In-depth: Beyond ABC: The challenge of Prevention
BURUNDI-COTE D'IVOIRE: AIDS groups have soldiers in their sights
AIDS prevention campaigns are taking aim at soldiers
NAIROBI, 14 November 2005 (IRIN In-Depth) - In the conflict and post-conflict zones of West and Central Africa, AIDS prevention campaigns are taking aim at soldiers, but hitting the bull's-eye can be a real challenge.
"We have to replace the dead!" said Ivorian soldiers, who have been largely responsible for the explosion in the number of pregnancies along the country's 700-km frontline.
Since the failed coup of 2002, the country has been divided into a government-controlled south and a rebel-held north. Thousands of men in uniform, including 7,000 UN peacekeepers, patrol the confidence zone separating the two.
Because most soldiers live alone, far from their partners, humanitarian groups and health officials worry that sexually transmitted infections (STIs) could spread even faster in a country that already has one of the highest HIV/AIDS rates in West Africa.
The official rate of seven percent is based on old information, according to humanitarian groups, who placed the true figure somewhere between 10 and 20 percent in the west and north of the country.
The American NGO, Population Services International (PSI), noted that the increased number of pregnancies since the start of the war was evidence of the high-risk behaviour of soldiers.
As an example, the NGO cited the practice, referred to locally as "dog eat dog", by which the men have sex with the same partners as the soldiers who came before them.
"We've heard of a record set in Yamoussoukro [the Ivorian capital] by one soldier who was responsible for 11 pregnancies," said Mariam Djebre, head of PSI's education campaign targeting soldiers.
DEVELOPING A 'CONDOM CULTURE'
According to Djebre, the average soldier impregnated three or four women each year.
"The sheer number of pregnancies prove that the fighters are having unprotected sex," she said. "We're trying to instil a culture of wearing condoms."
Condoms are standard military issue in Cote d'Ivoire, as in Burundi.
In Burundi, a small Central African country trying to leave behind 12 years of civil war, all military camps receive shipments of condoms, which are made available in the canteens and washrooms, according to Sylvain Ndayikengurukiye, spokesperson for the National Committee for the Fight against AIDS (CNLS).
The CNLS has trained over 6,500 community activists, who not only educate populations living near barracks but also provide free condoms.
The government is also trying to back local organisations working with vulnerable segments of society, such as displaced people and ex-combatants.
More than 300,000 people died during the civil war that followed the 1993 assassination of Melchior Ndadaye, the country's first Hutu president. His death triggered the anger of Hutus, who were convinced that the killing was ethnically motivated and exacted a massive revenge on the Tutsi community before the army stepped in.
A 5,000-strong international peacekeeping force was sent to the country as part of the UN Operation in Burundi (UNOB) that began in June 2004.
The top health official at Burundi's ministry of defence, Dr Remy Hagerimana, believes that military officers were instrumental in setting up prevention campaigns and care programmes for infected soldiers.
ROLE OF OFFICERS IN PREVENTION
The defence ministry's decision to decentralise its HIV/AIDS unit allowed it to bring in 3,000 peer educators. "The unit commander makes sure at the outset that all the soldiers have condoms," explained Hagerimana.
As proof of its commitment, the ministry gave 20 million Burundian francs (nearly US $20,000) to a fund for providing free antiretroviral (ARVs) drugs to HIV-positive soldiers.
According to Hagerimana, the prospect of available treatment has helped to increase the number of soldiers willing to be tested for the virus.
In Cote d'Ivoire, where treatment costs US $5.50 for three months, senior officers and the ministry of defence are conspicuous by their absence from the fight against HIV/AIDS in the military, according to Mariama Haidara, of PSI-Cote d'Ivoire.
"We believe the real weakness of this operation is the officers' lack of involvement," she said. "Peer educators aren't doing their work; they have other duties that get in the way."
Haidara said PSI planned to get military authorities more involved in its programme, and to enlist the help of members of a group of HIV-positive soldiers.
It would be difficult to bring about the kinds of changes that PSI was promoting, according to the group's Djebre, in spite of the films it has been screening once a month in barracks and the discussions it holds on prevention.
For example, after the screening of 'You and Me', a film composed of the testimonials of HIV-positive people, some soldiers were unconvinced and said the people "looked too healthy to be infected".
Myths and prejudices were alive and well among soldiers, especially in conflict zones. "A bullet kills faster than AIDS," said Ivorian soldiers on both sides of the divide.
To fight destructive behaviour, PSI-Cote d'Ivoire has trained 140 government soldiers as peer educators. "We're also going to have a mobile testing station because soldiers are more motivated [AIDS aware] after we pass through," Djebre observed.
The campaign to educate combatants started in the very first months of the war, at the end of 2002. Rebels were also targeted but, because of the lack of security in the zones under their control, efforts did not get under way until April 2004.
Since then, 46 soldiers have been trained to educate their peers in the main northern rebel-held centres of Bouake and Korhogo, and Man in the west.
"I go into the field to talk to the rebels myself when the STI rate goes up," said Sergeant-Major Niame Soro, who is in charge of the health of the rebel New Forces in the western zone.
"Disease is on the rise generally, and AIDS is no exception," he told IRIN.
According PSI's Djebre, soldiers were similar throughout the country. "They behave the same way and they have the same prejudices."
In Burundi, the defense ministry's Ndayikengurukiye agreed. "They are young, single and on the move, and they visit prostitutes. That makes all soldiers extremely vulnerable to HIV," he said, adding that these risk factors had to be taken into consideration in attempts to counter the ignorance and prejudice that thrived during wartime.
"Some say drinking Koutoukou [a potent local alcoholic drink] will prevent the virus from entering the body, while others believe urinating after sex can get it out," said PSI-Cote d'Ivoire's Haidara.
For PSI's Djebre it was essential to know what soldiers were thinking. "I met a young rebel soldier in Man and I talked to him about wearing a condom," she said. "He listened to me and then said that his amulets made him immune to diseases."