|AIDS and the Military (Best Practice - Points of View) (UNAIDS, 1998, 8 p.)|
|Why dont they just make all personnel take an HIV test?|
Mandatory testing for the military was first established in the USA in 1985. By 1995, according to a survey carried out by UNAIDS and the Civil-Military Alliance to Combat HIV and AIDS, HIV testing was carried out in some form by 93% of reporting militaries (58 of 62 countries responding to the question).
Some 43 of the reporting countries stated that they impose mandatory HIV testing in some situations: pre-recruitment (25 countries); before foreign deployment (24 countries); before separation from active duty (12 countries), periodically (9 countries); and before a new assignment (8 countries). Rejection of candidates for recruitment based on a positive HIV test is the rule for 45 of 54 respondents, while 44 out of 56 impose restriction of duties for those who are known to be HIV-positive (for example, banning them from combat or from piloting aircraft). Finally, 37 of 41 respondents exclude HIV-positive personnel from overseas deployment.
Military authorities in many parts of the world are under considerable pressure to institute or maintain mandatory HIV testing, whether before recruitment, prior to foreign deployment, or at regular intervals. At the same time, this policy has been criticized from various points of view. It is argued that mandatory testing is a violation of individual rights that cannot be justified by military-specific demands; that testing is not cost-effective. It is also argued that a positive test in an asymptomatic individual does not bear on that persons right to work or fitness for work. Another argument is that a strongly promoted and fully financed voluntary testing programme would be as effective as mandatory testing - and possibly more so.
The role of the soldier is a special one, and the debate over voluntary testing must take this into account. Military policy-makers must consider not only the demands of combat but also the fact that soldiers cannot question superiors orders the way most civilians can.
UNAIDS believes that voluntary testing accompanied by counselling has a vital role within a comprehensive range of measures for HIV/AIDS prevention and support. It also believes that mandatory testing without informed consent is a violation of human rights, and there is no evidence that it achieves public health goals. In order to justify mandatory testing (with its inevitable invasion of privacy and differential or discriminatory treatment), military forces should have to:
· demonstrate compelling aspects of the military workplace that make it different from other workplaces;
· show that HIV/AIDS is not being singled out for such treatment as compared with similar diseases that raise comparable issues; and/or
· show that mandatory testing and its consequences (rejection, limitation on deployment, dismissal) is the least restrictive means available and actually achieves the goals being sought; i.e. that mandatory testing achieves goals more effectively than voluntary testing, counselling and prevention programmes.
The first reaction of many organizations - not just the military - is to test in order to keep people who are HIV-positive from being recruited. But the fact is that most infections occur after people have been recruited. So testing isnt the answer to everything. In fact, its doubtful that involuntary testing is the answer to anything.
- Peter Piot, Executive Director, UNAIDS
UNAIDS Best Practice Collection