Foreign Affairs December 2006

Containment Strategy

Iran. North Korea. Uganda? Why the Pentagon ranks Africa’s AIDS crisis as a leading security threat

Perhaps the only thing worse than having few peacekeepers ready to send is the risk to those who actually go. Eighty-one percent of UN peacekeepers are on missions in Africa, home to 60 percent of the world’s people living with AIDS. A 1999 study by the head of Nigeria’s medical corps found that the longer Nigeria’s soldiers were deployed as peacekeepers in Sierra Leone, the greater their chance of contracting HIV. Infection rates increased from 7 percent after one year abroad to 10 percent after two years, and to more than 15 percent after three years.

It’s not hard to see why. During a short stay in the Congolese city of Goma last year, I was shown a dozen or so children allegedly fathered by soldiers from the UN mission, including two light-skinned boys whose fathers were said to be Moroccan. One visitor to Bunia, where the fighting is most brutal, said that she had seen women stripping in the headlights of vehicles of soldiers on night patrol. “The United Nations has helped me a lot,” Bibishe, a twenty-five-year-old prostitute, told me. “They bought me the mattress I’m sleeping on. They bought me clothes.” In the courtyard of her brothel waited a drunken South African sergeant. It was about ten o’clock in the morning.

Since its beginnings in 1981, AIDS has infected about 65 million people worldwide, and killed more than 25 million of them. Yet in parts of Africa, the first waves of death are just beginning. Andrew Price-Smith, a political scientist at Colorado College, cites Zimbabwe, where the epidemic accelerated a general slide into chaos, as a warning of what might happen in other countries. “We’ve already peaked in terms of infections,” says Price-Smith. “Now we’re starting to see the mortalities crest. The subsequent wave will be the wave of economic and political disruption that follows.” Nigeria is another focus of concern, not so much because of its infection rate (which, at between 4 and 6 percent, is relatively low) but because of its general instability and its importance as an oil supplier. “When AIDS affects a large portion of a population, that creates instability,” said General William “Kip” Ward, who took over Wald’s position. “That instability can lead to conditions that are right for terrorist exploitation as they seek to recruit new followers.” While the security threat that AIDS poses is for now largely confined to Africa and Southeast Asia, stirrings of epidemics in Russia and India (which happens to be the third-biggest contributor of UN peacekeepers) are, given their size, strength, and strategic importance, more worrisome still.

As the U.S. military pivots to confront these risks, it’s starting to have to think preventively. The Navy—whose Naval Health Research Center is a leader in military research on behavioral issues—oversees and funds prevention and treatment programs in sixty-seven countries. In Vietnam, U.S. forces teach AIDS prevention to the army they once fought. In Ukraine, they’re setting up testing and counseling centers. In India, they’re providing clinical training and lab support. “We can’t just sit back and wait until the crisis is fully blown and treat every problem like it’s the nail and we’re the hammer,” says Wald.

The spectacular rollout of anti­retro­viral medication may be stopping the gap across Africa, but treatment programs will remain hostage to donor funding and vulnerable to viral resistance to drugs. Future military missions may increasingly be like the AIDS-vaccine research proj­ect in western Kenya, where the Walter Reed Army Institute of Research helps care for 2.5 million civilians on the tea plantations around the city of Kericho and in the neighboring Southern Rift Valley. The Army provides 6,500 patients with anti­retro­viral drugs and supports a youth center along with church-based counseling and in-home care. It has renovated the district hospital and brought in more staff and doctors. To teach AIDS sufferers the basics of nutrition and feed them in the meantime, Walter Reed has even planted a model farm, complete with rows of maize and grazing areas for three cows and their calves. “The main mission is [vaccine] development for the American war fighter,” says Colonel Samuel Martin, commander of Walter Reed in Kenya. “This just helps us put a more human dimension to our operations.” In the leafy hills around Kericho, the Army is hoping to keep Americans safe by helping Africans to stay alive.

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Stephan Faris is a freelance journalist.

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