthlink Worldwide, "Combat AIDS: HIV and the World's Armed Forces," 2002, http://www.healthlink.org.uk (accessed May 30, 2004).
14. A. De Waal, "How Will HIV/AIDS Transform African Governance?" African Affairs 102 (2003): 11.
15. J. Kemoli Sagala, "HIV/AIDS and the Military in Sub Saharan Africa: Impact on Military Organizational Effectiveness," Africa Today 53, 1 (Fall 2006): 55-77.
16. A. Millett, W. Murray, and K. Watman, "The Effectiveness of Military Organizations," International Security 11, 1 (Summer 1986): 37-71. See p. 37.
17. See the following works by M. R. Smallman-Raynor and A. D. Cliff, "Civil War and the Spread of AIDS in Central Africa," Epidemiology and Infection 107 (1991): 69-80;
18. "The Epidemiological Legacy of War: The Philippine-American War and the Diffusion of Cholera in Batangas and la Laguna, South-West Luzon, 1902-1904," War in History 7, 1 (2000): 29-64;
19. War Epidemics: A Historical Geography of Infectious Diseases in Military Conflict and Civil Strife 1850-2000 (New York: Oxford University Press, 2004).
20. Ibid;
21. also see J. Ban, "Health as a Global Security Challenge," Seton Hall Journal of Diplomacy and International Relations 4, 2 (Summer/Fall 2003): 19-28.
22. Smallman-Raynor and Cliff, War Epidemics.
23. A. M. Smith, "Military Medicine: Not the Same as Practicing Medicine in the Military," Armed Forces & Society 18, 4 (Summer 1992): 578.
24. Smallman-Raynor and Cliff, War Epidemics.
25. E. G. Bing et al., "Protecting Our Militaries: A Systematic Literature Review of Military Immunodeficiency Vims/Acquired Immunodeficiency Syndrome Prevention Programs Worldwide," Military Medicine 170,10 (October 2005): 886.
26. R. Yeager, C. W. Hendrix, and S. Kingma, "International Military Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Policies and Programs: Strengths and limitations in Current Practice," Military Medicine 165, 2 (February 2000): 87-92.
27. M. Ricardo Calderon, ed. "Civil-Military Collaboration." AIDSCAP/Family Health International 3 (1997), http://www.fhi.org/NR/ rdonlyres/ entpjbeohlq77xzjln6zsovwlhoavjbzsyd6tpdley4sf2dxjmrfwxezytqbejfjjzmwqv24gupqja/ civilmilitary.pdf (accessed August 10, 2005).
28. C. W. Hendrix and F. D. Daniell, "Military HIV-Prevention Education: The Use of Evaluation to Inform the Evolution of Policy," AIDS & Public Policy Journal 14, 2 (Summer 1999): 80-91.
29. Smallman-Raynor and Cliff, War Epidemics.
30. Whiteside, De Waal, and Gebre-Tensae, "AIDS, Security and the Military in Africa."
31. Sagala, "HIV/AIDS and the Military in Sub Saharan Africa."
32. Millett, Murray, and Watman, "The Effectiveness of Military Organizations" 71.
33. C. Boone and J. Batsell, "Politics and AIDS in Africa: Research Agendas in Political Science and International Relations," Africa Today 48, 2 (2001): 3-33.
34. S. Elbe, "Should HIV/AIDS Be Securitized? The Ethical Dilemmas of Linking HIV/AIDS and Security," International Studies Quarterly 50, 1 (March 2006): 119-44.
35. Sagala, "HIV/AIDS and the Military in Sub Saharan Africa," 56.
36. L. Garrett, HIV and National Security: Where Are the Links? Council of Foreign Relations Report (Washington, DC: Council on Foreign Relations, 2005), 13.
37. U.S. National Intelligence Council, "The Global Infectious Disease Threat and Its Implications for the U.S.: NIC Report," 2000, http://www.dni.gov/nic/PDF_GIF_otherprod/infectiousdisease/infectiousdiseases. pdf (accessed November 9, 2003)
38. Heinecken, "Facing a Merciless Enemy," 284.
39. U.S. Department of Defense, "International HIV/AIDS Activities," 2005, http://www.iom.edu/object.File/master/25/618/0.pdf (accessed August 30, 2005).
40. UNAIDS, "AIDS Epidemic Update," 2004, http://wwwunaids.org/ wad2004/EPIupdate2004_html_en/epi04_00_en.html (accessed June 15, 2004).
41. N. Poku, ed., Security and Development in Southern Africa (Westport, CT: Praeger, 2001).
42. W. Ebomoyi and O. G. Afoaku, "Confronting the HIV/AIDS Crisis in Post-Military Nigeria," The Western Journal of Black Studies 24, 1 (2000): 43-52.
43. C. Schocken, "Overview of the Global Fund to Fight AIDS, Tuberculosis and Malaria," from Center for Global Development Web site http://www.cgdev.org/doc/HIVAIDSMonitor/OverviewGlobalFund.pdf (accessed August 8, 2006).
44. M. Sessions, "Overview of the President's Emergency Plan for AIDS Relief (PEPFAR)," 2006, from Center for Global Development Web site http://www.cgdev.org/doc/HIVAIDSMonitor/OverviewPEPFAR.pdf (accessed August 8, 2006).
45. The White House Office of Management and Budget (OMB) FY 2007, "Department of State and Other Programs," 2006, http://www.whitehouse. gov/omb/budget/fy2007/pdf/budget/state.pdf (accessed August 8, 2006).
46. Center for Global Development, "Global HIV/AIDS and the Developing World," 2006, http://www.cgdev.org/files/2851_file_GLOBAL_HIV_AIDS1.pdf (accessed August 8, 2006).
47. UNAIDS, 2006 Report on the Global AIDS Epidemic (New York: Corrigenda, 2006).
48. U.N. Office for the Coordination of Humanitarian Affairs, "HIV/AIDS among Military Personnel in the 14-Nation Southern African Development Community (SADC)," 2003, http://www.irinnews.org/homepage.asp (accessed November 7, 2003).
49. G. Prins, "AIDS and Global Security," International Affairs 80, 5 (2004): 931-52.
50. N. Van Beelen, "HIV/AIDS and the Military: Fighting the War against HIV/STIs," Sexual Health Exchange 2, 2 (2003): 6-14.
51. Daily Nation, "AIDS Accounts for 75 Percent of Police Deaths," November 27,2000, www.nationaudio.com (accessed July 25, 2004).
52. Bing et al., "Protecting Our Militaries."
53. R. D'Amelio, E. Tuerlings, O. Perito, R. Biselli, S. Natalicchio, and S. Kingma, "A Global Review of Legislation on HIV/AIDS: The Issue of HIV Testing," Journal of AIDS 28, 2 (2001): 173-79.
54. Yeager, Hendrix, and Kingma, "International Military."
55. Hendrix and Daniell, "Military HIV-Prevention Education," 85.
56. S. Miles, "HIV in Insurgency Forces in Sub-Saharan Africa - A Personal View of Policies," International Journal of STD & AIDS 14 (2003): 174-78.
57. E. Van der Ryst, G. Joubert, F. Steyn, C. Heunis, J. Le Roux, and C. Williamson, "HIV/AIDS-Related Knowledge, Attitudes and Practices among South African Military Recruits," South African Medical Journal 91, 7 (July 2001): 587-91.
58. L. Heinecken, "South Africa's Armed Forces in Transition: Adapting to the New Strategic and Political Environment," Society in Transition 36, 1 (2005): 74-96. See p. 91 for further explanation.
59. L. N. Bakhireva et al., "Human Immunodeficiency Virus/Acquired Immonodefieciency Syndrome Knowledge and Risk Factors in Ethiopian Military Personnel," Military Medicine 169, 3 (2004): 221-26.
60. D. J. Ortiz et al., "Evidence-Based Recommendations for Prevention of Human Immunodeficiency Virus and Sexually Transmitted Infections in the Angola Armed Forces: Challenges and Opportunities at the End of 30 Years of War," Military Medicine 170, 4 (2005): 327-32.
61. S. B. Adebajo, J. Mafeni, S. Moreland, and N. Murray, "Knowledge, Attitudes, and Sexual Behavior among the Nigerian Military Concerning HIV/AIDS and STDs," Final Report (September 2002) to U.S. Agency for International Development, Contract HRN-C-00-00-00006-00, http://pdf.dec.org/pdf_docs/ Pnacr050.pdf (accessed June 25, 2006).
62. U. A. Nwokoji and A. J. Ajuwon, "Knowledge of AIDS and HIV Risk-Related Sexual Behavior among Nigerian Naval Personnel," BMC Public Health 4 (June 21, 2004): 24-32.
63. M. Fleshman, "AIDS Prevention in the Ranks," June 2001; Whiteside, De Waal, and Gebre-Tensae, "AIDS, Security and the Military in Africa."
64. Miles, "HIV in Insurgency Forces in Sub-Saharan Africa."
65. Fleshman, "AIDS Prevention in the Ranks," 17.
66. Ibid., 17
67. M. M. Lom, "Senegal's Recipe for Success: Early Mobilization and Political Commitment Keep HIV Infections Low," Africa Recovery 15, 1-2 (June 2001): 24-25, 29.
68. Fleshman, "AIDS Prevention in the Ranks."
69. Daily Nation, "AIDS a Distance-Related Disease," story by Elly Wamari, which quotes Kenya Military Spokesman Col. Bogita Ongeri. Published August 10, 2005, on www.nationmedia.com.
70. UNAIDS Country Reports (country overview), "Engaging Uniformed Services in the Fight against HIV/AIDS," http://uniformservices.unaids.org/ region.asp?region=Africa%20and%20the%20Middle%20East (accessed July 19, 2006).
71. J. D. Fisher and W. A. Fisher, "Understanding and Promoting AIDS Preventive Behavior: Conceptual Model and Educational Tools," Canadian Journal of Human Sexuality 1 (1992): 99-106.
72. South African Military Health Services and South African National Defence Force, "A Prospective Epidemiological Cohort Study of HIV and Risk-Related Co-Infections in the South African National Defence Force (SANDF)," January 2004, http://www.phidisa.org.za/images/phidisal.pdf (accessed July 21, 2006).
73. Sagala, "HIV/AIDS and the Military in Sub Saharan Africa."
74. R. Bazergan, "HIV/AIDS: Policies and Programs for Blue Helmets," Institute for Security Studies Paper 96 (November 2004): 1-14, http://www.iss.co.za/pubs/paper/96/96.pdf
75. Agence France-Presse or AFP, Health-AIDS-Africa-Security: Africa's Battle with AIDS Raises Security, Terrorism Fears, September 18, 2003. Statement by Major General Bakwena Oitsile on September 8, 2003, http://www.aegis.com/news/alp/2003/AF030973.html (accessed January 6, 2004).
76. R. Shell, "Trojan Horses: HIV/AIDS and Military Bases in Southern Africa," www.afroaidsinfo.org (accessed November 8, 2003).
77. Whiteside, De Waal, and Gebre-Tensae, "AIDS, Security and the Military in Africa."
78. Heinecken, "South Africa's Armed Forces in Transition."
79. D. Achary, "HIV/AIDS Training in the South African Department of Defence: An African Experience," International Review of the Armed Forces Medical Services 11, 3 (2004): 186-88.
80. R. Yeager, "Armies of East and Southern Africa Fighting a Guerilla War with AIDS. Special Report: AIDS and the Military," AIDS Analysis Africa 5, 6 (December 1995): 10-12.
81. J. C. Puta, "Enhancing Training Capacities through Regional Military Networking in Countries of Eastern and Southern Africa." Paper presented at the XII International AIDS Conference, Geneva, Switzerland, June 28-July 3, 1998, http://gateway.nlm.nih.gov/robot_pa ges/MeetingAbstracts/102231554.html (accessed August 1, 2006).
82. R. Magnezi et al., "Comparison of Health Care Services for Career Soldiers throughout the World," Military Medicine 170, 12 (December 2005): 995-98.
83. L. Rushton et al., "Health Surveillance Mechanisms Used by Armed Forces Worldwide," Military Medicine 169, 12 (December 2004): 1005.
84. Ibid., 1005.
85. Whiteside, De Waal, and Gebre-Tensae, "AIDS, Security and the Military in Africa."
86. Ibid.
87. UNAIDS Country Reports (Country Overview), "Engaging Uniformed Services in the Fight against HIV/AIDS," http://uniformservices.unaids.org/ region.asp?region=Africa%20and%20the%20Middle%20East (accessed July 19, 2006).
88. Ibid.
89. D. R. Hospenthal, "History of U.S. Military Contributions to the Understanding, Prevention, and Treatment of Infectious Diseases: An Overview," Military Medicine 170, 4 (April 2005): 1-2.
90. A. W. Artenstein et al., "History of U.S. Contributions to the Study of Vaccines against Infectious Diseases," Military Medicine 170, 4 (April 2005): 3-11.
91. C. F. Ockenhouse et al., "History of U.S. Military Contributions to the Study of Malaria," Military Medicine 170, 4 (April 2005): 12-16.
92. M. G. Ottolini et al., "History of U.S. Military Contributions to the Study of Respiratory Infections," Military Medicine 170, 4 (April 2005): 66-70.
93. N. F. Crum et al., "History of U.S. Military Contributions to the Study of Parasitic Diseases," Military Medicine 170, 4 (April 2005): 17-29.
94. M. L. Lim et al., "History of U.S. Military Contributions to the Study of Diarrheal Diseases," Military Medicine 170, 4 (April 2005): 30-38.
95. G. W. Christopher et al., "History of U.S. Military Contributions to the Study of Bacterial Zoonoses," Military Medicine 170, 4 (April 2005): 39-48.
96. M. F. Bavaro et al., "History of U.S. Military Contributions to the Study of Rickettsial Diseases," Military Medicine 170, 4 (April 2005): 49-60.
97. M. S. Rasnake et al., "History of U.S. Military Contributions to the Study of Sexually Transmitted Diseases," Military Medicine 170, 4 (April 2005): 61-65.
98. C. Hoke Jr., "History of U.S. Military Contributions to the Study of Viral Encephalitis," Military Medicine 170, 4 (April 2005): 92-105.
99. D. P. Dooley et al., "History of U.S. Military Contributions to the Study of Viral Hepatitis," Military Medicine 170, 4 (April 2005): 71-76.
100. S. J. Thomas et al., "History of U.S. Military Contributions to the Study of Viral Hemorrhagic Fevers," Military Medicine 170, 4 (April 2005): 77-91.
101. According to the Bureau of Medicine and Surgery Letter 5400 Ser 00/MED-26 of November 9, 2000, the U.S. Navy's Naval Health Research Center is the Lead Executive Agent tasked with managing DoD's International HIV/AIDS prevention activities. The DHAAP Office at the U.S. Navy reports to the Deputy Assistant Secretary of Defense (DASD).
102. See U.S. DoD/HIV/AIDS Prevention Program (DHAPP), http://www.nhrc.navy. mil/programs/dhapp/background.html (accessed August 20, 2005).
103. The White House Office of National AIDS Policy, Leadership and Investment in Fighting an Epidemic: A Global AIDS Initiative, 1999, http://clinton4.nara.gov/media/pdf/2pager.pdf (accessed October 27, 2006).
104. Elbe, "Should HIV/AIDS Be Securitized?"
105. U.S. DoD/HIV/AIDS Prevention Program (DHAPP), "Background," http://www.nhrc.navy.mil/programs/dhapp/background.html (accessed August 20, 2005).
106. J. Fisher-Thompson, "Kenya Provides Firm Ground for U.S. Military AIDS Partnership," Washington File Staff Writer, February 21,2005, http://usinfo.state.gov/gi/Archive/2005/Feb/22-541177.html (accessed August 19, 2005).
107. DHAPP, "All Africa Military HIV/AIDS Prevention Workshop September 8-11, 2003," http://www.nhrc.navy.mil/programs/life/worlsshop.htlm
108. HIV/AIDS in Africa U.S. Department of Defense Initiative, "Workshops," http://www.nhrc.navy.mil/programs/dhapp/workshops.html (accessed August 21, 2005).
109. United Nations Department of Public Information, "United Nations Peacekeeping operations," Background Note: May 31, 2006, http://www.un.org/Depts/dpko/dpko/bnote010101.pdf (accessed August 1, 2006).
110. United Nations Department of Public Information, "A Note on Financial Crisis," http://www.un - .org/Depts/dpko/dpko/intro/finance.htm (accessed August 1, 2006).
111. United Nations Department of Peacekeeping Operations, "Fact Sheet," http://www.un.org/Depts/ dpko/factsheet.pdf (accessed August 1, 2006).
112. United Nations Development Programme (UNDP), United Nations System Annual Statistical Report 2003 (New York: Author, 2004). For analysis on U.S. logistical and operational contributions to U.N. peacekeeping effectiveness
113. see W. E. Kretchik, "Multinational Staff Effectiveness in UN Peace Operations: The Case of the U.S. Army and UNMIH, 1994-1995," Armed Forces & Society 29, 3 (Spring 2003): 393-413.
114. The White House Office of Management and Budget (OMB) FY 2007, "Department of State and Other Programs."
115. United Nations Department of Peacekeeping Operations, "Fact Sheet."
116. For a more in-depth analysis of U.N. peacekeeping missions in Africa, see A. Adebajo and C. Landsberg, "Back to the Future: UN Peacekeeping in Africa," International Peacekeeping 1, 4 (Winter 2000): 161-88.
117. These include the United Nations Mission in Western Sahara, the United Nations Mission in Sierra Leone, the United Nations Mission in Ethiopia/Eritrea, the United Nations Mission in Liberia, the United Nations Mission in the Democratic Republic of Congo, and the United Nations Operation in Cote d'Ivoire.
118. U.S. General Accounting Office, "U.N. Peacekeeping: United Nations Faces Challenges in Responding to the Impact of HIV/AIDS on Peacekeeping Operations," GAO-02-194 (December 2001): 1-35, http://www.gao.gov/ new.items/d02194.pdf (accessed January 20, 2003).
119. See P. Tripodi and P. Patel, "The Global Impact of HIV/AIDS on Peace Support Operations," 2002; "HIV/AIDS, Peacekeeping and Conflict Crises in Africa," 2004.
120. R. Bazergan, "Analysis," Conflict, Security, and Developments, 1 (April 2003): 27-50.
121. T. Barnett and G. Prins, "A Report to UNAIDS: HIV/AIDS and Security, Fact, Fiction, and Evidence," September 2005, http://www.lse.ac.uk/ collections/DESTIN/publink/barnett/LSE%20Aids%20V2.pdf (accessed August 1, 2006).
122. U.N. Security Council, "Ensuring an Effective Role for the Security Council in the Maintenance of International Peace and Security, Particularly in Africa," Resolution 1318 (2000), www.un.org/Docs/scres/2000/sc2000.html (accessed December 29, 2003);
123. "The Responsibility of the Security Council in the Maintenance of International Peace and Security: HIV/AIDS and International Peacekeeping Operations," Resolution 1308 (2000), www.un.org/Docs/sares/2000/sc2000.html (accessed December 29, 2003);
124. "The Situation in Africa: The Impact of AIDS on Peace and Security in Africa," 2000, www.un.org/Docs/scres/2000/sc2000.html (accessed December 29, 2003).
125. D. Bratt, "Blue Condoms: The Use of International Peacekeepers in the Fight against AIDS," International Peacekeeping 9, 3 (Autumn 2002): 67-86.
126. Fleshman, "AIDS Prevention in the Ranks."
127. I. Skjelsbaek, "Sexual Violence in Times of War: A New Challenge for Peace Operations." International Peacekeeping 8, 2 (Summer, 2001): 69-84;
128. J. Rasmussen, "MONUC: Sexual Exploitation and Abuse. End of Assignment Report," February 25, 2005, http://pbpu.unlb.org/pbpu/library/ MONUC%20SEA%20EOA-Rasmussen%20(25-02-05).pdf (accessed August 1, 2006).
129. Bazergan, "HIV/AIDS: Policies and Programs for Blue Helmets," 5.
130. Ibid.
131. Ibid.
132. Sarin, "A New Security Threat."
133. U.S. General Accounting Office, "U.N. Peacekeeping."
134. Heinecken, "South Africa's Armed Forces in Transition," 91.
135. E. J. Essien et al., "Emerging Sociodemographic and Lifestyle Predictors of Intention to Use a Condom in Human Immunodeficiency Virus Intervention among Uniformed Services Personnel," Military Medicine 171, 10 (October 2006): 1027.
136. Bakhireva et al., "Human Immunodeficiency Virus/Acquired Immonodefieciency Syndrome."
137. Ortiz et al., "Evidence-Based Recommendations . . . in the Angola Armed Forces."
138. Nwokoji and Ajuwon, "Knowledge of AIDS and HIV . . . among Nigerian Naval Personnel."
139. U.S. General Accounting Office, "U.N. Peacekeeping."
140. R. Bazergan, "Analysis."
141. Barnett and Prins, "A Report to UNAIDS."
142. Sagala, "HIV/AIDS and the Military in Sub Saharan Africa."
143. Whiteside, De Waal, and Gebre-Tensae, "AIDS, Security and the Military in Africa."
144. Hendrix and Danieli, "Military HIV-Prevention Education."
145. Elbe, "Should HIV/AIDS Be Securitized?"
146. See Note 114.
147. Elbe, "Should HIV/AIDS Be Securitized?"