The New York Times - July 18, 2005
Lawrence K. Altman

The effort began in 2000, amid concern that peacekeepers could be helping to spread H.I.V. in countries they were assigned to or after coming back home. The United Nations Security Council declared AIDS a threat to the political and economic stability of many countries and mandated inclusion of H.I.V. prevention programs in peacekeeping missions. The officials said they had introduced AIDS education and training programs in all peacekeeping missions and were offering H.I.V. tests, promoting use of condoms, and distributing information kits to troops.

But many among the 105 countries that provide uniformed troops to the peacekeeping missions still have a long way to go to meet the Security Council's goal for education and prevention programs, the officials said. The missions involve more than 66,000 frequently rotated uniformed personnel and more than 13,000 international and national civilians serving in 17 peacekeeping and related field operations."AIDS is still not part of the core military business everywhere," Dr. Peter Piot, the director of the United Nations AIDS program, said in providing the Security Council with a progress report.

Most United Nations peacekeeping efforts depend on troops from low- or middle-income countries. Though the number of peacekeepers is tiny compared with the hundreds of millions of people at risk of becoming infected with H.I.V., the virus that causes AIDS, many of those countries are in sub-Saharan Africa, with the world's highest rates of H.I.V. infection.

One hope is that peacekeepers will further contribute to H.I.V. prevention efforts by sharing information with the local population.

Richard C. Holbrooke, a former United States ambassador to the United Nations, who is regarded as the father of the resolution the Security Council passed in 2000, said Monday that at the time some "United Nations peacekeepers were bringing AIDS to regions and some were bringing it home with them, as the Finns found out in Namibia." Similar transmissions "happened all over Africa and in Cambodia," he said.

The resolution was also a response to reports of sexual abuse and exploitation in peacekeeping areas.

Jean-Marie Guehenno, the United Nations under secretary general for peacekeeping operations, said that the resolution "turns out to have provided the jolt that we desperately needed" to make AIDS a priority issue for his office.

Wars and the unsettling conditions after their settlement create conditions that increase the risk of H.I.V. transmission. Factors making troops and people in the war zones more vulnerable to H.I.V. include the youth of the troops who are separated from their families and who are often economically better off than those in countries they are serving. Also, troops often do not use condoms in having sex with multiple partners in war zones.

Dr. Piot and Mr. Guehenno said the lack of reliable data on the number of troops who were H.I.V.-infected in 2000 made it difficult to determine the effectiveness of efforts since then. Many governments keep such information "a military secret," Dr. Piot said.

Initial analysis of a scientifically controlled survey of 660 uniformed peacekeepers of all ranks serving in Liberia and conducted in May and June by the United Nations and the Centers for Disease Control and Prevention produced mixed findings.

More than 94 percent of those surveyed said that they knew H.I.V. could be transmitted through unprotected sex and exposure to contaminated blood, and 87 percent had received AIDS awareness training. But less than 2 percent said they had been briefed about AIDS by their commanding officers.

In India, where recruits must be uninfected before joining the military, AIDS has become the fifth leading medical reason for dismissal from the army and the second most common cause of death in the navy, Dr. Piot said.

He concluded that the best strategy to control H.I.V.'s threat to national security was to bring the epidemic under control.

Toward that goal, the Council on Foreign Relations recommended in a separate report that health officials use a technique known as molecular epidemiology to verify or refute claims that so-called rogue states and groups have deliberately spread H.I.V.

Another council recommendation was that "hard hit, impoverished nations should take steps to preserve their trained elites, within both military and civilian sectors," by providing them with life-extending anti-retroviral drugs. But the report cautioned that providing such drugs only to the elite could prove demoralizing, even destabilizing, to the general population.

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