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Gerald R Ford School of Public Policy ** Integrated Policy Exercise ** January 2003

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AIDS in Africa Imperiling Armies That Are Seen as Keys to Stability

November 24, 2002

By HENRI E. CAUVIN

LUANDA, Angola - First Sgt. Domingos Leiria may be the

future of the Angolan Armed Forces.

Like thousands of other soldiers in Angola, and thousands

more across Africa, Sergeant Leiria has H.I.V., the virus

that causes AIDS.

Struggling to stay fit for duty, he is fighting a battle he

does not expect to win. But the war is one that the armed

forces of Africa, already the epicenter of the epidemic,

cannot afford to lose.

For better or worse, no institution is more central to the

stability of many African nations than the military, and

few institutions in Africa are more threatened by AIDS.

At Angola's central military hospital here in the capital,

AIDS has surpassed malaria as the leading cause of death,

and after the long civil war, the situation will almost

certainly worsen.

"With the end of the war, we expect there will be an

explosion in numbers," Dr. Francisco Ernesto, the commander

of the military health service, said in an interview.

But leaders here are not the only ones who have reason to

be alarmed. Africa is figuring in American foreign policy

more than at any other time since the end of the cold war,

both in terms of economic security and military strategy.

The United States is importing more and more oil from West

Africa, particularly Angola and Nigeria, to reduce its

reliance on the volatile Middle East. On the other side of

the continent, the United States is establishing an

antiterrorist command center in the tiny nation of Djibouti

and stepping up contacts with Ethiopia and Kenya, all in an

effort to build alliances in a region where Al Qaeda has

been active, especially in Somalia, Sudan and Yemen.

AIDS in the military will undermine such efforts, and that

helps explain why the Pentagon is spending several million

dollars this year to help Angola and 20 other African

countries begin dealing with the crisis. A new Central

Intelligence Agency report on AIDS cites Nigeria and

Ethiopia, sub-Saharan Africa's two most populous countries,

as crucial American security concerns, and the rising toll

on their armed forces is part of the reason.

"A key ingredient of regional cooperation is national

militaries that are capable and competent and not dying off

because of AIDS," Theresa Whelan, director of the Defense

Department's office of Africa policy, said in a telephone

interview from Washington.

Angola's civil war made travel around the country difficult

and dangerous, and that kept H.I.V. from spreading as much

as it has in the rest of southern Africa.

But the war ended this year, after nearly three decades of

fighting, and millions of Angolans are on the move, making

their way back to villages and towns they abandoned long

ago. H.I.V., now estimated to infect 5.5 percent of adults

in Angola, will not be far behind, experts say.

"People couldn't move," said Dr. Eric Bing, an assistant

professor at Charles R. Drew University of Medicine and

Science in Los Angeles and the civilian coordinator of the

Defense Department project here. "That's about to change."

Soldiers are already among the sick. Some, infected on

missions in foreign capitals like Kinshasa and Brazzaville,

will carry the virus to their home villages, passing it on

to wives and girlfriends. Others risk being infected as the

cycle of transmission gathers pace, and prostitutes and

truckers also spread the virus as they ply their trades in

areas that had long been inaccessible.

Angola has only to look around the continent, to countries

like Ethiopia, Nigeria and South Africa; they are all at

peace after long periods of upheaval, and like Angola, all

aspire to influence and power on the continent. Yet the

stability they are trying to entrench and the ambitions

they are trying to realize are threatened by AIDS.

In Nigeria, at least 6 percent of adults are

H.I.V.-positive, with the spread fueled by many factors,

among them the Nigerian military's emerging role as

regional peacemaker.

In Ethiopia, at least 10 percent of the adult population

has H.I.V., and the number has been climbing, driven in

part by the demobilization of tens of thousands of soldiers

after the country's long civil war and more recently after

the war against Eritrea.

In South Africa, which has more H.I.V.-positive people than

any other country, roughly one in four soldiers are

infected, the Ministry of Defense says.

Sergeant Leiria, a 31-year-old commando, has been an

Angolan soldier since 1990. Along with missions around the

country, he has been sent to Congo and the Congo Republic,

countries where Angola has been instrumental in shoring up

embattled governments.

These days, he is fighting for his own survival.

He seems fit enough, but he is not. He suffers from thrush, a fungal

infection that makes swallowing difficult. He has fought

off tuberculosis. He endures debilitating headaches and

diarrhea. He is dogged by fever that gives way to chills.

"Usually, from 4 o'clock, I feel too cold," he says. "Even

at the moment, I am too cold." Asked how he contracted

H.I.V., he says he does not know. It might have been from

shaving with a fellow soldier's razor or perhaps from a

battlefield blood transfusion, he says.

What about sex? he is asked.

Sent away from home for long stretches, soldiers strike up relationships with local

women or prostitutes, though like Sergeant Leiria they

often have wives at home. Such liaisons have long spread

sexually transmitted diseases like syphilis, and now H.I.V.

"I think it's possible," Sergeant Leiria said. "I cannot

lie to you. I walked a lot of places."

Indeed, many soldiers do. The sex is cheap, and in war,

life itself seems cheap. Fatalism creeps into their

thinking. "People used to say we should enjoy life,"

Sergeant Leiria said. "If we get it, we get it."

Slowly, though, he and others in the military say, reckless

behavior is waning, but too late for Sergeant Leiria.

Sitting in a quiet corner of a downtown hotel, he was

dressed in gray jeans, a dark T-shirt and calf-high combat

boots that were the only obvious hint of his work. Soon, he

said, he will be shedding the uniform altogether. "I want

to be demobilized, because of the AIDS, because I need to

rest," he said. "I fought a lot and I didn't manage to do

almost anything with my life. Now I want to do something in

my life. I have children. I have a wife."

It is a painful decision for a man who has known little

besides a soldier's life. When he tested positive in 2000,

horrified relatives turned their back on him, and he

contemplated killing himself.

Since then, he and some of his relatives have come to

accept his fate, helped by an AIDS support organization.

None of that has helped to arrest the march of the disease.

Without consistent access to the anti-retroviral drugs that

have made the disease manageable for many people in the

West, Sergeant Leiria has little hope. "If I was like other

people who have a lot of money - they go abroad to buy

medicines, they go to South Africa for treatment - then I

could continue," he said.

While Angola is a long way from wielding the broad

influence of South Africa or Nigeria, it has fashioned

itself into a regional power, and its military, as the

fulcrum of power in the country, will remain for now an

important engine of the country's aspirations - and a

crucial component in the fight against AIDS.

Like other countries, Angola does not know exactly how many

soldiers are H.I.V.-positive, and so it is planning a

survey with the help of Dr. Bing and other specialists.

The United States military does not enlist anyone who has

tested positive for H.I.V., but does not discharge people

solely on the basis of infection with the virus unless the

symptoms of AIDS render them physically unfit to serve.

Experts say the survey is likely to show that the

prevalence is higher than the current estimate of 5.5

percent of adults, and likely to increase. The question is

whether Angola will contain the surge. Like many African

countries, Angola is too poor to think about providing

treatment for most of its H.I.V.-positive people, so for

now the efforts focus on prevention.

On the main military base here in the capital, 18 young

soldiers were training to teach their colleagues to defend

themselves against H.I.V. This is the military's new war,

symbolized by the soldier depicted in the class manual, his

old weapon - a gun - in one hand, his new weapon - a condom

- in the other.

Maj. Fernando Paxião Damião, the doctor in charge of the

training, wants to think that his efforts will do some

good, but on the future of the armed forces sees little to

be cheerful about. "We're going to have an army of sick

people," he said.