Foreign Affairs December 2006

Containment Strategy

Iran. North Korea. Uganda? Why the Pentagon ranks Africa’s AIDS crisis as a leading security threat
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In a dark-green shipping container outside a Ugandan military hospital, a visiting Tanzanian general and four of his colonels encircle a desk. On the desk sits a green plastic paper tray. And from the tray rises a polished wooden dildo. “This weapon,” a Ugandan warrant officer tells them, “I’m sorry for exposing it to you. This is one of the weapons we have used in fighting HIV and AIDS.”

In the Ugandan military’s program for AIDS prevention and treatment, the dildo is used to demonstrate condom use. It is part of the first line of defense in a larger conflict that very much involves American forces: the fight to prevent countries from collapsing into failed states that can foment armed conflict, chaos, and terrorism beyond their borders. In fact, the United States Department of Defense funds a good part of the Ugandan military’s AIDS program. It trains doctors and clinicians, helps support AIDS orphans, and stocks labs with instruments and supplies. And it has donated thirteen prefabricated HIV-testing labs and AIDS-counseling centers, including the one in which the officers were sitting on a summer afternoon out at the Bombo Barracks, about an hour’s drive from Kampala.

The impact of AIDS on Africa’s health and well-being is a matter of grim statistical record. By 2010, USAID estimates, the epidemic will have cut the life expectancy in Botswana to twenty-seven years from what would have been at least seventy years. Some countries expect to lose half a generation. “When you have countries where you have 40 percent of the adult population affected, where teachers are disproportionately infected, where we’re creating a generation of orphans, you can see the stress on the social fabric,” says Ambassador Mark R. Dybul, the U.S. global AIDS coordinator.

But what was once seen as a humanitarian catastrophe is viewed increasingly as a security threat—an important reason behind the $15 billion Emergency Plan for AIDS Relief that President Bush announced in January 2003. A study of 112 countries by Susan Peterson, a political scientist at the College of William and Mary, and Stephen Shellman, a political scientist at the University of Georgia, found that countries with severe AIDS epidemics had correspondingly high levels of human-rights abuse and civil conflict. “Does AIDS make war or civil strife more likely?” asks Peterson. “The answer is yes.”

Even in countries that don’t collapse, AIDS deaths can threaten security in the form of AIDS orphans, who are desperate, disenfranchised, vulnerable to radicalization, and projected to reach 25 million worldwide by 2010. “Where do you think the breeding ground for terrorism will be?” asks General Charles Wald, the former operational head of European Command, which also oversees U.S. military operations in most of Africa. At a recent conference, Wald listed the biggest threats to U.S. security. After terrorism and weapons of mass destruction came AIDS.

High on the list of the Pentagon’s concerns about AIDS is its impact on African militaries; for many, it has become the biggest killer. Young, often far from home, and with cash in their pockets, soldiers who must live under fire cultivate a sense of invulnerability that can kill them when they come back to the barracks. The epidemic accounts for seven out of ten military deaths in South Africa and kills more Ugandan soldiers than any other cause, including a brutal twenty-year insurgency and two wars in Congo. AIDS deaths have reduced Malawi’s forces by 40 percent. Mozambique can’t train police officers fast enough to replace those dying of the disease. “As we fight the enemy, the HIV is also fighting us,” John Amosa, a forty-five-year-old AIDS-afflicted Ugandan sergeant, told me. “We have two front lines.”

Uganda kicked off the fight that became a model for AIDS prevention in 1986, after President Yoweri Museveni sent sixty of his top officers for training in Cuba, where eighteen tested positive for HIV. At a conference later that year, Fidel Castro took the Ugandan president aside. “He said, ‘You’ve got a big problem on your hands,’” recalled Sam Kibende, a deputy director of Uganda’s national AIDS research center. “That’s when the president woke up and realized his fighting force was going to be decimated.” With national infection rates leveling off somewhere between 6 and 7 percent after peaking at 15 percent in the early 1990s, the Ugandan army plans to hold every officer responsible for AIDS education. “Behavior change needs sustained fire,” says Dr. Stephen Kusasira, who runs the Ugandan military’s anti-AIDS efforts. “We want it to be a command problem. It should only become a medical situation when they are sick.”

Unfortunately, AIDS hampers the ability of Uganda and other African nations to maintain not only their own security but also that of their neighbors. Asked to send troops to the troubled Darfur region of Sudan, South Africa couldn’t field a complete battalion of uninfected troops; an estimated 17 to 23 percent of its military is HIV-positive, and tests in 2004 on two battalions found infection rates as high as 80 percent. “They had to kludge together units to get enough healthy troops to send,” says Wald, who retired from his post at European Command in July. Because African Union members contribute 37 percent of all United Nations peacekeepers, the shortage of healthy manpower has rippled out through the world’s hot spots and is of growing concern to the United States, which leaves peacekeeping duties mostly to other nations. “AIDS is a readiness issue,” says Richard Shaffer, a retired Navy commander who runs the Defense Department’s HIV/AIDS Prevention Program. “It’s not just having your weapon. It’s not just knowing how to use it. It’s being healthy enough to use it.”

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Stephan Faris is working on a book about global immigration.

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