12 Jun 2007: ISS Today: A Further Perspective On Exclusion Of Potential Recruits Who Are HIV-Positive From Enlisting With The Security Sector In Afric

12 June: A Further Perspective On Exclusion Of Potential Recruits Who Are Human Immune Virus (HIV)-Positive From Enlisting With The Security Sector In Africa

According to the 2006 UNAIDS report, most security sector institutions, at least on the African continent, where HIV/AIDS is exacting the most casualties – accounting for 69% of global fatalities and infections -- have convinced their governments to pass legislation banning the recruitment of potential recruits that are HIV-positive. Our own recently completed publication: The Enemy Within: Southern African Militaries’ Quarter-Century Battle with HIV&AIDS (ISS, 2006) also found that in each of the case studies, ranging from the armed forces in Botswana, Tanzania, Swaziland, Zambia and Zimbabwe, almost all potential recruits who were found to be HIV-Positive are summarily dismissed and not enlisted. In mid-2000, the Namibian Defence Minister, Erkki Nghimtina, in a Labour Court dispute with a potential recruit, Haindongo Nghidipohamba Nanditume, who had been refused enlistment in the Namibian Defence Force (NDF) after testing HIV-Positive in 1996, put it more bluntly when he addressed the media and the Namibian National Assembly.(1) Paraphrasing his comments, the Minister stated that,

... recruiting HIV-Positive people in the NDF is tantamount to allowing for the recruitment of blind and crippled people. We need a strong (defence) force, a healthy force and on this we cannot compromise. [In his view] The country could not be defended by ill persons.(2)

In this instance, although the Labour Court overturned the NDF position, a ruling that the MoD appealed, the sitting judge made a ruling with conditions that are interesting for HIV-Positive people. This aspect is examined more fully below.

A closer examination of this rough and ready practice reveals serious flaws and inadequacies in a policy that appears to have become commonplace. The uncritical acceptance of this position also reinforces the frequent criticism that policies adopted to combat the incidence of HIV/AIDS are generally not fully informed by empirical evidence and, as a consequence, are characterised by myths, assumptions and ignorance.

This article therefore seeks to re-examine the veracity of the practice of rejecting HIV-Positive potential recruits by the security sector and its implications in maintaining the (health) integrity of the institutions. To this end, we need to begin to either question or better understand the HIV-Positive science that has led to this widespread belief that candidates so identified must be rejected.

First, it has been sufficiently argued that a HIV-Negative result during the initial test does not exclude victims who may be in what has been termed the ‘window period’ from being recruited. This is the average 90-day period in which affected victims do not yet reveal to medical science that they have become affected. Hence, the summary test should not be taken as conclusive. Stated differently, the only conclusion to be drawn would be from at least two 90-day interspersed tests. Consequently, anything less than six months of dedicated medical investigation is scientifically unsustainable to make a definitive conclusion on the status of an individual. Furthermore, it is also now common cause that the HIV condition found in a person may on average take anything between 8 to 12 years [the popular number is to simply say 10 years] before developing further into acquired immunodeficiency syndrome (AIDS). The latter, AIDS, is not a single malady but a collection of illnesses affecting the immune system and until one succumbs to this condition one may still be regarded as relatively healthy.

A second feature that has always been present but ignored in the assessments and debate about testing is that an HIV test needs two other dimensions to complete the picture barring a potential recruit from enlistment. On the one hand, being HIV-Positive does not necessarily translate into ill health until this is associated with a low CD4 count: T-Lymphocytes cells that have been found to be significant for maintaining one’s immune system. When the CD4 cells are compromised – measured as a number of cells per cubic millimetre of blood to indicate the damage to the immune system -- the immune system becomes progressively weaker and weaker and in the process negates the ability of the body’s natural propensity to fight infection and certain cancers – sometimes commonly known as ‘opportunistic diseases’. After much furious debate, again common cause has emerged that HIV-Positive persons are otherwise deemed fit until their CD4 count falls to below 200. Anyone with a CD4 count below 200 is therefore clinically attributed to be suffering from AIDS.

On the other hand, an HIV-Positive status has also to consider a person’s viral load level. The viral load test measures the level of viruses multiplying in the blood at a given point in time. Consequently, a high level depicts high levels of infection and therefore a shorter period before the compromised immune position is reached, while conversely, a low viral load means the victim has a longer period before becoming incapacitated. More specifically, laboratory and clinical assessments have arrived at an agreed position that any increase beyond 100 000 translates into serious incapacity and therefore AIDS.

Taken as a whole, the HIV-Positive picture becomes complete only if: a) an individual is tested repeatedly over a period spanning 180 days; b) the HIV test is followed up by a CD4 count that reveals a count of below 200; and c) a Viral Load test reflects an increase of over 100 000. It is only after these three criteria are taken into account that an individual can be clinically categorised as suffering from HIV/AIDS and deemed unable to undertake strenuous and physically demanding training and tasks.

Against this guideline, it is clear that few security institutions within Africa have the means, time and technical know-how to carry out the three components of the comprehensive tests before making the sorts of blanket pronouncements that are guiding policy and practice at the moment. In other words, combating HIV/AIDS continues to pose contradictions and challenges and the sooner we move away from the myths, stigmatisation and assumptions, the sooner we can tackle the real problems associated with the epidemic. The scientific evidence on determining the HIV status of potential recruits makes nonsense of the current position adopted by states and institutions.

For the moment, governments and security sector institutions may themselves be “blind and crippled” in providing informed policy and practice on the issue of testing and recruitment, unnecessarily discriminating against the young recruits seeking to find employment with the state.

Martin Rupiya, Defence Sector Programme, ISS Tshwane (Pretoria)