AIDS Prevention in the Ranks

With a new "civilization killer" strain of the AIDS virus emerging, it has become critical fordefense forces to take a primary role in preventing the spread of the contagion and in preserving thestructures and strengths of societies in developing states. As well, the virulent spread of the new strains ofthe disease will impose significant constraints on international force projection and peacekeeping,particularly in Africa in the coming years. “AIDS and African Armies: A Crisis Worse Than War”. Defense & Foreign Affairs, 1999, vol. 27, no. 11. Abstract: The HIV virus, which leads to AIDS, spreads most rapidly and pervasively as a result of militaryconflict. Indeed, the rapid global dissemination of HIV/ADS was a direct consequence of the civil andcross-border war in Angola during the 1970s; the speed of its global transmission was caused by themovement of international forces, in particular the Cuban Armed Forces. The HIV virus, which leads to AIDS, spreads most rapidly and pervasively as a result of militaryconflict. Indeed, the rapid global dissemination of HIV/ADS was a direct consequence of the civil andcross-border war in Angola during the 1970s; the speed of its global transmission was caused by themovement of international forces, in particular the Cuban Armed Forces. “AIDS cases soar”. Leprosy Review. 1999 Jun; 70(2):238. Abstract not available. Accorsi, S.; Fabiani, M.; Lukwiya, M.; Ravera, M.; Costanzi, A.; Ojom, L.; Paze, E.; Manenti, F.; Anguzu, P.;Dente, M. G., and Declich, S. Impact of insecurity, the AIDS epidemic, and poverty on populationhealth: disease patterns and trends in Northern Uganda. American Journal of Tropical Medicine &Hygiene. 2001 Mar-2001 Apr 30; 64(3-4):214-21. Abstract: A retrospective analysis of the discharge records of 186,131 inpatients admitted to sixUgandan hospitals during 1992-1998 was performed to describe the disease patterns and trendsamong the population of Northern Uganda. In all hospitals, malaria was the leading cause ofadmission and the frequency of admissions for malaria showed the greatest increase. Otherconditions, such as malnutrition and injuries, mainly increased in the sites affected by civil conflictand massive population displacement. Tuberculosis accounted for the highest burden on hospitalservices (approximately one-fourth of the total bed-days), though it showed a stable trend over time.A stable trend was also observed for acquired immunodeficiency syndrome (AIDS), which is incontrast to the hypothesis that AIDS patients have displaced other patients in recent years. Inconclusion, preventable and/or treatable communicable diseases, mainly those related to poverty andpoor hygiene, represent the leading causes of admission and death, reflecting the socioeconomicdisruption in Northern Uganda. A retrospective analysis of the discharge records of 186,131 inpatients admitted to sixUgandan hospitals during 1992-1998 was performed to describe the disease patterns and trendsamong the population of Northern Uganda. In all hospitals, malaria was the leading cause ofadmission and the frequency of admissions for malaria showed the greatest increase. Otherconditions, such as malnutrition and injuries, mainly increased in the sites affected by civil conflictand massive population displacement. Tuberculosis accounted for the highest burden on hospitalservices (approximately one-fourth of the total bed-days), though it showed a stable trend over time.A stable trend was also observed for acquired immunodeficiency syndrome (AIDS), which is incontrast to the hypothesis that AIDS patients have displaced other patients in recent years. Inconclusion, preventable and/or treatable communicable diseases, mainly those related to poverty andpoor hygiene, represent the leading causes of admission and death, reflecting the socioeconomicdisruption in Northern Uganda. Barreto, A.; De Hulsters, B., and Fransen, L. “Is a multisectorial approach to the STD/HIV/AIDS epidemic anoption in post war Mozambique?” International Conference on AIDS 1996 Jul 7; 11(2):375 (abstractno. Th.C.4789). Abstract: Issue: How can the Ministry of Health of Mozambique motivate other sectors to considerthe STD/HIV/AIDS epidemic and plan for its future impact in one of the poorest countries of theworld,beginning its reconstruction after 30 years of conflict? Project: The Ministry of Health ofMozambique has a National STD/AIDS Control Programme running since 1988. Although it has Issue: How can the Ministry of Health of Mozambique motivate other sectors to considerthe STD/HIV/AIDS epidemic and plan for its future impact in one of the poorest countries of theworld,beginning its reconstruction after 30 years of conflict? Project: The Ministry of Health ofMozambique has a National STD/AIDS Control Programme running since 1988. Although it has developed activities of treatment and prevention of these diseases, the greatest challenge to stimulateother sectors to take measures against these diseases remains greatly unanswered. An evaluation ofthe reasons for this unresponsiveness was done. Results: After nearly 30 years of conflict,Mozambique has started its reconstruction. Nearly 25% of its total population of 16 million people,which had been displaced, were reintegrated and successful democratic elections were held in 1994.In 1991, a study by Green et al. showed that 69% of the population lived in extreme poverty. GNPper capita in 1994 was 85 US $. Cities have been growing at very high rates between 1980 and 1991,varying between 2.1 and 14.8%. Economically speaking, the country is very dependent on foreignaid. Illiteracy is very high: adult illiteracy: 67%, female adult illiteracy: 79%. The economic andsocial recovery programme is having some positive economic impact, but is also creating atremendous burden on citizens, decreasing their purchasing power and undermining their potential touse social services as schooling and health care. Lessons Learned: Though the political situation isstabilized, poverty is increasing dramatically. Reconstruction of the country is causing an enormousstrain on all sectors. Tremendous efforts are being made to adjust the economy. Consequences ofHIV/AIDS will set back certain improvements expected through the economic reform programmeand they are not being contemplated for at this moment. Integration of the expected consequences ofthis epidemic in the planning of all sectors should become a priority. However, the MozambicanMinistries depend for more than 75% of their budget on external donors. This dependency makesplanning very difficult for the government. External donors do not see HIV/AIDS planning as apriority. They do not integrate the HIV/AIDS problem and its consequences in projects or othersectors either. Cossa, H. A.; Gloyd, S.; Vaz, R. G.; Folgosa, E.; Simbine, E.; Diniz, M., and Kreiss, J. K. “Syphilis and HIVinfection among displaced pregnant women in rural Mozambique”. International Journal of STD andAIDS. 1994 Mar-1994 Apr 30; 5(2):117-23. Abstract: A cross-sectional study was conducted among displaced pregnant women in Mozambiqueto determine the prevalence and correlates of HIV infection and syphilis. Between September 1992and February 1993, 1728 consecutive antenatal attendees of 14 rural clinics in Zambezia wereinterviewed, examined, and tested for HIV and syphilis antibodies. The seroprevalence of syphilisand HIV were 12.2% and 2.9%, respectively. Reported sexual abuse was frequent (8.4%) but sex formoney was uncommon. A positive MHA-TP result was significantly associated with unmarriedstatus, history of past STD, HIV infection, and current genital ulcers, vaginal discharge, or genitalwarts. Significant correlates of HIV seropositivity included anal intercourse, history of past STD,and syphilis. In summary, displaced pregnant women had a high prevalence of syphilis but arelatively low HIV seroprevalence suggesting recent introduction of HIV infection in this area orslow spread of the epidemic. A syphilis screening and treatment programme is warranted to preventperinatal transmission and to reduce the incidence of chancres as a cofactor for HIV transmission. A cross-sectional study was conducted among displaced pregnant women in Mozambiqueto determine the prevalence and correlates of HIV infection and syphilis. Between September 1992and February 1993, 1728 consecutive antenatal attendees of 14 rural clinics in Zambezia wereinterviewed, examined, and tested for HIV and syphilis antibodies. The seroprevalence of syphilisand HIV were 12.2% and 2.9%, respectively. Reported sexual abuse was frequent (8.4%) but sex formoney was uncommon. A positive MHA-TP result was significantly associated with unmarriedstatus, history of past STD, HIV infection, and current genital ulcers, vaginal discharge, or genitalwarts. Significant correlates of HIV seropositivity included anal intercourse, history of past STD,and syphilis. In summary, displaced pregnant women had a high prevalence of syphilis but arelatively low HIV seroprevalence suggesting recent introduction of HIV infection in this area orslow spread of the epidemic. A syphilis screening and treatment programme is warranted to preventperinatal transmission and to reduce the incidence of chancres as a cofactor for HIV transmission. Eshete, H.; Heast, N.; Lindan, K., and Mandel, J. “Ethnic conflicts, poverty, and AIDS in Ethiopia”. Lancet. 1993May 8; 341(8854):1219. Gasasira, A.; Simbeye, I. V.; Harris, A. O.; Bruce, L. M., and Kamara, J. A. “Improving HIV/AIDSepidemiological surveillance in Liberia: do health facilities have the capacity?”. InternationalConference on AIDS 1998; 12:1060 Abstract: ISSUE: Strengthening HIV/AIDS epidemiological surveillance in a developing country,emerging from a seven year civil conflict with is believed to have have had a profound effect on anexisting nascent HIV epidemic. PROJECT: During the seven year civil crisis in Liberia, factors thatfoster the spread of HIV/AIDS BECAME RAMPANT. Realizing that an accurate understanding ofthe magnitude and determinants in this post war era is an important requirement for effectiveinterventions to be developed, the National AIDS & STD Control Programme has embarked onstrengthening its epidemiological surveillance system. Assessment of existing structures, capacitybuilding and refocusing goals and strategies in data collection are some of the components in this ISSUE: Strengthening HIV/AIDS epidemiological surveillance in a developing country,emerging from a seven year civil conflict with is believed to have have had a profound effect on anexisting nascent HIV epidemic. PROJECT: During the seven year civil crisis in Liberia, factors thatfoster the spread of HIV/AIDS BECAME RAMPANT. Realizing that an accurate understanding ofthe magnitude and determinants in this post war era is an important requirement for effectiveinterventions to be developed, the National AIDS & STD Control Programme has embarked onstrengthening its epidemiological surveillance system. Assessment of existing structures, capacitybuilding and refocusing goals and strategies in data collection are some of the components in this exercise. An initial situation analysis of health facilities capacity to participate in HIV/AIDSsurveillance activities is being undertaken nation-wide. RESULT: To date 32 health facilities havebeen assessed. 34% of these are urban, 19% periurban and 41% rural, 65% do not have electricity orpipe water. 75% have a basic functioning laboratory. Less than 30% of these facilities have healthworkers who have undergone any form of HIV/AIDS training. All the facilities assessed run out-patient clinics, 84% run antenatal services, and 34% perform blood donor recruitment. Only 25%report having ever handled a suspected or confirmed AIDS patient, while HIV sero-prevalenceamong blood donors in 1997 was 3.9%. LESSONS LEARNED: Despite the recent war, many healthfacilities possess the necessary physical infrastructure for HIV/AIDS surveillance, have access topotential sentinel population, and only require support in terms of provision of hardy HIV test kits,appropriate AIDS case definition and data collection tools. Girdler-Brown B., “Eastern and Southern Africa”, International Migration, December 1998, vol. 36, no. 4. Abstract:The countries included in this review are Angola, Botswana, Burundi, Djibouti, Eritrea,Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Somalia, South Africa,Sudan, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. Very little research has specificallyaddressed the important issue of the relationship between migration and HIV/AIDS in theseregions of Africa. However there is a great deal of information about migration, and also aboutHIV/AIDS, in isolation from each other. rates are now high in almost all African countries, theconcern that migrants may bring the virus with them is no longer appropriate. Instead, the concernis that migrants may be vulnerable to acquiring the infection during migration, and that they mayspread HIV/AIDS is widespread and prevalent throughout the two regions. Since HIV prevalencethe infection when they return to their homes at the end of migration. In the eastern African regionthere has been rapid growth of urban populations during the last ten years, mainly as a result ofrural to urban migration. In addition, the conflict in Sudan and disputes in the Horn of Africa havecreated large numbers of internally displaced persons. Most recently, conflict in the Great Lakesregion has also resulted in very large numbers of refugees crossing international borders. TheUNHCR estimates that there were approximately 1.3 million refugees from and in eastern Africancountries in 1997, and an estimated 5 million internally displaced persons (4 million in Sudanalone).The countries included in this review are Angola, Botswana, Burundi, Djibouti, Eritrea,Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Somalia, South Africa,Sudan, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. Very little research has specificallyaddressed the important issue of the relationship between migration and HIV/AIDS in theseregions of Africa. However there is a great deal of information about migration, and also aboutHIV/AIDS, in isolation from each other. rates are now high in almost all African countries, theconcern that migrants may bring the virus with them is no longer appropriate. Instead, the concernis that migrants may be vulnerable to acquiring the infection during migration, and that they mayspread HIV/AIDS is widespread and prevalent throughout the two regions. Since HIV prevalencethe infection when they return to their homes at the end of migration. In the eastern African regionthere has been rapid growth of urban populations during the last ten years, mainly as a result ofrural to urban migration. In addition, the conflict in Sudan and disputes in the Horn of Africa havecreated large numbers of internally displaced persons. Most recently, conflict in the Great Lakesregion has also resulted in very large numbers of refugees crossing international borders. TheUNHCR estimates that there were approximately 1.3 million refugees from and in eastern Africancountries in 1997, and an estimated 5 million internally displaced persons (4 million in Sudanalone). Guimond, M.; Philip, N., and Sheikh, U. “Health concerns of peacekeeping: a survey of the current situation”.Journal of Humanitarian Assistance, 2001 Jul 13. No abstract available. Gustafson, P.; Gomes, V. F; Vieira, C. S; Jensen, H.; Seng, R.; Norberg, R.; Samb, B.; Naucler, A., and Aaby, P.“Tuberculosis mortality during a civil war in Guinea-Bissau”. JAMA: the Journal of the AmericanMedical Association. 286(5):599-603. Abstract: CONTEXT: Tuberculosis (TB) is an increasing global problem, despite effective drugtherapies. Access to TB therapy during conflict situations has not been studied. OBJECTIVE: Todetermine the effect of irregular TB treatment due to an armed conflict in Guinea-Bissau, WestAfrica. DESIGN, SETTING, AND PATIENTS: Ongoing retrospective cohort study conducted inthe capital city of Bissau among 101 patients with TB who received irregular or no treatment duringthe civil war (war cohort; June 7-December 6, 1998) and 108 patients with TB who receivedtreatment 12 months earlier (peace cohort; June 7-December 6, 1997) and comparison of anadditional 42 patients who had completed treatment before June 6, 1998, and 69 patients who hadcompleted treatment before June 6, 1997. MAIN OUTCOME MEASURE: Mortality rates,compared by irregular (war cohort) vs regular (peace cohort) access to treatment, by intensive vscontinuation phase of treatment, and by those who had previously completed treatment for TB.RESULTS: Irregular treatment was associated with an increased mortality rate among patients withTB. The mortality rate ratio (MR) was 3.12 (95% confidence interval [CI], 1.20-8.12) in the warcohort, adjusting for age, sex, human immunodeficiency virus (HIV) infection, residence, and lengthof treatment. Each additional week of treatment before the war started increased probability ofsurvival by 5% (95% CI, 0%-10%). In the intensive phase of treatment, the adjusted MR was 3.30 CONTEXT: Tuberculosis (TB) is an increasing global problem, despite effective drugtherapies. Access to TB therapy during conflict situations has not been studied. OBJECTIVE: Todetermine the effect of irregular TB treatment due to an armed conflict in Guinea-Bissau, WestAfrica. DESIGN, SETTING, AND PATIENTS: Ongoing retrospective cohort study conducted inthe capital city of Bissau among 101 patients with TB who received irregular or no treatment duringthe civil war (war cohort; June 7-December 6, 1998) and 108 patients with TB who receivedtreatment 12 months earlier (peace cohort; June 7-December 6, 1997) and comparison of anadditional 42 patients who had completed treatment before June 6, 1998, and 69 patients who hadcompleted treatment before June 6, 1997. MAIN OUTCOME MEASURE: Mortality rates,compared by irregular (war cohort) vs regular (peace cohort) access to treatment, by intensive vscontinuation phase of treatment, and by those who had previously completed treatment for TB.RESULTS: Irregular treatment was associated with an increased mortality rate among patients withTB. The mortality rate ratio (MR) was 3.12 (95% confidence interval [CI], 1.20-8.12) in the warcohort, adjusting for age, sex, human immunodeficiency virus (HIV) infection, residence, and lengthof treatment. Each additional week of treatment before the war started increased probability ofsurvival by 5% (95% CI, 0%-10%). In the intensive phase of treatment, the adjusted MR was 3.30 (95% CI, 1.04-10.50) and in the continuation phase it was 2.26 (95% CI, 0.33-15.34). Increasedmortality among the war cohort was most marked in HIV-positive patients, who had an adjusted MRof 8.19 (95% CI, 1.62-41.25). Mortality was not increased in HIV-positive or HIV-negative patientswho had completed TB treatment when the war started. CONCLUSIONS: Interruption of treatmenthad a profound impact on mortality among patients with TB during the war in Guinea-Bissau.Regular treatment for TB was associated with significantly improved survival for HIV-infectedindividuals. In emergencies, it is crucial to ensure availability of TB drugs. Hailegnaw, E. Poverty, war and the AIDS epidemic in Ethiopia. International Conference on AIDS 1992 Jul 19;8(3):164. Abstract: OBJECTIVE: To determine the trends of the AIDS epidemic in Ethiopia and factorsaffecting it. METHODS: Pertinent information about war, poverty and AIDS in Ethiopia weregathered from international and national reports, as well as aggregated data from scientific journalsand reports of the Ethiopian Ministry of Health. RESULTS: Ethiopia has been in a state of constantwar and internal conflict for the last several years. Poverty and diseases are prominent features of thecountry. The rate of HIV infectivity has dramatically increased to 2.3%, 44%, 13%, 2.4%, 17.5%among blood donors, commercial sex workers, long distance truck drivers, scholarship students andmilitary recruits respectively. CONCLUSION: In Ethiopia, because of war and poverty, there is ahigh mobility of population throughout the country. Many families have been disintegrated and as aresult the divorce rate has increased. There is a high rate of unemployment throughout the country.Prostitution has flourished in major towns and cities. Military troops, probably one of the largest inAfrica, is target particularly vulnerable to HIV infection. They are potentially capable ofdisseminating the virus particularly from endemic to non-endemic areas. Because of poverty andwar, inadequate attention has been given to AIDS and health education resulting in little impact onhealth-positive behavioral and attitudinal changes. OBJECTIVE: To determine the trends of the AIDS epidemic in Ethiopia and factorsaffecting it. METHODS: Pertinent information about war, poverty and AIDS in Ethiopia weregathered from international and national reports, as well as aggregated data from scientific journalsand reports of the Ethiopian Ministry of Health. RESULTS: Ethiopia has been in a state of constantwar and internal conflict for the last several years. Poverty and diseases are prominent features of thecountry. The rate of HIV infectivity has dramatically increased to 2.3%, 44%, 13%, 2.4%, 17.5%among blood donors, commercial sex workers, long distance truck drivers, scholarship students andmilitary recruits respectively. CONCLUSION: In Ethiopia, because of war and poverty, there is ahigh mobility of population throughout the country. Many families have been disintegrated and as aresult the divorce rate has increased. There is a high rate of unemployment throughout the country.Prostitution has flourished in major towns and cities. Military troops, probably one of the largest inAfrica, is target particularly vulnerable to HIV infection. They are potentially capable ofdisseminating the virus particularly from endemic to non-endemic areas. Because of poverty andwar, inadequate attention has been given to AIDS and health education resulting in little impact onhealth-positive behavioral and attitudinal changes. Heinecken, L., “HIV/AIDS, the Military and the Impact on National and International Security,” Society inTransition, 2001, vol. 32, no. 1. No abstract available. Kellett, J. “Medicine in Uganda: the impact of prolonged war and epidemic AIDS on medical care”. CanadianMedical Association Journal. 1989 Mar 15; 140(6):699-701. No abstract available. Khaw, A.; Salama, P.; Burkholder, B., and Dondero, T. “HIV risk and prevention in emergency-affectedpopulations: a review”. Disasters. 2000 Sep 24; (3):181-197. Abstract: While basic guidelines on HIV prevention in emergencies have been available for severalyears, international agencies involved in the provision of health services have not placed sufficientpriority on the prevention of the human immune deficiency virus (HIV) and other sexuallytransmitted infections (STIs) in complex emergencies. This paper reviews the factors that mayincrease the risk of HIV transmission in populations affected by complex emergencies and outlinesrecommendations for reserach and programmes. Research into the most appropriate methods ofcarrying out HIV surveillance and interventions in these settings is needed. In the post-emergencyphase programmes need to be far more extensive than those offered under the Minimal InitialServices Package (MISP). While the potential for stigmatization represents an important constraint,there is a need to prioritize HIV/STI interventions in order to prevent HIV transmission inemergency-affected poulations themselves, as well as to contribute to regional control of theepidemic. While basic guidelines on HIV prevention in emergencies have been available for severalyears, international agencies involved in the provision of health services have not placed sufficientpriority on the prevention of the human immune deficiency virus (HIV) and other sexuallytransmitted infections (STIs) in complex emergencies. This paper reviews the factors that mayincrease the risk of HIV transmission in populations affected by complex emergencies and outlinesrecommendations for reserach and programmes. Research into the most appropriate methods ofcarrying out HIV surveillance and interventions in these settings is needed. In the post-emergencyphase programmes need to be far more extensive than those offered under the Minimal InitialServices Package (MISP). While the potential for stigmatization represents an important constraint,there is a need to prioritize HIV/STI interventions in order to prevent HIV transmission inemergency-affected poulations themselves, as well as to contribute to regional control of theepidemic. Kingma, S. J. “AIDS prevention, testing and care in current military practice”. International Conference on AIDS1996 Jul 7; 11(1):47 Abstract: Issue: Armed forces personnel constitute a population at special risk for infection withHIV. Studies show that military personnel on deployment regularly have sexual contacts withprostitutes and the local population. Infection rates of STDs among the military are 2 to 5 timeshigher than STD infection rates in comparable civilian populations even in peace times but muchhigher in conflict situations. It is 5-20 times easier to acquire HIV in the presence of other untreatedSTDs, in either partner, than if no STD is present. Response: Decisions must be made by all militaryleaders to embark on a vigorous effort of STD/AIDS prevention in the military population, takinginto account the interface with civil society. An effective control programme begins with preventioneducation through the training of health care staff, and through the regular behaviour is crucial. Alsoessential are the provisions of counselling and voluntary testing, and a non-discriminatoryenvironment. Provision of adequate care for those living with HIV and AIDS is also needed, and thiscan be facilitated by strong links with the civil National AIDS Programme. The Civil-MilitaryAlliance to Combat HIV and AIDS provides support to the military in developing countries toaddress these issues, initially through a series of regional policy seminars. The Alliance has surveyed115 countries to determine their current policies and practices in regard to HIV/AIDS-relatedprevention, testing and care. The returns from this survey to date will be presented to theConference. Issue: Armed forces personnel constitute a population at special risk for infection withHIV. Studies show that military personnel on deployment regularly have sexual contacts withprostitutes and the local population. Infection rates of STDs among the military are 2 to 5 timeshigher than STD infection rates in comparable civilian populations even in peace times but muchhigher in conflict situations. It is 5-20 times easier to acquire HIV in the presence of other untreatedSTDs, in either partner, than if no STD is present. Response: Decisions must be made by all militaryleaders to embark on a vigorous effort of STD/AIDS prevention in the military population, takinginto account the interface with civil society. An effective control programme begins with preventioneducation through the training of health care staff, and through the regular behaviour is crucial. Alsoessential are the provisions of counselling and voluntary testing, and a non-discriminatoryenvironment. Provision of adequate care for those living with HIV and AIDS is also needed, and thiscan be facilitated by strong links with the civil National AIDS Programme. The Civil-MilitaryAlliance to Combat HIV and AIDS provides support to the military in developing countries toaddress these issues, initially through a series of regional policy seminars. The Alliance has surveyed115 countries to determine their current policies and practices in regard to HIV/AIDS-relatedprevention, testing and care. The returns from this survey to date will be presented to theConference. Lucas, S. E. “AIDS: refugees and the homeless”. AIDS Care. 1991; 3(4):443-6. No abstract available. Mbabazi P., MacLean S.J., Shaw T.M., Governance for Reconstruction in Africa: Challenges for PolicyChallenges for Policy Communities and Coalitions, Global Networks: a Journal of TransnationalAffairs January 2002, vol. 2, no. 1. Abstract: This article seeks to advance analyses and responses to conflict prevention andreconstruction in Africa that go beyond state-centric perspectives to include a range of non-stateplayers. Drawing on examples from both Uganda and Canada, it focuses on the activities of NGOsthat have ‘partnered’ with state-based actors in various peacekeeping and peace-building operationsas well as on the increasingly important role played by think-tanks. The latter have emerged inAfrica as major contributors to the proliferating literature on the political economy of violence, anapproach that recognizes that African conflict reflects imperatives of production and consumption inrelations that juxtapose Africa’s political institutions and cultures with international and globalpolitical economies. The article argues that novel forms of ‘security communities’ are emergingfrom the non-state/state/international partnerships and coalitions that have developed aroundcontemporary issues like ‘blood’ diamonds, small arms, debt and HIV/AIDS, thus drawing attentionto connections between conflict and development. This article seeks to advance analyses and responses to conflict prevention andreconstruction in Africa that go beyond state-centric perspectives to include a range of non-stateplayers. Drawing on examples from both Uganda and Canada, it focuses on the activities of NGOsthat have ‘partnered’ with state-based actors in various peacekeeping and peace-building operationsas well as on the increasingly important role played by think-tanks. The latter have emerged inAfrica as major contributors to the proliferating literature on the political economy of violence, anapproach that recognizes that African conflict reflects imperatives of production and consumption inrelations that juxtapose Africa’s political institutions and cultures with international and globalpolitical economies. The article argues that novel forms of ‘security communities’ are emergingfrom the non-state/state/international partnerships and coalitions that have developed aroundcontemporary issues like ‘blood’ diamonds, small arms, debt and HIV/AIDS, thus drawing attentionto connections between conflict and development. McCarthy, M. C.; Khalid, I. O., and El Tigani, A. “HIV-1 infection in Juba, southern Sudan”. J Med Virol. 1995May; 46(1):18-20. Abstract: Thirty years of civil war in the Sudan have resulted in the isolation of the southernprovinces which border Central and East Africa. Consequently, little is known about theepidemiology of HIV-1 infection in this region. To estimate the prevalence of HIV-1 infection insouthern Sudan and the risk factors associated with disease transmission, a seroepidemiologic surveywas conducted in the township of Juba. Study subjects invited to participate in this study includedmedical outpatients, inpatients hospitalized for active tuberculosis, and female prostitutes. A total of401 subjects participated in the study. HIV-1 infection was confirmed in 25 subjects. The prevalenceof HIV-1 infection was 19% (8/42) among tuberculosis patients, 16% (8/50) among prostitutes, and3% (9/309) among outpatients. A significantly higher prevalence of HIV-1 infection was foundamong female prostitutes when compared to female outpatients: 16% (8/50) vs. 2% (4/178), P <0.001. Correspondingly, the prevalence of seropositives was significantly higher among maleoutpatients reporting a history of sexual relations with prostitutes during the prior 10 years comparedto male outpatients denying relations with prostitutes: 14% (5/37) vs. 0% (0/94), P = 0.0011. A Thirty years of civil war in the Sudan have resulted in the isolation of the southernprovinces which border Central and East Africa. Consequently, little is known about theepidemiology of HIV-1 infection in this region. To estimate the prevalence of HIV-1 infection insouthern Sudan and the risk factors associated with disease transmission, a seroepidemiologic surveywas conducted in the township of Juba. Study subjects invited to participate in this study includedmedical outpatients, inpatients hospitalized for active tuberculosis, and female prostitutes. A total of401 subjects participated in the study. HIV-1 infection was confirmed in 25 subjects. The prevalenceof HIV-1 infection was 19% (8/42) among tuberculosis patients, 16% (8/50) among prostitutes, and3% (9/309) among outpatients. A significantly higher prevalence of HIV-1 infection was foundamong female prostitutes when compared to female outpatients: 16% (8/50) vs. 2% (4/178), P <0.001. Correspondingly, the prevalence of seropositives was significantly higher among maleoutpatients reporting a history of sexual relations with prostitutes during the prior 10 years comparedto male outpatients denying relations with prostitutes: 14% (5/37) vs. 0% (0/94), P = 0.0011. A history of a sexually transmitted disease (STD) was also associated with HIV-1 infection amongmale outpatients. The findings of this study indicate that HIV-1 infection is highly prevalent insouthern Sudan and that prostitutes and their sexual partners represent a major reservoir of HIVinfection in this population. This epidemiologic pattern resembles that seen in the African nationsneighboring southern Sudan. Newman L.M. et. al., “HIV Seroprevalence Among Military Blood Donors in Manica Province, Mozambique”,International Journal of STD and AIDS, April 2001, vol. 12, no. 4. Abstract:H HIV seroprevalence data show an alarming HIV situation in central Mozambique, butlittle is known about the situation of HIV in Mozambican military personnel. This study is aretrospective analysis of laboratory records for voluntary blood donors at a rural hospital fromJanuary 1997 through December 1999. The hospital screened blood samples with HIV SPOT rapidtest for HIV and rapid plasma reagin (RPR) serological test for syphilis. Of the 797 blood donorsduring this period, 110 (13.8%) were military personnel of whom 39.1% were HIV positive (35.0%in 1997, 33.3% in 1998 and 48.7% in 1999). Among the 687 nonmilitary donors 15.3% were HIVpositive (P<0.0001 vs military). 74.4% of HIV-positive military personnel were also RPR positive.Conversely, only 3.0% of HIV-negative military donors were RPR positive. In light of the high ratesof HIV and syphilis in military personnel, aggressive intervention measures must be taken to preventand treat HIV and STDs in this population.H HIV seroprevalence data show an alarming HIV situation in central Mozambique, butlittle is known about the situation of HIV in Mozambican military personnel. This study is aretrospective analysis of laboratory records for voluntary blood donors at a rural hospital fromJanuary 1997 through December 1999. The hospital screened blood samples with HIV SPOT rapidtest for HIV and rapid plasma reagin (RPR) serological test for syphilis. Of the 797 blood donorsduring this period, 110 (13.8%) were military personnel of whom 39.1% were HIV positive (35.0%in 1997, 33.3% in 1998 and 48.7% in 1999). Among the 687 nonmilitary donors 15.3% were HIVpositive (P<0.0001 vs military). 74.4% of HIV-positive military personnel were also RPR positive.Conversely, only 3.0% of HIV-negative military donors were RPR positive. In light of the high ratesof HIV and syphilis in military personnel, aggressive intervention measures must be taken to preventand treat HIV and STDs in this population. Noji E.K., The Global Resurgence of Infectious Diseases, Journal of Contingencies and Crisis Management,December 2001, vol. 9, no. 4 Abstract:In an increasingly interdependent world, we face an array of new global challenges thattranscend the traditional definition of national security. One important example is the resurgence ofinfectious diseases. In the 1960s and 1970s, powerful antibiotic drugs and vaccines appeared to havebanished the major plagues from the industrialized world, leading to a mood of complacency and theneglect of programs for disease surveillance and prevention. Over the past few decades, however,infectious diseases have returned with a vengeance. Many factors, or combinations of factors, cancontribute to disease emergence. New infectious diseases may emerge from genetic changes inexisting organisms; known diseases may spread to new geographic areas and populations; andpreviously unknown infections may appear in humans due to changing ecological conditions thatincrease their exposure to insect vectors, animal reservoirs, or environmental sources of novelpathogens. Reemergence may also occur because of the development of anti-microbial resistance inexisting infections (e.g., malaria) or breakdowns in public health measures for previously controlledinfections due to civil conflict (e.g., cholera, tuberculosis). Not only does the re-emergence ofinfectious diseases threaten health directly, but devastating epidemics such as AIDS are spawningwidespread political instability and civil conflict. This instability, in turn, will contribute tohumanitarian emergencies and economic crises.In an increasingly interdependent world, we face an array of new global challenges thattranscend the traditional definition of national security. One important example is the resurgence ofinfectious diseases. In the 1960s and 1970s, powerful antibiotic drugs and vaccines appeared to havebanished the major plagues from the industrialized world, leading to a mood of complacency and theneglect of programs for disease surveillance and prevention. Over the past few decades, however,infectious diseases have returned with a vengeance. Many factors, or combinations of factors, cancontribute to disease emergence. New infectious diseases may emerge from genetic changes inexisting organisms; known diseases may spread to new geographic areas and populations; andpreviously unknown infections may appear in humans due to changing ecological conditions thatincrease their exposure to insect vectors, animal reservoirs, or environmental sources of novelpathogens. Reemergence may also occur because of the development of anti-microbial resistance inexisting infections (e.g., malaria) or breakdowns in public health measures for previously controlledinfections due to civil conflict (e.g., cholera, tuberculosis). Not only does the re-emergence ofinfectious diseases threaten health directly, but devastating epidemics such as AIDS are spawningwidespread political instability and civil conflict. This instability, in turn, will contribute tohumanitarian emergencies and economic crises. “Passing Through Turbulence”, Armed Forces Journal International, 2000, vol. 138, no. 1. Abstract:The South African army's latest group of new junior leaders will complete their initialtraining in December. They will face a number of difficult challenges as the army transitions throughturbulent times. The challenges include government attempts to reduce the size of South Africa'smilitary forces, the HIV/AIDS epidemic, and peacekeeping deployments to the north. Meanwhile,the army's relatively small budget is limiting the scope of its ambitious modernization efforts.The South African army's latest group of new junior leaders will complete their initialtraining in December. They will face a number of difficult challenges as the army transitions throughturbulent times. The challenges include government attempts to reduce the size of South Africa'smilitary forces, the HIV/AIDS epidemic, and peacekeeping deployments to the north. Meanwhile,the army's relatively small budget is limiting the scope of its ambitious modernization efforts. Pearn, J. “War zone paediatrics in Rwanda”. Journal. 1996 Aug; 32(4):290-5.; ISSN: 1034-4810. Abstract: Children are particularly vulnerable to injury and death in two types of 20th centuryconflicts; terrorist attack and civil war. This account describes some first-hand experiences of the Children are particularly vulnerable to injury and death in two types of 20th centuryconflicts; terrorist attack and civil war. This account describes some first-hand experiences of the aftermath of the Rwandan Civil War of 1994. Events leading to the conflict are described, eyewitness accounts of child trauma during the war are recorded and the medical problems (currentlyongoing) affecting children are described. Over a period of 3 months from April to June 1994,between half and one million Rwandese, a significant proportion of them women and children, weremurdered in brutal hand-to-hand killing, dying from close-quarter gunshot and machete slaughter.Nearly half of the population became refugees in neighbouring countries or displaced persons intheir own land. UNAMIR II, the United Nations Emergency Humanitarian Response, grew to some7000 persons by May 1995. Medical aid was provided by emergency medical contingents from theUnited Kingdom, Canada and Australia, the latter through its Australian Medical Support Force,providing the definitive emergency medical infrastructure from August 1994. In the consequentpost-war civil and social disruption, children suffered from burns, cholera and from motor vehicletrauma. Ongoing landmine blasts continue to affect children and adolescents especially. A newInternational humanitarian code to build a time-expiry device into landmines and other similarordinance is urgently required as the post-conflict ongoing disasters in Rwanda, Afghanistan andCambodia illustrate. Current problems affecting children include an increasing risk of HIV infection,trauma and the special humanitarian needs of thousands of orphans. Profile. The risks--and rewards--of war zone research. Science. 2000 Jun 23; 288(5474):2159. No abstract available. Quinn, T. “Population migration and the spread of types 1 and 2 human immunodeficiency viruses”. ProceedingsNational Academy of Sciences USA. 1994 Mar; 91:2407-2414. Abstract: Over 14 million people are estimated to be infected with the human immunodeficiencyvirus (HIV), with nearly three-fourths of the infected persons residing in developing countries. Onefactor responsible for dissemination of both HIV-1 and HIV-2 worldwide was the intense migrationof individuals from rural to urban centers with subsequent return migration and internationally due tocivil wars, tourism, business purposes, and the drug trade. In sub-Saharan Africa, between 1960 and1980, urban centers with more than 500,000 inhabitants increased from 3 to 28, and more than 75military coups occurred in 30 countries. The result was a massive migration of rural inhabitants tourban centers concomitant with the spread of HIV-1 to large population centers. With the associateddemographic, economic, and social changes, an epidemic of sexually transmitted diseases and HIV-1was ignited. Migratory patterns were also responsible for the spread of endemic HIV-2 toneighboring West African countries and eventually to Europe, the Americas, and India. AlthoughSoutheast Asia was the last region in which HIV-1 was introduced, it has the greatest potential forrapid spread due to population density and inherent risk behaviors. Thus, the migraion of poor, ruraland young sexually active individuals to urban centers coupled with large international movementsof HIV-infected indiviuals played a prominent role in the dissemination of HIV globally. Theeconomic recession has aggravated the transmission of HIV by directly increasing the population atrisk through increased urban migration, disruption of rural families and cultural values, poverty, andprostitution and indirectly through a decrease in health care provision. Consequently, social andeconomic reform as well as sexual behavior education need to be intensified if HIV transmission isto be controlled. Over 14 million people are estimated to be infected with the human immunodeficiencyvirus (HIV), with nearly three-fourths of the infected persons residing in developing countries. Onefactor responsible for dissemination of both HIV-1 and HIV-2 worldwide was the intense migrationof individuals from rural to urban centers with subsequent return migration and internationally due tocivil wars, tourism, business purposes, and the drug trade. In sub-Saharan Africa, between 1960 and1980, urban centers with more than 500,000 inhabitants increased from 3 to 28, and more than 75military coups occurred in 30 countries. The result was a massive migration of rural inhabitants tourban centers concomitant with the spread of HIV-1 to large population centers. With the associateddemographic, economic, and social changes, an epidemic of sexually transmitted diseases and HIV-1was ignited. Migratory patterns were also responsible for the spread of endemic HIV-2 toneighboring West African countries and eventually to Europe, the Americas, and India. AlthoughSoutheast Asia was the last region in which HIV-1 was introduced, it has the greatest potential forrapid spread due to population density and inherent risk behaviors. Thus, the migraion of poor, ruraland young sexually active individuals to urban centers coupled with large international movementsof HIV-infected indiviuals played a prominent role in the dissemination of HIV globally. Theeconomic recession has aggravated the transmission of HIV by directly increasing the population atrisk through increased urban migration, disruption of rural families and cultural values, poverty, andprostitution and indirectly through a decrease in health care provision. Consequently, social andeconomic reform as well as sexual behavior education need to be intensified if HIV transmission isto be controlled. Salama, P. and Dondero, T. J. “HIV surveillance in complex emergencies”. AIDS. 2001 Apr; 15 Suppl 3:S4-12. Abstract: Many studies have shown a positive association between both migration and temporaryexpatriation and HIV risk. This association is likely to be similar or even more pronounced forforced migrants. In general, HIV transmission in host-migrant or host-forced-migrant interactionsdepends on the maturity of the HIV epidemic in both the host and the migrant population, therelative seroprevalence of HIV in the host and the migrant population, the prevalence of othersexually transmitted infections (STIs) that may facilitate transmission, and the level of sexualinteraction between the two communities. Complex emergencies are the major cause of masspopulation movement today. In complex emergencies, additional factors such as sexual interaction Many studies have shown a positive association between both migration and temporaryexpatriation and HIV risk. This association is likely to be similar or even more pronounced forforced migrants. In general, HIV transmission in host-migrant or host-forced-migrant interactionsdepends on the maturity of the HIV epidemic in both the host and the migrant population, therelative seroprevalence of HIV in the host and the migrant population, the prevalence of othersexually transmitted infections (STIs) that may facilitate transmission, and the level of sexualinteraction between the two communities. Complex emergencies are the major cause of masspopulation movement today. In complex emergencies, additional factors such as sexual interaction between forced-migrant populations and the military; sexual violence; increasing commercial sexwork; psychological trauma; and disruption of preventive and curative health services may increasethe risk for HIV transmission. Despite recent success in preventing HIV infection in stablepopulations in selected developing countries, internally displaced persons and refugees (or forcedmigrants) have not been systematically included in HIV surveillance systems, nor consequently inprevention activities. Standard surveillance systems that rely on functioning health services may notprovide useful data in many complex emergency settings. Secondary sources can provide someinformation in these settings. Little attempt has been made, however, to develop innovative HIVsurveillance systems in countries affected by complex emergencies. Consequently, data on the HIVepidemic in these countries are scarce and HIV prevention programs are either not implemented orinterventions are not effectively targeted. Second generation surveillance methods such as cross-sectional, population-based surveys can provide rapid information on HIV, STIs, and sexualbehavior. The risks for stigmatization and breaches of confidentiality must be recognized.Surveillance, however, is a key component of HIV and STI prevention services for forced migrants.It is required to define the high risk groups, target interventions, and ultimately decrease HIV andSTI transmission within countries facing complex emergencies. It is also required to facilitateregional control of HIV epidemics. Schneider, H. and Stein, J. “Implementing AIDS policy in post-apartheid South Africa”. Social Science & Medicine.2001 Mar; 52(5):723-731. Abstract: In common with the rest of the Southern African sub-continent. South Africa is currentlyexperiencing a serious HIV epidemic. When it came into power in 1994, the new, Mandela-ledgovernment immediately mobilised funds and adopted a far-reaching AIDS Plan for the country.However, the implementation of AIDS policy in the first four years after 1994 has beencharacterised by a lack of progress and a breakdown of trust and co-operation, both withingovernment and between government and NGOs. This paper outlines the political context whichshaped the development of the AIDS Policy, then examines the difficulties of implementing acomprehensive response to AIDS in a country undergoing restructuring at every level. It questionsthe notion of "inadequate political will" as an explanation for lack of progress. Involvement bypoliticians has, in fact, been experienced as a double-edged sword in South Africa, withinappropriate, "quick-fix" actions creating conflict and hampering a more longer-term, effectiveresponse. The paper also highlights the importance of groupings outside of government in promotingeffective policy actions, and the types of leadership required to mobilise a broad range of actorsaround a common vision. It concludes by emphasising the need to develop approaches to policyimplementation rooted in the possibilities and constraints of the local situation, rather than relying onuniversal blue-prints developed out of context. [Journal Article; In English; England] In common with the rest of the Southern African sub-continent. South Africa is currentlyexperiencing a serious HIV epidemic. When it came into power in 1994, the new, Mandela-ledgovernment immediately mobilised funds and adopted a far-reaching AIDS Plan for the country.However, the implementation of AIDS policy in the first four years after 1994 has beencharacterised by a lack of progress and a breakdown of trust and co-operation, both withingovernment and between government and NGOs. This paper outlines the political context whichshaped the development of the AIDS Policy, then examines the difficulties of implementing acomprehensive response to AIDS in a country undergoing restructuring at every level. It questionsthe notion of "inadequate political will" as an explanation for lack of progress. Involvement bypoliticians has, in fact, been experienced as a double-edged sword in South Africa, withinappropriate, "quick-fix" actions creating conflict and hampering a more longer-term, effectiveresponse. The paper also highlights the importance of groupings outside of government in promotingeffective policy actions, and the types of leadership required to mobilise a broad range of actorsaround a common vision. It concludes by emphasising the need to develop approaches to policyimplementation rooted in the possibilities and constraints of the local situation, rather than relying onuniversal blue-prints developed out of context. [Journal Article; In English; England] Smallman-Raynor, M. R. and Cliff, A. D. “Civil war and the spread of AIDS in Central Africa”. Epidemiology andInfection. 1991 Aug; 107(1):69-80. Abstract: Using ordinary least squares regression techniques this paper demonstrates, for the firsttime, that the classic association of war and disease substantially accounts for the presently observedgeographical distribution of reported clinical AIDS cases in Uganda. Both the spread of HIV 1infection in the 1980s, and the subsequent development of AIDS to its 1990 spatial pattern, areshown to be significantly and positively correlated with ethnic patterns of recruitment into theUgandan National Liberation Army (UNLA) after the overthrow of Idi Amin some 10 years earlierin 1979. This correlation reflects the estimated mean incubation period of 8-10 years for HIV 1 andunderlines the need for cognizance of historical factors which may have influenced current patternsof AIDS seen in Central Africa. The findings may have important implications for AIDS forecastingand control in African countries which have recently experienced war. The results are comparedwith parallel analyses of other HIV hypotheses advanced to account for the reported geographicaldistribution of AIDS in Uganda. Using ordinary least squares regression techniques this paper demonstrates, for the firsttime, that the classic association of war and disease substantially accounts for the presently observedgeographical distribution of reported clinical AIDS cases in Uganda. Both the spread of HIV 1infection in the 1980s, and the subsequent development of AIDS to its 1990 spatial pattern, areshown to be significantly and positively correlated with ethnic patterns of recruitment into theUgandan National Liberation Army (UNLA) after the overthrow of Idi Amin some 10 years earlierin 1979. This correlation reflects the estimated mean incubation period of 8-10 years for HIV 1 andunderlines the need for cognizance of historical factors which may have influenced current patternsof AIDS seen in Central Africa. The findings may have important implications for AIDS forecastingand control in African countries which have recently experienced war. The results are comparedwith parallel analyses of other HIV hypotheses advanced to account for the reported geographicaldistribution of AIDS in Uganda. Temoshok, L. R. and Kingma, S. J. “HIV exposure risk in military populations: an uncharted prevention frontier”.International Conference on AIDS 1996 Jul 7; 11(1):48 (abstract no. Mo.D.354). Abstract: Objective: To apply the results of the first large-scale survey of HIV exposure risk-relevant factors in a military population (the US Army) to the development of targetted HIVbehavioural prevention strategies for world-wide military populations. Methods: An anonymousself-administered survey of HIV exposure risk-relevant factors was completed by 18,031 soldiers ina stratified, probability sample of all US Army installations world-wide. Results: Data from thisrepresentative survey of the ethnically and geographically diverse men and women in the US Armyindicate that soldiers, in general, have greatly increased vulnerability to HIV infection, compared togeneral civilian populations in the US, the UK, and France, in which recent national surveys havebeen conducted. Risk factors include high rates of sexual partner change, elevated rates of STD,relatively low rates of condom use with prostitutes and other "casual" partners, and significantmixing between groups having high and low-risk behaviour patterns, as well as higher and lowerHIV prevalence. Findings were used by GPA/WHO and UNAIDS to develop an HIV/AIDSinformation booklet for police and armed forces personnel worldwide, as well as for the training ofmedical officers who carry out UN peacekeeping missions. Conclusions: Even militaries which arenot considered "high-risk" populations, may represent potential venues for epidemic spread if theyhave high prevalence of HIV exposure risk factors, and if certain conditions are met. Examples of"situational changes" which have triggered HIV epidemics in some parts of the world include civilconflict and large-scale military conscription and/or deployment to an area with high HIVprevalence. Targetted HIV behavioural surveillance and prevention programmes, which are typicallynot priorities in military populations, are urgently needed on this largely uncharted preventionfrontier. Objective: To apply the results of the first large-scale survey of HIV exposure risk-relevant factors in a military population (the US Army) to the development of targetted HIVbehavioural prevention strategies for world-wide military populations. Methods: An anonymousself-administered survey of HIV exposure risk-relevant factors was completed by 18,031 soldiers ina stratified, probability sample of all US Army installations world-wide. Results: Data from thisrepresentative survey of the ethnically and geographically diverse men and women in the US Armyindicate that soldiers, in general, have greatly increased vulnerability to HIV infection, compared togeneral civilian populations in the US, the UK, and France, in which recent national surveys havebeen conducted. Risk factors include high rates of sexual partner change, elevated rates of STD,relatively low rates of condom use with prostitutes and other "casual" partners, and significantmixing between groups having high and low-risk behaviour patterns, as well as higher and lowerHIV prevalence. Findings were used by GPA/WHO and UNAIDS to develop an HIV/AIDSinformation booklet for police and armed forces personnel worldwide, as well as for the training ofmedical officers who carry out UN peacekeeping missions. Conclusions: Even militaries which arenot considered "high-risk" populations, may represent potential venues for epidemic spread if theyhave high prevalence of HIV exposure risk factors, and if certain conditions are met. Examples of"situational changes" which have triggered HIV epidemics in some parts of the world include civilconflict and large-scale military conscription and/or deployment to an area with high HIVprevalence. Targetted HIV behavioural surveillance and prevention programmes, which are typicallynot priorities in military populations, are urgently needed on this largely uncharted preventionfrontier. Thomson, Alistair. “Refugee rapes fuel AIDS in Africa's war zones” Reuters. 2001 Jun 20. No abstract available. “Uganda tackles AIDS from the very top down”. Aids Alert. 1999 Aug; 14(8 Suppl):3-4. No abstract available. Wakhweya, A. M. “Health care in Africa -which way?”. Medicine and War. 9(3):234-241. Abstract: This article gives a personal view of the health situation in a typical country in the South.Uganda is a country which is well endowed with natural resources, as are many countries in theSouth, but is plagued by poverty, conflict, endemic infectious diseases and, more recently, diseasedue to HIV. The article argues for an integrated solution to appropriate health care, proposing thatgood health results from sustainable development. It focuses on constraints to development such asconflict, militarization, environmental degradation, lack of community action, and inappropriatepolicies by both developing world governments and members of the international arena. All of theseplay a role in the achievement of sustainable equity world-wide. [Journal Article; In English;England] This article gives a personal view of the health situation in a typical country in the South.Uganda is a country which is well endowed with natural resources, as are many countries in theSouth, but is plagued by poverty, conflict, endemic infectious diseases and, more recently, diseasedue to HIV. The article argues for an integrated solution to appropriate health care, proposing thatgood health results from sustainable development. It focuses on constraints to development such asconflict, militarization, environmental degradation, lack of community action, and inappropriatepolicies by both developing world governments and members of the international arena. All of theseplay a role in the achievement of sustainable equity world-wide. [Journal Article; In English;England] Yeager, Rodger, Hendrix, Craig W. & Kingma, Stuart, “International Military Human ImmunodeficiencyVirus/Acquried Immunodeficiency Syndrome Policies and Programs: Strengths and Limitations inCurrent Practice”, Military Medecine, 2000, vol. 165, no.2. No abstract available. Zwi, A. B. “'High Risk Situations' and AIDS prevention”. International Conference on AIDS 1991 Jun 16; 7(1):419. Abstract: Relatively little attention has been focused on the political, social and economic factorsrelated to the transmission of HIV disease. 'High risk situations' are circumstances in which societiesare disrupted and in which marginalised groups have little control over their immediate social Relatively little attention has been focused on the political, social and economic factorsrelated to the transmission of HIV disease. 'High risk situations' are circumstances in which societiesare disrupted and in which marginalised groups have little control over their immediate social environment. This paper describes the nature of 'high risk situations' and why their identificationmay assist the control of HIV disease. The variety of 'high risk situations' include areas of rapid peri-urban settlement, population relocation, military conflict, migrant labour and poverty: all of thesepresent opportunities for increased transmission of HIV infection. The factors which play some partin transmission include an increase in risk-taking behaviours, decreased access to health and socialservices, and limitations in access to prevention-oriented messages and services. Specificallydefining such contexts as 'high risk situations' will help emphasise the source of the problem: illswithin society that play some part in the transmission of HIV infection and other sexuallytransmitted diseases. Shifting the focus from individuals to the society will assist in avoiding victim-blaming, defining necessary areas of research, helping determine priorities for prevention andintervention initiatives and acknowledging the social determinants of HIV disease.