|AIDS and the Military (Best Practice - Points of View) (UNAIDS, 1998, 8 p.)|
|Are military and civilian populations really that different when it comes to AIDS?|
Military personnel are a population group at special risk of exposure to sexually transmitted diseases (STDs), including HIV. In peace time, STD infection rates among armed forces are generally 2 to 5 times higher than in civilian populations; in time of conflict the difference can be 50 times higher or more. Paradoxically - and fortunately - strong traditions of organization and discipline give the military significant advantages if they move decisively against HIV/AIDS.
Recently, comparative studies of sexual behaviour in France, the UK and the USA showed that military personnel (both career and conscripted personnel) have a much higher risk of HIV infection than groups of equivalent age/sex in the civilian population. Armed forces in other parts of the world reflect the same phenomenon. A 1995 estimate of HIV in Zimbabwe, for instance, places the infection rate for the armed forces at 3 to 4 times higher than the level in the civilian population.
What is there in the military environment that raises the risk of HIV infection?
· Military and peacekeeping service often includes lengthy periods spent away from home, with the result that personnel are often looking for ways to relieve loneliness, stress and the building up of sexual tension.
· The militarys professional ethos tends to excuse or even encourage risk-taking.
· Most personnel are in the age group at greatest risk for HIV infection - the sexually active 15 - 24-year age group.
· Personnel sent on peacekeeping missions often have more money in their pockets than local people, giving them the financial means to purchase sex.
· Military personnel and camps, including the installations of peacekeeping forces, attract sex workers and those who deal in illicit drugs.
The number of sex partners that a person has is a key factor in the risk of STD infection, especially HIV. The chances of encountering someone with prior exposure to HIV go higher as the number of sex partners goes up. The risk is particularly high with partners who are one-night stands or sex workers when no condom is used.
Military personnel on deployment often indulge in risky activities. For example, a study of Dutch sailors and marines on peacekeeping duty in Cambodia found that 45% reported having sexual contact with sex workers or other members of the local population during a five-month tour. Another study indicated that 10% of US naval personnel and marines contracted a new STD during trips to South America, West Africa and the Mediterranean during 1989-91. War itself offers a particularly rich breeding ground for HIV infection. The mobilization of large numbers of young men (already a high-risk group for STDs), the practice of intimidation through rape, and displacement of refugees (a highly vulnerable group) - all these factors increase the virus prevalence. To make matters worse, war is often accompanied by the breakdown of health and educational infrastructures, crippling efforts to minimize the spread of HIV during or following conflict.
Military personnel are not only a special group because of objective factors such as their relative youth, but also because of their attitudes. Some attitudes include both those purposefully inculcated by the armed forces in training and those which are learnt informally as part of military culture and strongly encouraged through peer pressure.
For instance, willingness to accept risk is highly important in combat, but off the battlefield it may increase soldiers willingness to engage in needlessly risky behaviour (sex without a condom, purchased sex, etc.) A high value placed on aggressiveness may make soldiers prone to pursuing sex with many different partners as a type of conquest. Finally, the sense of prestige that comes with being part of the uniformed armed forces, reinforced by bonding within units, may tempt soldiers to view civilians - especially women - as people over whom power can be exerted. This may increase the likelihood of soldiers engaging in anonymous, purchased or even coercive sex.
Probably the single most important factor leading to high rates of HIV in the military is the practice of posting personnel far from their accustomed community or their families for long periods of time. Aside from the emotional stress this places on individuals, the practice encourages use of commercial sex. As a result, local sex industries grow in response to demand from military bases and units. It is a prime challenge to military establishments to re-think this traditional feature of operational practice in the light of health and social issues, both of which suggest the high value of finding ways to support stable family relationships and marriages. (Note that these issues must also be faced in relation to other people such as long-distance truck drivers, migratory workers and labourers, prisoners and refugees. For more information, see UNAIDS Best Practice documents Prisons and AIDS and Refugees and AIDS.)