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Prevalence of HIV/AIDS among UN peace keepers in Democratic Republic of the Congo
Peace keeping mission in Democratic Republic of the Congo (DRC) is in force since 30 Nov 1999 with a mandate under chapter VII of the charter of United Nations (UN) to monitor the implementation of ceasefire agreement and investigate violations of ceasefire, protect United Nations and co-located JMC personnel, ensure security and protect civilians under imminent threat of physical violence.
The current strength of UN mission in the Democratic Republic of the Congo (MONUC) is 17480 uniformed personnel, including 15,591 troops, 786 military observers, 1,103 police supported by 993 international civilian personnel, 1,786 local civilian staff and 553 United Nations volunteers. Total Strength of Indian peace keepers in MONUC is 7200 [1].
Sexual exploitation and abuse by a few of the UN personnel during operational deployment is shocking and tarnishes the reputation of peacekeepers [2]. These abuses/sexual encounters can infect members of national contingents with Sexually Transmitted Infections (STI) and Human Immune-deficiency Virus (HIV) infection since the prevalence rate of HIV/AIDS is high in mission areas of war-torn DRC and neighboring African countries [3].
HIV testing conducted for peace-keepers who sought voluntary testing and for in-patients with suspicious co- morbid conditions admitted at Level III Hospital, Goma, DRC which is a designated Counseling and Testing centre (VCTC) by UN. Incidence among Indian troops was obtained from the mandatory voluntary De-induction HIV testing carried out at Armed Forces Transfusion Center, Delhi Cant on returning from Mission. Confirmation of HIV infection is by ELISA.
Results
A total of 103 peace-keepers (45 inpatients and 58 out patients sought Voluntary Counselling and Testing (VCT) were tested for HIV infection at level III Hospital. 5 peace keepers of central and western African countries were found to be HIV positive during period from 01 Jan 07 to 31 Dec 07. Among Indian military Peacekeepers NIL HIV positive cases detected on testing at VCT Center of UN Level-III Hospital during period of deployment or Armed Forces Transfusion Center, Delhi Cant on arrival from Mission area.
Discussion
Sexually transmitted diseases (STD) and HIV/ AIDS are occupational diseases affecting UN Peacekeepers. Its prevalence rates are 2 to 5 times higher in military personnel of certain troop contributing countries as compared to respective general population [4]. Incidence of HIV infection in Indian Armed Forces personnel is 0.4 per thousand [5], against the estimated National average of 1.7 per thousand [6]
India is second largest troop contributing country for peace keeping operations world-wide, ninety percent of peacekeeping operations are in African countries. In Democratic Republic of the Congo (DRC), 17,480 military personnel are deployed mainly in its eastern provinces bordering Rwanda, Burundi, Uganda and Sudan.
WHO survey estimates
In 16 African countries more than one tenth of the productive population, aged 15 to 49 years is infected with HIV [3]
In Botswana, South Africa and Zimbabwe almos25-40% of adults are infected with HIV [7]
In Democratic Republic of the Congo (DRC) Prevalence of HIV is 3.2% in population aged between 15 to 49 years [3]
Indian peace keepers are exposed to not only to all the risks of acquiring HIV infection like any other individual in the country, but also at greater risk of acquiring HIV during operational deployment in DRC because of their lengthy periods away from home and separation from there regular sex partner, influence of alcohol and peers, less inhibitions and restriction in new country, availability of money with less opportunity to spend during operational deployment, risk taking ethos and behavior in military personnel and ready access to sex workers near campsites, frequented off duty/ recreational areas and transit camps.
Since the peacekeepers are at risk for contracting this infection, both UN Security Council and Troop contributing countries enforced strict preventive measures against HIV infection and zero tolerance for Sexual Exploitation and Abuse (SEA) perpetuators
UN Recommendations on preventive measures for Troops Contributing Countries during Peace- keeping Operations issued jointly by Directorate of Peace Keeping Operation (DPKO) and UN Program on HIV/AIDS (UNAIDS) Include HIV/AIDS awareness training as a standard component of pre-deployment training and preparation.
Voluntary Counseling and Testing (VCT)
USAIDs has set up Voluntary Counseling & HIV testing Centers at various vulnerable places for people who want to have more information on HIV/AIDS and their HIV status. Such VCT Centre has been established at Goma, DR Congo for testing, counseling and motivating people for taking up voluntary testing for HIV. These centers also provide retrospective treatment by Anti-retroviral drugs (ARVs) for positive cases.
UN Policy on HIV/AIDS
The UN system has adopted a comprehensive workplace policy on HIV/AIDS that expressly prohibits discrimination against employees living with HIV and ensures that all UN staff members are able to make informed decisions to protect themselves from HIV and if they are infected or affected by HIV, to turn for the best possible care and treatment at VCTC. However, it is not mandatory69 by UN for Pre-deployment HIV testing for any personnel employed/deployed in the UN Missions.
Indian national policy of aids awareness, prevention program for UN peacekeeping missions:-
Mandatory Pre-induction Testing for HIV infection is carried out to all selected Peace Keepers before induction into mission. Pre-deployment and in-mission HIV training and education of personnel include massive information campaign for education on HIV/AIDS by organizing a workshop for prevention of HIV/AIDS, the content of training included pre course questionnaire, overview of HIV/AIDS epidemiology, basics of HIV, prevention of HIV transmission and a post training questionnaire.
Centre for United Nations Peacekeeping, New Delhi in a series of lectures explained the universal principles of peacekeeping, responsibilities of contingents, code of conduct expected from peacekeepers, policies for prevention of SEA.
The contingent medical officers educated the troops on precautions and prevention of HIV infection with case studies of Peace Keepers involved in breach of conduct and SEA perpetrations, highlighting repatriation and punishments. The commanders of contingent monitored and curbed the risky behavior of troops by enforcing curfew hours, strictly enforcing out of bounds areas, clubs and pubs, wearing of uniform and moving in group with group in-charge (Junior commissioned officer) on booking-out, regular arranged games, intra and inter contingent competitions, recreational picnics, tours, exhorting rich Indian social and cultural traditions to maintain highest standards of professional behavior and moral conduct, promoting regular communication with home. Granting leave to visit home was made compulsory after six months of stay in mission area.
Conclusion
The survey revealed that a total of 103 male peacekeepers undergone the voluntary HIV testing, Two military personnel of African troop contributing countries and three local Congolese civilian MONUC employees have been found to be HIV positive. All the Indian contingent members are well aware about the preventive aspects of this dreaded disease. With counseling , knowledge and training personnel have adopted adequate precautionary measures against infection by HIV/AIDS. NIL cases of HIV/ AIDS have been found among Indian troops returning after completion of Mission, thus No Indian peacekeeper has either arrived in Africa with HIV/AIDS or left with it. Indian soldiers are in great demand for their excellence in professionalism in tackling combat situation and exemplary morale behavior in performing UN Peace Keeping operation. Rotation for UN Peace Keeping is going to continue in near future, so the approach adopted for Prevention of HIV Infection needs to be continued stringently.
Wg Cdr KS Raju
Cl Spl (Av Med) & SMO
AF Station, Naliya
References
- Force Commander’s directive for sexual exploitation and abuse by members of the MONUC Military on 5 March 2007.
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- Epidemiology and biology of HIV In: Davidson’s Principles and Practice of Medicine (19th ed). London: Churchill Livingstone; 2006. p. :108.
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- Park’s text book of preventive and social medicine (18th edition). Jabalpur: Banarasidas Bhanot; p. :260.
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