SARPCCO Training: HIV/AIDS

Transcription

1 30 SARPCCO Training: HIV/AIDS MODULE 3 THE IMPACT OF HIV/AIDS ON HUMAN, NATIONAL AND REGIONAL SECURITY Contributor: Robyn Pharoah Institute for Security Studies

2 31 MODULE 3: THE IMPACT OF HIV/AIDS ON HUMAN, NATIONAL AND REGIONAL SECURITY Module Goal: To gain a broad understanding of the social and economic impact of HIV/AIDS, with a specific awareness of the challenges to safety, security and the police in the Southern African region. Module Outline: 1. Introduction 2. Social and economic impact of HIV/AIDS. 3. The susceptibility of police personnel 4. Effect on the police 5. Effect on national and regional security 1 Introduction HIV/AIDS strikes hardest at the most productive members of society. This creates a complex web of effects that has implications for individuals, households, communities and states. HIV/AIDS stands to impact on police services and personnel at both an individual and organisational level. Dealing with the fallout has broad security implications. It is important for us to understand how HIV/AIDS stands to impact on our societies, on us as individuals and the units in which we serve. 2 Social and economic impact Section objective: Describe four key social and economic implications of HIV/AIDS for the Southern African region. Unlike other infectious diseases such as tuberculosis and malaria, HIV/AIDS does not impact most on the weak, the very young and the elderly. Individuals are most likely to contract HIV in their late teens and twenties, and due to the lag between contracting HIV and developing the symptoms of AIDS, are likely to become ill and die in their late thirties and early forties. 1 In South Africa, for example, it is estimated that the average age of those dying as a result of AIDS is 37 years. This has several implications, including that: The most productive members of society such as teachers, workers, farmers, soldiers, policemen and politicians, are falling ill and dying at a time in their lives when they should be contributing most to their household, economy and country. Men, and women in particular, are also falling ill during the years they are most likely to have children, which leaves them at risk of not only infecting their children with HIV, but also failing to care for and raise their offspring. This in turn stands to impact on societies and economies in the region in a number of ways. Key impacts may include: Reduced household incomes. As breadwinners become ill and die, other adults give up work and economic activities to provide care and family income and assets are used to cover health and funeral costs.

3 32 Declining economic productivity. As skill levels and productivity decline, businesses face increasing costs associated with recruiting and training workers to replace those who have become ill or died as a result of AIDS. In the face of declining productivity and increasing costs, both foreign and local investment is also likely to decline. Break up of families. As caregivers become ill and die, children are sent to live with relatives or are left to raise younger siblings. Reduced service provision. As large numbers of teachers and other civil servants become ill and die, the reach and capacity of government institutions is reduced and government spending potentially focuses on health related issues associated with the epidemic Such impacts are likely to increase poverty, reduce quality of life and increase the gap between the rich and the poor. They may also increase the numbers of children living in precarious circumstances and result in declining skills levels as the quality of education declines and children drop out of school, either because they can not afford to pay for schooling or need to provide care for younger siblings. Such trends could, in turn, potentially result in increasing levels of social instability and conflict. The impact of HIV/AIDS: Millions of AIDS orphans strain Southern Africa Cemento, Mozambique On the day that he died of AIDS, 36 year old Samossoni Nhambo leaned up from his hospital bed a few miles from this village of thatched huts and asked his preacher a despairing question: who would take care of his children? Five months later the answer is glaringly obvious: no one. Three-year-old Fatima died in early December, perhaps from AIDS, perhaps from malnutrition. Sixteen-year-old Maria, who dropped out of school to care for her sick parents, was pregnant by a man whom she refuses to idenitfy and early in December she gave birth to a boy. That leaves the eldest, Jose, a slim, short 17-year-old who just finished seventh grade, as the surrogate father. In their half built shelter of stones and sticks on the bad side of a poor village, with no walls and a single cane chair for furniture, the Nhambo children move from crisis to crisis. 'Life is very difficult', Jose said. 'No food, no clothing, no bed covers. We have to struggle.' So do millions of others like them. Southern Africa is increasingly home to children like the Nhambo's, robbed of their childhood by AIDS and straining under adult-sized hardships. The social implications are enormous, Unicef and relief organizations say. Orphans often drop out of school to suffer chronic malnutrition, live on the street, they are exploited by adults, turn to prostitution or other forms of crime and themselves become infected with HIV, the virus that causes AIDS. African social traditions dictate that relatives should take them in. But AIDS has pushed so many families to the brink that surviving adults are beginning to turn away their young relatives. An aunt and grandfather live down a dirt path from the Nhambos, but the grandfather says neither can help them. Sixty miles away, in the village of Nhamatanda, Jorge Daniell, 15, said he cared for his two younger sisters for four years after his mother died of AIDS. Then, quite recently, a couple who claimed to be friends of his dead parents took the nine and twelve-year-old girls away, he said. He now lives alone in an eight-by-nine foot hut and survives on handouts of rice and the pennies he earns by carrying parcels at the local market. 'They told me, we cannot feed you too, so you must fend for yourself ' he said. I am very sad because they are far away from me. Now I am always alone.'

4 33 Amador Ernesto Luis, a volunteer with a Unicef-financed relief group called Asvimo, said he feared that the two girls had been taken away for labor or prostitution. But without relatives to care for the children, and in the absence of government help, he said he was powerless to stop the couple. Except from New York Times article by Sharon LaFraniere (December 24, 2003) 1 The susceptibility of police personnel Section objective: Describe Four factors that place police personnel at particular risk of contracting HIV Police personnel, along with other 'high risk' groups such as sex workers and long distance truck drivers, are particularly susceptible to HIV infection. Factors that place personnel at risk include: Status As a member of the police with a steady income, you enjoy relatively high status. In some settings you may also wield considerable power over others. Status and money mean that police tend to attract opportunities for sex. While not widespread, some police personnel can and do also misuse their power over members of the public by demanding sex in return for favours. High stress environment Operating in a high stress environment, and regularly putting your life on the line, creates a need to unwind and may encourage risky behaviour. Alcohol and drugs (see Module 1) increase the chance of one having 'risky' sex, while the injection of drugs may directly transmit the virus. Sex may itself also become a way of 'letting off steam'. Working away from home You may be posted away from your home and family, often for long periods of time. As in the case of migrant workers, loneliness, boredom and, sometimes, peer pressure may lead personnel to engage in casual or commercial sex and recreational drug use. Postings may also be to remote areas, where it is difficult to access health care, including information about STIs and HIV, condoms and treatment for STIs. Separation from family as a risk factor: Home Away From Home The Zambian Police Service's School of Public Order and Maintenance is tasked with policing the country's borders. Platoon members are sent away from home for long periods of time. Separated from their families, many members temporarily 're-marry' for the duration of their posting. The role of such practices in increasing officers' risk of contracting HIV can be seen in the fact that this division is estimated to have the highest AIDS related death rates in the Zambian police service. Several officers are estimated to be dying each month as a result of AIDS related illnesses. Source: G Chakulunta, Data on school of public order and maintenance, Zambia Police Service, 2003.

5 34 Occupational risk of exposure Many police personnel are exposed to blood and other potentially infected fluids, practicularly in emergency settings. Unsafe contact with infected blood and bodily fluids is one of three ways that HIV is transmitted. Without proper protective gear, such as latex gloves, you may be in danger of contracting HIV from the people you assist. 'Culture' within the police Culture refers to the beliefs, customs and practices adopted by a particular group of people. Culture changes over time and from place to place. The culture within the police tends to encourage aggressiveness and risk taking, sometimes carrying over into sexual activity. Machismo within the police may also put female personnel at risk of sexual harassment, which may increase the risk of contracting HIV. Peer pressure from colleagues and commanding officers to engage in risky behaviour, including unprotected sex, excessive drinking and, to a lesser extent drug use, can also encourage risky behaviour. Inadequate information Prevention and awareness activities within the police are often inadequate. Many police services in the region have only relatively recently begun to educate their personnel about HIV and in many places such activities are still not prioritised by senior management. Despite the high risk environment in which police personnel work, many do not have adequate information on how their environment may put them at risk of contracting HIV. Given these factors, UNAIDS has estimated that uniformed personnel, including members of the police services and military, may be more than twice as likely as their civilian counterparts to contract HIV. Statistics on prevalence amongst police personnel in the region are difficult to come by, but the available information suggests that HIV prevalence is high: In the Zambian police service as many as 21 out of the service's roughly officers may be dying of AIDS each month. This equates to approximately 254 personnel each year, with over 3000 personnel having died of AIDS between January 1991 and April HIV Prevalence within the Zambian police force is unknown, but since AIDS cases usually represent only a small proportion of the total number of people infected with HIV, prevalence is likely to be high. On average, 31 out of Zimbabwe's police officers die each month as a result of AIDS, with approximately 1295 personnel having died of AIDS since January This equates to almost one AIDS related death each day. It is estimated that over 5000 police officers, or approximately 23 percent of all personnel, are currently living with HIV/AIDS. 4 Effect on the police Section objectives: 1. Describe the economic, psychological and social implications of HIV/AIDS for police personnel and their families. 2. List the main ways in which HIV/AIDS will reduce the operational effectiveness of police services in the region.

6 Individual effects At the individual level, HIV/AIDS has economic, social and psychological consequences for both those infected with HIV and their families and loved ones. Some of the main implications are highlighted below. Economic implications As with any other terminal illness, HIV/AIDS may drain household income as illness prevents work, or family members have to give up work in order to provide care. In addition to losses in income, spending on health care and transport is likely to increase as individuals seek treatment for either the virus or the opportunistic infections associated with it. Families will also eventually have to pay for a funeral, which may be extremely expensive. What makes HIV/AIDS particularly devastating is that, because of the way it is transmitted, the virus tends to cluster in families resulting in families going through this process more than once. Families often suffer the loss of several incomes, and have to find the money to pay for the treatment and funeral costs of more than one member. In this regard, police personnel are often fortunate to have access to support such as ill health and terminal benefits, retirement funds, pensions and medical aids or benefits and are often better off than members of the public in the same situation. Despite this, AIDS related illness and death may prove financially crippling. Where housing is provided as part of individuals conditions of service, surviving household members are likely to lose access to this housing on the death of the service member. Even where police services make an effort to accommodate surviving family members, the extent of AIDS related death in some services may prevent them from providing adequately for surviving families. Economic implications: overburdening of police responses The Zambian police service has taken the decision to provide housing to the widows of members who have died of AIDS. Limited space, combined with the large numbers of personnel dying as a result of AIDS, however, is putting increasing pressure on the system. This is resulting in long delays and some families being left homeless. Financial shortages have also resulted in widows and children having to wait for as long as four years to access the death benefits to which they are entitled. Without a means of support, many of these women use sex in order to get what they need to survive and to support their families, which may often serve to further spread the virus. Where surviving partners contract HIV and eventually die of AIDS, their children are often left unsupported, without access to either housing or income. Source: G Chakulunta, Data on school of public order and maintenance, Zambia Police Service, Psychological implications People infected with HIV sometimes suffer from depression following their diagnosis, especially if it is viewed as an imminent death sentence. Personnel may also feel confused, anxious, guilty or ashamed, especially where a partner or loved one has been infected. Even In the absence of a diagnosis, anxiety and fear about one's HIV status is common. In a region where stigma is still a major problem, an HIV positive diagnosis may also require learning to cope with both one's own beliefs and those that others may have about the virus.

7 36 Family members too must cope with the emotions involved in knowing that a person they love has the virus. They must also deal with their own attitudes towards people living with HIV, as well as potential stigmatisation by others. Caring for an HIV positive spouse, partner, child or relative puts enormous physical and emotional strain on the caregivers involved. Dealing with those issues can be extremely difficult and stressful and people are sometimes unable to come to terms with the virus. This has resulted in personnel taking their own lives. Anecdotal evidence from the region suggests that HIV/AIDS related suicide and homicide are not uncommon. Social implications In cases where HIV status has becomes public knowledge, stigmatisation may put stress on relationships and make it difficult for both those infected and affected by the virus to go about their daily lives. This may have a number of consequences, but common implications include divorce or abandonment. Adults may have to give up work and children may drop out of school. AIDS related illness and death also often forces families to splinter, as children lose their parents, or families are unable to 2 support their members financially. Children may have to go and live with relatives, live in child headed households, or be 3 left to fend for themselves in precarious circumstances. In the absence of adult role models, socialisation may be poor. Young people, sometimes children themselves, may be faced with the responsibility of raising their even younger siblings. This means having to earn money to support the household and playing a parental role. In many cases this results in children dropping out of school in order to search for work. In some instances it may also result in children resorting to crime or joining gangs in order to survive or gain a sense of belonging. 5.2 Organisational effects High prevalence among police personnel is likely to increase attrition (absenteeism, resignations and loss of staff as a result of early retirement and death). This may happen as: Infected personnel fail to come to work as a result of illness; Personnel suffering from AIDS die or take early retirement; Personnel, particularly women, take time off or resign in order to care for relatives with AIDS; Personnel take time off to attend the funerals of colleagues or relatives who have died of AIDS. Even where people are absent from work, AIDS related illness may leave individuals physical and emotionally unable to perform. Such dynamics may impact negatively on the productivity and operational effectiveness of the police services in the region. The reach and quality of police services may decline as there are fewer people to do the same amount of work. As mature, experienced personnel and managers are affected by the virus, there may be no choice but the replace them with younger, less experienced personnel. Personnel may also experience low morale as they have to cope with increasing workloads, see colleagues around them becoming ill or dying, or grieve the loss of colleagues or relatives. Personnel may also see a reduction in resources as police budgets are increasingly absorbed by spending on health care and funeral costs, pensions, death benefits, recruitment and retraining. Career oriented training and enrichment may also suffer as resources become focused on skills replacement rather than skills development.

8 37 HIV/AIDS may also increase corruption. Whether infected or not, the perception that they could soon die could make agents of the state, including police personnel, more likely to engage in corrupt and fraudulent behaviour, as people seek to live shortened lives to the fullest. As argued by one researcher: Instead of 25 years to build a house or to provide for one's dependents, for example, a civil servant may believe that he/she has only five or ten years. Those who are living with AIDS, or who have family members who are, may face demands for spending on drugs or care. Some of these demands can only be met through the diversion of public 4 funds or similar activities In an environment where people expect to live shorter lives, whether in fact they will or not, sanctions may also hold little or no meaning. 5 Effect on national and regional security Section objective: Discuss the consequences of weakened police services for national and regional security HIV/AIDS knows no national boundaries and, as people move between the countries, so does the virus. By its very nature the virus is thus a regional issue, with implications for the health and well-being of millions of Southern Africans. HIV/AIDS is also likely to impact on human security in a range of less obvious ways. The combination of individual and organisational impacts may result in police services being less able to perform the functions expected of them. As pressure on human resources increases, the visibility and responsiveness of the police could suffer, making it more difficult for the police to either effectively combat crime or to maintain the public's confidence in their ability to keep the peace. Even as the police services become less able to perform, however, increasing poverty, inequality, vulnerability and desperation may result in increasing levels of social unrest and crime in the communities in which they work. This may result in the demand for police services outstripping their ability to supply such services. This could seriously undermine the ability of the police to maintain the safety and security of both the communities they serve and their countries as a whole. National security issues have the potential to become regional security issues, as national police services are less able monitor and control crime within their borders. Weakened police services may result in increases in cross border crime and international trafficking of various kinds. Illegal migration is also likely to increase. Reduced capacity and resources within the services of the region could impact negatively on regional co-operation between SARPCCO countries, as individual police services become pre occupied with simply trying to manage crime in their own countries. This would not only make it more difficult for the region to respond effectively to cross-border crime, but would also prevent sharing of expertise and capacity building within the region's services. A lack of co-operation would also have the potential to encourage ill feeling between countries.

9 38 Effect on national and regional security: the potential impact on regional co-operation and capacity The South African police service is highly skilled and is best placed within the region to conduct international investigations, particularly those relating to vehicular crime. Few other police services in the region have the capacity or experience to conduct such investigations and rely heavily on South Africa to share its expertise. Should HIV/AIDS put enough pressure on human and financial resources in the region to limit such co-operation, this could have enormous implications for the ability of countries to combat cross-border vehicular crime.

10 39 Notes 1 Families tipping into destitution, Mail and Guardian, 27 September, S Hunter and J Williamson, Children on the brink, USAID, Washington DC, 'Orphaned children' refers to children who have lost either their mother or both their parents, or whose mother is terminally ill. 3 Orphans and children in the world of work, Global Crisis Global Action Fact Sheet, United Nations Special Session on HIV/AIDS, New York, June A. De Waal, How will HIV/AIDS transform African Governance?, African Affairs, 102, 1-23, Royal African Society, 2003.