ETHICS IN PEACEKEEPING

Supplement: HIV/AIDS

I N A S S O C I AT I O N W I T H

Accordia Foundation

Peace Operations Training Institute

I.

HIV AND AIDS AWARENESS

Lesson Objectives
By the end of this section the student will be able to:

Demonstrate detailed understanding of the basic facts of HIV and

AIDS;

Explain HIV prevention strategies in detail;

Explain the concept of positive prevention;
Explain issues peacekeepers need to consider when planning to set
up and maintain an HIV and AIDS prevention programme in their
communities; and

Discuss ethics and HIV in peacekeeping.

Introduction

In this lesson, we will discuss prevention of HIV

and AIDS specifically regarding peacekeepers. In
order to protect themselves, peacekeepers must
understand and consider the peculiar risk factors
that make them more vulnerable to acquiring HIV.
As duty calls, peacekeepers must often be away
from their loved ones for long stretches of time, and
this can predispose them to practices that increase
their susceptibility to HIV infection. Indeed, studies
have shown military officers to be at a higher risk
of acquiring HIV and other sexually transmitted
diseases. This is due to a combination of their age
range and mobility, their uniforms which represent
force and influence, their easy access to water
and food compared to the local population, and
their generally pervasive risk-taking attitudes.
Furthermore, there often exists a power imbalance
that favours peacekeepers over a local population
that tends to be overwhelmingly submissive.
Female combatants, women associated with
armed forces, and abductees are frequently at
high risk as sexual violence and abuse are often
widespread in these settings.
National and multi-national military personnel
are among the most susceptible populations to
sexually transmitted infections (STIs), particularly
HIV. HIV is five to 20 times more likely to occur
in the presence of other STIs. In some countries,
STIs amongst military personnel may be two to
five times higher than STIs amongst the civilian
population. In foreign deployment situations,
military STIs may quickly equal or exceed those
of disrupted local populations whose infection
rates may already be high. In the growing number
of post-Cold War conflicts to which UN and other
peacekeeping contingents are deployed, HIV
poses a deadly threat, not only to those directly
involved, but also to future peace and security.
Seen in this light, the development of effective
HIV prevention and control programmes for
multi-national peacekeepers and civilian police is
of vital and immediate importance.
It is important that peacekeepers familiarize
themselves with the facts about HIV infection and
how it can be prevented. This lesson presents
basic facts about HIV and HIV prevention and

addresses how HIV prevention can be integrated

into the activities and mandates of peacekeepers
on all levels.

II.

Basic Facts About HIV and

AIDS

What is HIV and AIDS?

HIV (human immunodeficiency virus) is a
microscopic virus that can infect a persons body
and cause a syndrome known as AIDS, which is
an acronym for:

Acquired means that HIV is passed from an

infected person to another person;

Immune refers to the bodys immune system.

The immune system is made up of cells
that protect the body from disease. HIV is a
problem because, once it gets into a persons
body, it attacks and kills cells of the immune
system;

Deficiency means not having enough of

something. In this case, the body does not

have enough of a certain type of cell, called
immune cells, that it needs to protect against
infections. HIV enters the body and acts like a
patient sniper, hidden for as long as it takes to
do its job to weaken the immune system. Over
time, HIV kills more and more immune cells,
the bodys immune system becomes too weak
to do its job, and the person living with HIV
becomes sick; and

Syndrome refers to a group of signs and

symptoms that occur together and are

associated with a particular disease. AIDS is
a syndrome because people with AIDS have
a combination of symptoms and diseases
specific to AIDS.

It is important to understand the difference between

HIV infection and AIDS. A person may have the
HIV virus within their body (infection) but show no
signs of AIDS. Once the person begins to show
signs and symptoms of HIV (commonly seen as
opportunistic infections like cryptococcal meningitis,
severe wasting disease, and widespread/
disseminated tuberculosis), they are said to have
AIDS. All patients with AIDS have the HIV infection.

ETHICS IN PEACEKEEPING: HIV/AIDS SUPPLEMENT

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 Oral sex HIV can enter the body through

How is HIV spread?

Body fluids that can spread HIV include semen,
vaginal fluid, blood, and breast milk. Almost all
transmission of HIV is through sexual intercourse
between two people who do not correctly use
condoms, either in heterosexual or homosexual
relations. Mothers who are infected with HIV can
pass the virus to their babies while pregnant,
during labour and delivery, or after birth through
breast milk. There are some cases when blood
taken from a person infected with HIV is transfused
to another person, although this is highly unlikely in
the current era due to proper testing and screening
of all donors.
Other ways of HIV transmission include sharing sex
toys between people without cleaning or sanitizing
them; using blood-contaminated needles, syringes,
water, cotton filters, straws, or pipes that contain
HIV to inject drugs or other substances; and using
needles or ink contaminated with HIV-infected
blood for tattooing, skin piercing, scarification
rituals, or acupuncture. Often blood contamination
is not visible to the naked eye.

any cuts or tears inside the mouth due to injury

or gum disease. The person taking semen
into his/her mouth is more vulnerable than the
person who is ejaculating. Oral sex has a much
lower risk for infection than vaginal or anal sex,
especially if semen is not taken into the mouth.

Infected needles Those who share needles

can transfer infected blood to each other.
This is particularly the case with those who
inject drugs such as heroin.

Mother-to-child During pregnancy, HIV

can be passed from mother to baby through

the placenta. At birth, HIV can be transmitted
through blood from the birthing process. In
addition, HIV is present in breast milk and can
be transmitted to a baby during breastfeeding.
Without preventative measures, there is a
one in three chance an infected mother can
transmit HIV to her baby.

What factors are associated with HIV

infection?
High viral load
A high viral load increases the risk of HIV
transmission. The viral load is the number of HIV
virus copies that the infected person has per
millilitre of blood. A high viral load is likely to occur
during the window period and when HIV infection
has progressed to the AIDS stage. When infected
by the HIV virus, it takes time before the virus
concentration is high enough to convert your test
from negative to positive. The time before this
happens is called the window period. The window
period may last up to six weeks. During this time,
a person may be infected and have the ability to
transmit the disease, even though the test may be
negative. Medications called antiretrovirals (ARVs)
decrease viral load thus decreasing the risk of HIV
transmission, as we shall see later on.

It only takes one unsafe sexual act or drug injection

for someone anyone to become infected
with HIV. Eighty per cent of all HIV infections are
caused by having unprotected intercourse with
an HIV-infected partner. Its important to note that
some sexual practices, like penetrative anal sex,
have a greater HIV transmission risk than either
vaginal or oral sex.

Vaginal sex HIV can enter the body through

Sex without a condom

any cuts or tears inside the vagina or the penis.

When the penis is erect it stretches and when
a woman is aroused the vagina stretches.
This stretching makes both these organs more
susceptible to injuries that increase the risk of
infection.

Anal sex HIV can enter the body through

4 |

Drinking alcohol or using illegal drugs will reduce

a persons judgment, ability, and desire to act within
the bounds of safe behaviour. In addition, when
people are under the influence of alcohol and/
or drugs, they are more likely to indulge in risky
sexual contacts. Consumption of alcohol also tends
to increase the libido and make people feel like
having sex. Sex workers can often be found at
places where alcohol is served. Peacekeepers
who serve in uniformed services may look
forward to their monthly salaries, getting leave,
getting drunk, and having unprotected sex with
women. Though their intention may be to have
protected sex by using condoms, they are often
less concerned with HIV infection when they
are drunk.

Increased length and frequency of exposure

Increased length and frequency of exposure can
also increase the risk of HIV transmission. People
who have multiple sexual partners have a higher risk
of acquiring HIV. Having unprotected sex with a sex
worker will further increase the risk of transmission.
Sex workers have multiple partners increasing their
chances of being infected. Additionally, frequent
unprotected sexual acts with the same partner
who is HIV-positive also increases the risk of
transmission.

cuts or tears in the rectum or anus. Because

the rectum does not stretch readily (unlike
the vagina), it tears and bleeds more easily. A
person can contract HIV through semen when
a man ejaculates in his/her rectum. A penis can
irritate and cut the anal lining, increasing the
opportunity for the virus to enter the body.

Drinking alcohol or using illegal drugs

In some cities in Africa, up to 25% of pregnant women tested

in antenatal clinics are found to be infected with HIV. A
young woman breast-feeding her baby in the Kagera Region
of the United Republic of Tanzania. (UN Photo #19997 by
Louise Gubb, January 2001)

P E A C E O P E R AT I O N S T R A I N I N G I N S T I T U T E

Damage to the mucous membranes or different

coverings of the body increases the risk of
transmission. This is more likely to occur in the
presence of other sexually transmitted diseases,
rough sex, and anal sex where a penis can irritate
and cut the anal lining, increasing the opportunity
for the virus to enter the body. The presence of an
untreated STI like syphilis or gonorrhoea facilitates the
transmission of HIV. Open sores and blisters provide
an easy entrance into the body for STIs, including
HIV. Using a condom greatly lessens the chances
of HIV transmission by these means. Also, using
petroleum jelly or oil-based products can weaken
a condom and cause it to break.

Be aware that the consumption of alcohol can impair your judgement,

which could result in risky sexual contact. (UNAIDS, Peer Education Kit for
Uniformed Services, September 2003)

Low-risk behaviour

Sex with condoms;

Oral sex (even without a condom), unless the
person has cuts in his/her mouth;

Touching the blood of an infected person; and

Sharing razors.

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Behaviours that CANNOT Transmit HIV (No risk!)

It is important to appreciate that HIV cannot be

transmitted through the following ways:

Casual, non-sexual, social contact like shaking

hands, touching, or hugging;

Toilet seats;
Eating food prepared by someone living with
HIV and AIDS;

Sharing eating and cooking utensils like cups,

plates, pots, or forks and spoons;

Kissing. Though HIV has been found in saliva,

the amount of HIV in saliva is extremely small
that there is minimal risk of contracting HIV by
kissing;

Mosquitoes. Mosquitoes transmit other

diseases like malaria, but not HIV;

Abstinence;
Sex between mutually faithful and uninfected
partners;

Donating blood;
Sharing a bathroom or latrine; and
Caring for a person who has HIV Those who
are caring for women with HIV should be extra
careful handling menstrual blood.

The stages of HIV infection

Window Period

Asymptomatic Period
After a person is infected with HIV, there is usually
no change in that persons health for quite a few
years. The person feels well, is able to work as
before, and shows no signs or symptoms of being
sick. In other words, they are asymptomatic. This
asymptomatic period varies from a few years to up
to as many as 12 years.
Symptomatic Period
The symptomatic period begins when the
infected person begins experiencing illnesses
related to their suppressed immune system. Most
of the conditions that start to appear are called
opportunistic infections. Opportunistic infections
are caused by bacteria or viruses that normally do
not cause illness in a person with a strong immune
system, but they do cause illness in a person
with a weakened immune system. Opportunistic
infections include infections such as diarrhoea,
tuberculosis, and pneumonia, and they
repeatedly make the person sick. Remember,
AIDS is a syndrome, or a collection of conditions
that, taken together, allows us to make a diagnosis
of AIDS. When a person is diagnosed with
AIDS, the length of time until death can vary
among individuals depending on the number and
type of opportunistic infections and the availability
of treatment and drugs. Individuals can live for one
to two years or much longer (if receiving treatment
with drugs).
Is there a Cure for AIDS?

Once a person becomes infected with HIV, he

or she will not immediately test positive for the
infection. There is a period of usually three to six
weeks (sometimes as long as three to six months)
before the body reacts to the presence of the virus
and produces antibodies that can be detected
during blood testing in the laboratory. The detection
of these antibodies results in a positive test. The
period of time between the actual infection
and when the test can detect the infection is
referred to as the window period. It is important to
understand that in this time an infected person has
the ability to transmit the disease even though they
test negative.

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There is no cure for AIDS at present. A

combination of drugs called antiretroviral drugs
(ARVs) can result in controlling the virus so it
does not weaken the immune system, which
would make it vulnerable to AIDS-related illnesses.
In some places, however, the high cost of ARVs
makes them unaffordable for people. Progress
has been made in reducing the cost of the
drugs, which has increased their availability. Many
countries are now able to offer free antiretroviral
drugs for people who have tested positive for HIV.
Traditional healers, or folk healers, around the
world are selling herbs reported to cure HIV and

P E A C E O P E R AT I O N S T R A I N I N G I N S T I T U T E

AIDS. Many of these have been examined by

scientists but none so far has proved to eliminate
HIV. There would be great joy in the world if
traditional healers did come up with something
that cured AIDS. Traditional healers can
ease some of the symptoms of AIDS-related
illnesses and opportunistic infections.
Unfortunately, many with HIV and AIDS turn to
traditional healers with false hope and waste their
money.

III.

HIV and AIDS Prevention

Strategies

Over the past 20 years, several strategies have

been developed to prevent HIV transmission. No
single solution has proven effective on its own.
Combining multiple strategies has proven to have
the most impact. The following are descriptions
of the major strategies that, when used in
combination, are effective for preventing sexual,
blood-borne, and mother-to-child HIV transmission.
Strategies for Prevention of Sexual
Transmission
The majority of new HIV infections around the
world are sexually transmitted. The prevention
strategies for sexual transmission are:
Behaviour Change Programmes
Behaviour change programmes aim to have people
change their sexual behaviours, thus reducing
the risk of both acquiring and transmitting HIV.
Safer sex1 is a means of preventing the sexual
transmission of HIV. The easiest form of safer sex
for those who are sexually active is the use of latex
condoms every time they engage in vaginal, oral,
or anal sex. Safer sex also includes abstinence,
fidelity between uninfected partners, and practicing
non-penetrative sex, such as hugging, kissing,
masturbation, mutual masturbation, and simulating
sex between a partners thighs or breasts.
1
Safer sex is the preferred term over safe
sex because these prevention methods only reduce the
chances of transmission, but does not eliminate them.
In other words, following these prevention methods will
make a person safer than he or she otherwise would be,
but not completely safe from HIV.

Additionally, people are encouraged to:

Limit number of sexual partners;

Practice less risky sexual activities;
Recognize STI symptoms and need for prompt
treatment; and

Avoid risky social behaviour like consuming

too much alcohol.

Peacekeepers are often away from their families

for a long periods of time. This often predisposes
them to temptations of adopting other methods
of sexual gratification like getting involved with
commercial sex workers. This vulnerability can
also be increased by use of alcohol and other
drugs. Use of these substances impairs judgement
and may lead to unprotected and unintended
sexual encounters which will increase the risk
of HIV transmission. It is therefore important for
peacekeepers to drink alcohol responsibly or
abstain from its use if at all possible.
Promoting Condom Use
Condoms are highly effective in preventing
sexual transmission of HIV and other STIs. The
U.S. National Institutes of Health (NIH) issued
a report in 2001 showing that consistent and
correct condom use can reduce the risk of HIV
transmission by 85 per cent. In order for condoms
to work they should be used all the time during sex.
The challenge with condom use is that most often
people use them in the early phases of their sexual
relationship but abandon them as the relationship
matures. This is often done without knowing the
partners status. It is advisable to use condoms
in all sexual contacts until the HIV status of your
partner is confirmed.
The effective and consistent use of condoms
remains the most powerful weapon in the
global struggle against HIV and AIDS, even
though condom use varies widely within and
among societies. As highly structured, formal
organizations with well-developed command and
control mechanisms, the military is virtually unique
in their capacity for achieving and maintaining
standardized patterns of behaviour. Most of the
worlds military recognize these advantages in

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promoting and providing condoms amongst their

troops, but fewer are fully prepared to maximize
condom use and, thus, HIV prevention in
their ranks. Absent in some national militaries are
specific plans through which condoms are routinely
promoted and provided. This lack of commitment
is often paralleled by passive, group-informational
approaches to condom promotion, as well as
inadequate instruction on effective condom use
and on-request distribution methods that are
equally indifferent to soldiers possible disregard of
and/or aversion to condoms.

for people who are in relationships that involve

unprotected sexual contact. This includes married
couples. HIV testing should be offered routinely
and all officers should be encouraged to have their
tests done on a regular basis.
Diagnosis and Treatment of Other STIs
Concurrent infection with other sexually transmitted
infections (STIs) increases the risk of HIV
acquisition and transmission. Common STIs
include gonorrhoea, syphilis, genital ulcers, and
herpes simplex. The risk of HIV transmission is
reduced by timely diagnosis and treatment of STIs.
Programmes for the prevention and treatment of
STIs, especially among populations at higher risk
for sexual transmission of HIV, remain important
elements of HIV prevention.
The main symptoms and signs of common STIs
are:

Discharge from the penis;

Ulcers/wounds in the genital area;
Abnormal vaginal discharge; and
Scrotal swellings.
To protect yourself from STIs and HIV, always insist on using a condom.
(UNAIDS, Peer Education Kit for Uniformed Services, September 2003)

Social and cultural factors can heavily influence

predispositions towards or against condoms;
therefore, the knowledge, attitudes, beliefs, and
practices (KABP) of individual military units should
be taken into consideration for successful HIV
prevention amongst UN peacekeeping forces,
which draw from many societies and cultures
around the world.
HIV Counselling and Testing
HIV counselling and testing play an important
role in prevention efforts. People who know
their status are more likely to practice safer sex,
protecting themselves and others from infection. It
is important that peacekeepers know their status
and take every opportunity to be tested for HIV.
HIV testing should be done on a regular basis

8 |

Common STIs include gonorrhoea, syphilis, genital

ulcers, and herpes simplex.

refrain from any sexual activity until the penis is

completely healed usually at least six weeks.
The World Health Organization (WHO)
recommends that all men who are seeking
circumcision should be offered voluntary HIV
testing and counselling. Additionally, circumcision
should only be undertaken by trained health
providers in a safe medical setting.
Blood-borne HIV Transmission
Blood Supply Safety
Routine screening of blood supply has nearly
eliminated the risk of HIV transmission through
donated blood, especially in developed countries.
No patient should be transfused with blood that
has not been screened properly for HIV.
UNAIDS recommends three essential elements of
an effective blood safety program:

National blood transfusion service runs on a

not-for-profit basis;

Policy of excluding paid donors and relying on

voluntary, low-risk donors; and

Screening all donated blood for HIV.

Infection control in emergency operation settings

Male circumcision

Infection control at the health facility

Several studies have shown that male circumcision

reduces the risk of sexual HIV transmission by
about 60 per cent. There is no definitive evidence
that male circumcision reduces the risk of HIV
transmission from men to women, or from men
to men. However, it does reduce the risk of the
circumcised male from acquiring HIV. Male
circumcision undertaken by appropriately trained
health providers is considered to be part of a
comprehensive HIV prevention package.

The requirements of some countries for health

workers to use universal precautions has nearly
eliminated HIV transmission in health care settings.
The concept of universal precautions assumes
that every patient has the potential to be infectious,
thus protective gear and procedures are used
with everyone. Additionally, workers use approved
protective protocols for equipment, syringes, and
sterilization processes. In addition, PEP (post
exposure prophylaxis) must be readily available for
care providers who become accidentally exposed
to HIV infection.

Male circumcision does not completely protect

a man against HIV, so circumcised men should
continue to engage in safer sexual practices.
These include reducing the number of sexual
partners as well as correct and consistent condom
use. Men who undergo circumcision should

P E A C E O P E R AT I O N S T R A I N I N G I N S T I T U T E

An HIV/AIDS test is conducted in one of Jordans Ministry of Health labs,

Amman. (UN Photo #20019 by G Pirozzi, January 2001)

Exposure to the blood of those receiving

care occurs most often via accidental injuries
from sharp objects such as syringe needles,
scalpels, lancets, broken glass, or other objects
contaminated with blood. Poor patient care
practices by HIV-infected medical staff may also
expose the patient to infection. Also, when injecting
using poorly sterilized equipment, HIV may be
passed from an HIV-infected individual to an
uninfected patient. Protecting service providers
and ensuring that they know their status and
receive HIV treatment as appropriate are important
priorities for the health sector. A good occupational
health programme aims to identify, eliminate, and
control exposure to hazards in the workplace.
WHO recommends that an occupational health
programme do the following:

Designate a person to be responsible for the

occupational health programme;

Allocate a sufficient budget to the programme

and procure the necessary supplies for the
personal protection of health workers;

Provide training to service providers and

involve them in identifying and controlling

hazards;

Promote health workers knowledge of their

own HIV, hepatitis, and TB status through:

--

Employment/pre-placement screening;

--

Providing immunization against hepatitis B;

and

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 Implement standard infection control

precautions;

Promote reporting of incidents and quality

Cases where PEP should not be given

If individual is already HIV positive (a test

should be administered at the beginning of

PEP);

control of services provided; and

Provide free access to post exposure

If a person has been chronically exposed to

Infection control in the field

If the exposure does not pose a risk of

the source;

antiretroviral prophylaxis for HIV.

The same universal principles of infection control

should be applied in the field as much as the
circumstances allow. However, in the field there
may be limited access to the equipment and
expertise available in health care settings. In such
circumstances, peacekeepers should ensure that
they always use protective gear like gloves when
resuscitating victims of injuries. Changing gloves
between victims is also necessary, as infections
can be transferred from one patient to another.
Also, peacekeepers should always (whenever
possible) carry safety boxes for disposal of used
needles as well as other sharp objects.
Principles of Post-Exposure Prophylaxis (PEP)

Immediately care for the exposed skin. Wash

cuts and skin with soap and water. Flush
mucus membranes with water.

Seek medical attention. Note that its important

for the source of contamination to be tested
for HIV and the affected person to know their
HIV status. There is a risk of transmission if
the source is positive and affected person is
negative.

Health worker will give PEP to persons

whose exposure puts them at risk of infection

transmission. For individuals who qualify for
PEP, they should start it as soon as possible
and preferably within 24 hours. PEP drugs
should never be given later than 72 hours!
The prophylaxis should be taken for at least
28 days with routine regular visits to health
workers to assess the effects of the drugs.

PEP can be used among peacekeepers in

situations of accidents where there is mixing

of blood amongst casualties, in cases of rape,
or accidental splashing of infected fluids into
ones eyes.

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transmission, e.g. any exposure to noninfectious body fluids (such as faeces, saliva,
urine, and sweat), or if infectious fluids came
into contact with intact skin;

If exposed to body fluids from a person

known to be HIV-negative, unless this person

is identified as being at high risk for recent
infection and thus likely to be within the window
period; and

If the exposure occurred more than 72 hours

previously.

IV.

Programmes for Injection Drug

Users

Use of drugs by UN peacekeepers should be

strongly discouraged. It is equally important that
those identified to be victims of this habit be
rehabilitated and supported to overcome and
abandon the addiction. UN peacekeepers should
support implementation of programmes that
discourage drug abuse in their areas of operation.

V.

Strategies for Prevention of

Mother-To-Child Transmission

Mother-to-child transmission (MTCT) of HIV, also

referred to as vertical transmission, occurs when
HIV is passed from an HIV-positive mother to her
infant. The majority of children infected with HIV
acquire the virus through MTCT. MTCT attaches no
blame or stigma to the woman who gives birth to
a child infected with HIV and it should not obscure
the fact that HIV is often introduced into a family
through the womans sexual partner. MTCT can
occur during pregnancy, labour and delivery, as
well as through breastfeeding. The highest risk of
transmission occurs during labour and delivery.

P E A C E O P E R AT I O N S T R A I N I N G I N S T I T U T E

There is a four-pronged strategy for the prevention

of MTCT:
Strategy One: Primary prevention
The focus is on prevention of HIV infection
amongst women and men of child-bearing age,
as well as the general population using the ABC
strategy (Abstinence, Being faithful, and Condom
use). This is the most ideal and effective strategy
for reducing MTCT and encompasses all the HIV
prevention strategies.
Strategy Two: Prevention of unintended
pregnancy among HIV positive women
The focus is on counselling and supporting
HIV positive women and their partners to avoid
unintended pregnancy through:

Abstinence; and

Strategy Four: Provision of treatment, care,

and support to women infected with HIV, their
infants, and families
The PMTCT programme routinely identifies women
infected with HIV who need medical care and
social support to address concerns about their own
health and that of their families.

If a woman is assured that she will receive

adequate treatment and care for herself, her

partner, and her children, she is more likely to
accept HIV testing and counselling and, if HIVpositive, accept interventions to reduce MTCT.

It is important to develop and reinforce linkages

with programmes for treatment, care, and
support services to promote long-term care of
women living with HIV and their families.

Promote community and family support,

especially spousal support.

Dual protection methods (effective

contraceptives in addition to condoms).

Strategy Three: Reduction of MTCT among

HIV-positive pregnant women
Recommendations for PMTCT (preventing MTCT)
when the first two strategies fail include:

Adoption of safer sexual practices during

pregnancy and lactation;

Modified care during prenatal, delivery, and

postnatal periods;

Provision of antiretroviral drugs for reduction of

MTCT; and

Counselling on optimal infant-feeding

practices.

How the interventions work:

Identify women infected with HIV;

Reduce maternal HIV viral load;
Reduce infant exposure to the virus during
labour and delivery; and

Reduce infant exposure to the virus by using

safer feeding options.

Positive Prevention
These are strategies aimed at supporting people
living with HIV. Positive prevention strategies
seek to protects ones sexual health, including
prevention of new STIs. They also work to delay
the progression of HIV and AIDS and to prevent
the transmission of HIV to others. Strategies
for positive prevention are not stand-alone
programmes, but work in combination with each
another.

VI.

Ethics and Prevention of HIV in

Peacekeeping

Ethics is a very important component of HIV

prevention for peacekeepers. The ethical principles
guiding the peacekeepers include impartiality,
integrity, respect, and loyalty.
These principles can be applied to the context
of HIV prevention as well. Peacekeepers should
be impartial in offering the services to all the
community members. There should be equity in
offering the HIV counselling and testing services.
People with HIV should not be denied services
because of their HIV status. This will not only
encourage members to get tested but they

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will also be able to access treatment and offer

better services to the community in need. While
peacekeepers are assured of access to health
care, including treatment of STIs and HIV Voluntary
Counselling and Testing (VCT), there should be an
effort to ensure their sexual partners have access
to these same resources.
Peacekeepers should have integrity which is the
ability to know what is morally right and should
refrain from all acts that may degrade their status,
such as sexual harassment. In addition, they
should respect the community they are serving,
especially women and children. If this principle is
adhered to, cases of rape and defilement, sexual
exploitation and abuse, all of which increase the
risk of HIV, would be minimized. A peacekeepers
uniform represents power and force and can also
be a source of respect and fear. This therefore
creates an imbalance between the officers and
the community, especially in areas of conflict. It is
therefore the responsibility of the peacekeepers to
be aware of the potential for abuse of this power.
Officers should neither indulge in alcohol abuse
nor get involved in any acts of sex-for-money
activities.
On-the-job sexual harassment of women should be
addressed and there should be a clear mechanism
through which complaints of this nature can be
handled. Peacekeepers implicated should not be
protected. Loyalty does not mean pardoning bad
behaviour. It is the duty of peacekeepers to ensure
that their colleagues adhere to the stipulated code
of conduct and to discipline those who deviate from
it. Sexual harassment is not acceptable at any time
and having sex with minors (below 18 years of age)
is punishable by law, even if it is consensual.
Degrading the Uniform
There are specific actions that degrade the image
of uniformed personnel and professional conduct.
These actions reinforce the avoidance of
practices that place uniformed service personnel
at risk of infection with HIV and STIs.

children, which spreads HIV and AIDS.

Additionally, they may unknowingly encourage
organized crime involving prostitution and the
trafficking of women.
Peacekeepers can also degrade themselves by
abandoning children they have fathered and by
abandoning women who have been promised
marriage or other benefits in exchange for a sexual
relationship. This compounds the difficulties these
communities face. Such behaviour is illegal and
morally unacceptable. Acting responsibly can
greatly reduce the spread of HIV.
Professionalism and respect for diversity are core
values of ethics in peacekeeping. Due to the nature
of their work, peacekeepers are often away from
their homes and must learn to adapt to the different
cultures. For example, in some cultures, women
do not cover their breasts when breast-feeding.
In other cultures, it may be common for women to
wear scant attire in public. None of this should be
misinterpreted as an invitation or an enticement to
have sex. It is the responsibility of peacekeepers
to learn about cultural norms and to adapt to the
places that they are working in.
Discretion and Respect
It is expected of peacekeepers to not consume
excessive amounts of alcohol or indulge in sexual
relations. Involvement in these activities, however,
is an undeniable reality and peacekeepers, along
with the community they serve, are exposed to HIV.
Peacekeepers have a responsibility to uphold the
high standards expected of them when they joined
and swore allegiance to their service. Officers,
because of their power and influence over other
personnel, must become positive role models and
must not breach the code of conduct themselves,
lest their subordinates follow their example.
Off-duty misconduct is also not acceptable.
Peacekeepers are held in high esteem whether in
uniform or not.

Unfortunately, some peacekeepers have used their

powerful position to abuse vulnerable populations.
They do this by hiring prostitutes, often including

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P E A C E O P E R AT I O N S T R A I N I N G I N S T I T U T E

Works Consulted
1. Joseph U. Becker, Christian Theodosis, and
Rick Kulkarni, HIV and AIDS, Conflict and
Security in Africa: Rethinking Relationships,
Journal of the International AIDS Society, vol.
11, No. 3 (August 2008).
2. Arthur Brown and Sorachai Nitayaphan, The
Armed Forces Research Institute of Medical
Sciences: Five Decades of Collaborative
Medical Research, Southeast Asian Journal
of Tropical Medicine and Public Health, vol. 42,
No. 3 (May 2011), pp. 47790.
3. Shari L. Dworkin, Sarah Degnan Kambou,
Carla Sutherland, Khadija Moalla, and Archana
Kapoor, Gendered Empowerment and HIV
Prevention: Policy and Programmatic Pathways
to Success in the MENA Region, Journal of
Acquired Immune Deficiency Syndrome, vol.
51, Suppl. 3 (July 2009), pp. S1118.
4. Brent W. Hanson, Alex Wodak, Agns
Fiamma, and Thomas J. Coates, Refocusing
and Prioritizing HIV Programmemes in
Conflict and Post-conflict Settings: Funding
Recommendations, AIDS, vol. 22, Suppl. 2
(August 2008), pp. S95103.
5. Robert H. Lutz, Darrell Carlton, and Shawn
F. Taylor, HIV Postexposure Prophylaxis for
Special Forces Soldiers, Journal of Special
Operations Medicine, vol. 9, ed. 1 (Winter
2009), pp. 105.
6. Nancy B. Mock, Sambe Duale, Lisanne F.
Brown, Ellen Mathys, Heather C. OMaonaigh,
Nina K.L. Abul-Husn, and Sterling Elliott,
Conflict and HIV: A Framework for Risk
Assessment to Prevent HIV in Conflict-affected
Settings in Africa, Emerging Themes in
Epidemiology, vol. 1, No. 6 (October 2004).
7. Robert H. Remien, Jenifar Chowdhury,
Jacques E. Mokhbat, Cherif Soliman, Maha El
Adawy, and Wafaa El-Sadr, Gender and Care:
Access to HIV Testing, Care, and Treatment,
Journal of Acquired Immune Deficiency
Syndrome, vol. 51, Suppl. 3 (July 2009), pp.
S10610.

8. Simcha M. Russak, Daniel J. Ortiz, Frank

H. Galvan, and Eric G. Bing, Protecting Our
Militaries: A Systematic Literature Review
of Military Human Immunodeficiency Virus/
Acquired Immunodeficiency Syndrome
Prevention Programs Worldwide, Military
Medicine, vol. 170, No. 70 (October 2005), pp.
88697.
9. Praneed Songwathana, Women and AIDS
Caregiving: Womens Work?, Health Care
for Women International, vol. 22, No. 3 (April
2001), pp. 26379.
10. Paul B. Spiegel, HIV/AIDS among Conflictaffected and Displaced Populations: Dispelling
Myths and Taking Action, Disasters, vol. 28,
No. 3 (September 2004), pp. 32239.
11. Virginiea Supervie, Yasminb Halima, and
Sallya Blower, Assessing the Impact of Mass
Rape on the Incidence of HIV in Conflictaffected Countries, AIDS, vol. 24, No. 18
(November 2010), pp. 28417.
12. Paolo Tripodi and Preeti Patel, HIV and AIDS,
Peacekeeping and Conflict Crises in Africa,
Medicine, Conflict and Survival, vol. 20, No. 3
(JulySeptember 2004), pp. 195208.
13. J. Volmink, Nandi L. Siegfried, Lize van der
Merwe, and Peter Brocklehurst, Antiretrovirals
for Reducing the Risk of Mother-to-hild
Transmission of HIV Infection, Cochrane
Database of Systematic Reviews, No. 7, Art.
No. CD003510, (2011).
14. T. Young, F.J. Arens, G.E. Kennedy, J.W.
Laurie, and G.W. Rutherford, Antiretroviral
Post-Exposure Prophylaxis (PEP) for
Occupational HIV Exposure, Cochrane
Database of Systematic Reviews, No. 1, Art.
No. CD002835, (2007).

ETHICS IN PEACEKEEPING: HIV/AIDS SUPPLEMENT

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End-of-Lesson Quiz
1. When a person has AIDS, their body lacks:

6. Antiretroviral drugs are:

a. Immune cells;

a. A cure for AIDS;

b. Blood vessels;

b. Used to control the virus so it does not

weaken the immune system;

c. Necessary nutrients;

c. An inexpensive source of relief for people

with AIDS;

d. Bone marrow.

2. Almost all transmissions of HIV occur

through:
a. Sexual intercourse;
b. Casual contact;

d. Placebos to help people with AIDS.

7. The following are ways to prevent the spread

of HIV EXCEPT:
a. Effective and consistent condom use;

c. Sharing items;

b. Avoiding risky social behaviour like

consuming too much alcohol;

d. Kissing.

3. Body fluids that can spread HIV include:

a. Blood;

c. Blaming HIV positive people for spreading

the virus;
d. Promoting HIV counselling and testing.

b. Breast milk;
c. Semen;

8. Whick of the following statements best

describe positive prevention in the context of
HIV and AIDS?

d. All of the above.

4. AIDS CANNOT be spread:

a. By sharing needles with a person living with
AIDS;
b. During the pregnancy of a mother with AIDS;
c. Through the bite of an infected mosquito;
d. By receiving a blood transfusion
contaminated with HIV.

a. Supporting HIV positive people from

acquiring other STIs;
b. Helping HIV positive people to accept their
status;
c. Empowering HIV positive people to avoid
spreading HIV to other people;

Stigma Fuels HIV, projected onto the faade of the UN Headquarters General Assembly building, is one of the topics of
discussion during the UNs high-level summit on HIV/AIDS. (UN Photo #475333 by Mark Garten, June 2011)

d. All of the above.

5. The stage of HIV infection before the body

reacts to the presence of this virus and
produces antibodies is called the:
a. Asymptomatic period;
b. Symptomatic period;
c. Window period;
d. Testing period.

ANSWER KEY:
1a, 2a, 3d, 4c, 5c, 6b, 7c, 8d
14 |

P E A C E O P E R AT I O N S T R A I N I N G I N S T I T U T E

ETHICS IN PEACEKEEPING: HIV/AIDS SUPPLEMENT

| 15

Peace Operations Training Institute

www.peaceopstraining.org