Wednesday, September 28, 2005

CAPE TOWN, South Africa — Across Africa, hospital wards are filling with military casualties. The cause: not anotherAfrican conflict, but AIDS.

More deadly than any of its wars, AIDS is hitting at Africa’s ability to defend itself at a time when its countries are shouldering a growing share of the peacekeeping burden.

“HIV and other diseases represent a readiness challenge to militaries throughout the world, and security for us all demands that we pay attention to this,” U.S. Deputy Assistant Secretary of Defense Theresa Whalen told a recent gathering of African military health officers.

South Africa, which has more people infected with HIV than any other country, has responded with a groundbreaking clinical research program in partnership with the United States that is investigating how best to manage the virus in a military setting and providing treatment to hundreds of infected members and their families.

Few of its neighbors, however, have the funding, expertise or infrastructure to do likewise.

Sub-Saharan Africa is home to about 25 million of the world’s nearly 40 million HIV-infected people.

“Members of the armed forces are in many ways at the [forefront] of the HIV and AIDS epidemic,” South African Deputy Defense Minister Mluleki George said at the Cape Town conference.

Their age, mobility and access to casual sex put them at a higher risk of catching and spreading the virus.

Few African militaries have even tried to produce reliable figures, but their infection rates are estimated to be up to twice those in the wider population, according to the Pretoria-based Institute for Security Studies.

The South African National Defense Force says 23 percent of its 75,000 members are infected, on par with the national adult prevalence. Seven of every 10 military deaths overall are AIDS-related, according to figures presented to lawmakers in 2002, the most recent year for which statistics are available.

AIDS is also the biggest killer in the Ugandan armed forces, said Lt. Col. Kenneth Ochen, a military doctor in Kampala who lost 200 patients to the disease last year.

“They are dying. Oh, they are dying,” he said.

While most militaries screen recruits for HIV, many soldiers are spending weeks, even months on sick leave, disrupting unit cohesion, availability for deployment and chains of command.

In Sierra Leone, at least four U.N. peacekeepers died and 10 others were sent home because of AIDS-related illnesses. Two officers deployed to Sudan as peacekeepers by the African Union, a regional bloc, died of similar causes.

The disease hits hardest people who are in their late 20s and 30s, many of whom hold key positions. Their care places a burden on already stretched military budgets.

South Africa’s military has been at the forefront of efforts to tackle the virus in the continent’s armed forces. It first approached the United States for help setting up AIDS drug trials in 2002, long before the life-prolonging medicines became available through the public health system. The five-year collaboration began in 2003.

Members of the U.S. National Institute of Allergy and Infectious Diseases now are working with their South African counterparts at five clinics, with one more clinic on the way.

Two years into Project Phidisa — “Prolong Life” — the military already is reporting progress getting critically ill members fighting fit.

More than 2,900 people have been tested. Those with HIV are monitored, while those with full-blown AIDS are put on one of four widely used combinations of drugs to compare their effectiveness, side effects and compliance levels.

Later, the study will consider the role of nutritional supplements and traditional medicines in delaying progression of the disease.

South African President Thabo Mbeki’s government has drawn criticism for its sluggish response to the crisis, and despite government promises to provide treatment to all, AIDS drugs still aren’t widely available.

Project Phidisa is providing the drugs to 834 force members and their dependents. An additional 232 are receiving medicines through separate U.S. funding until the military can provide them.

Sgt. Philisiwe Ntshangase, 36, was in and out of the hospital for months. She lost weight, started drinking and became suicidal.

Now, she is the picture of health. Her main worry: how to shed those extra pounds she has put on since she start started taking AIDS medicines.

“The medication made me a different person,” said Sgt. Ntshangase, a former anti-apartheid guerrilla who now advises other soldiers with HIV. “It reminded me what was my mission in the defense force: to take care of my beloved country.”

This is of strategic importance to the South African government in view of the leading peacekeeping role it is playing, Mr. George said. South Africa has about 1,250 troops in Burundi and 1,350 in Congo.

Now, some of its neighbors also are scaling up treatment. The Zambian military has more than 1,000 people on AIDS drugs. But the stigma still associated with HIV is keeping more soldiers from seeking treatment.

Many countries also are struggling to train staff to care for their infected troops. The few with the skills are leaving for better-paying jobs overseas. Others are infected and dying.

Mozambique still is recovering from years of civil war and lacks even basic diagnostic equipment, said Maj. Agostinho Afonso, a doctor at a military hospital in Maputo. It has just 200 people on treatment and must concentrate on prevention.

“We need more help,” he said.

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