|
Complex
Emergency Response and Transition Initiative In
Collaboration with Project
on TRAINING
FOR CRISIS PREVENTION AND MANAGEMENT Project
Manager Rodger
Yeager, Ph.D. Civil-Military
Alliance to Combat HIV and AIDS Behavioral
Scientist Donna
Ruscavage, M.S.W. Henry
M. Jackson Foundation for the Advancement of Military Medicine April
19, 2000 In
the post-Cold War era, the international community is being challenged to
develop new ways to address low-intensity conflicts, internal emergencies,
massive displacement of populations and complex humanitarian crises.
The profile of many nations is undergoing change due to civil war,
secession of provinces, and border disputes.
Peacekeeping forces and humanitarian relief missions are being deployed
to address these crises along with the already complex task of defusing
smoldering internal conflict and erupting violence. One long-term goal in this new era, in which “preventive
diplomacy” has not yet come of age, is a reduction in full-scale humanitarian
emergencies and an effective mitigation of their impact when and where they do
occur. Central
to this effort is the training of military and police forces, peace and election
observers, and humanitarian aid workers to deal with a daunting palette of
unexpected crisis events and to maintain their effectiveness over time. This, in turn, calls for training that is tailored to
individual crisis circumstances and is socially and culturally appropriate to
the personnel involved. At the
outset of the twenty-first century, HIV/AIDS prevention and control forms a key
subject of such training. The
Civil-Military Alliance to Combat HIV and AIDS (CMA) has developed and
field-tested a five-module teaching curriculum on “HIV
Prevention and Behavior Change in Military Populations.” This curriculum is available in a version that specifically
addresses the training needs of UN peacekeeping forces.
It is fully supported by Instructors’ Notes, so that it is at once both
a training-of-trainers package and training course that is readily adaptable to
a wide range of settings. It is
readily cut to a shorter version, or it can be spread over longer periods, and
includes approaches to reinforcing “booster” sessions.
A
second version of this curriculum is geared to generic military and police
forces “at home.” Like the
peacekeepers’ version, this edition addresses the structural nature of the
risk environment into which military and police personnel enter with their
families. A
sixth training module that will fit into both versions of the Curriculum is
under development. It addresses the
circumstances of Women in Crisis Settings.
In the context of HIV/AIDS prevention, this module emphasizes the
special risks of women and children, their vulnerability in crisis and civil
disruption, their reproductive health needs, and their need for protection
against bodily, sexual and psychological violence.
The sixth module focuses on women and children in crisis settings in
order to increase the uniformed services’ awareness of and sensitivity to
their special needs in these highly dangerous circumstances. TRAINING
MODULE 7: THE CRISIS PREVENTION AND MANAGEMENT PROJECT
The
Civil-Military Alliance to Combat HIV and AIDS will now undertake the
development and preliminary field testing of a seventh teaching module,
complementary to the modules already in hand.
This new module will be designed to develop skills in Crisis
Assessment, Crisis Prevention, Early Warning Systems and the Management of
Interventions in the context of Crisis Prevention and Response. It will recognize that dealing creatively with health and
social issues, such as the risks of STD and HIV transmission and the sexual
violence so often seen in humanitarian emergencies, offers a bridge to peace and
conflict resolution. THE
TARGET “SUBJECT” AUDIENCE OF TRAINEES
in Crisis Prevention and Response will consist of selected members of
the uniformed services, primarily senior commanding officers and training
officers, drawn from military, paramilitary, peacekeeping and internal security
forces as well police forces and demobilizing military personnel. SECONDARY
“OBJECT” BENEFICIARIES OF THE TRAINING,
and the behavior change that it engenders, will overlap somewhat with those
identified as beneficiaries of Module 6. These will be the especially
vulnerable populations in pre-crisis, crisis, and immediate post-crisis
situations – including 1.
refugee and internally displaced populations; 2.
women, both civilians and fighters; 3.
children and adolescents, including "child soldiers”; and 4.
other groups and organizations that are particularly dangerous and/or
vulnerable in pre-crisis, crisis, and immediate post-crisis situations, e.g.,
recently demobilized fighters, permanent humanitarian personnel (local clergy,
development workers, etc.) emergency relief workers, and endangered groups
within or routinely in contact with the contending forces themselves (e.g.,
women and children fighters, local vendors, and camp followers). THE
PEDAGOGICAL APPROACH
to be adopted in Module 7 will follow the lead of earlier modules, using
interactive dialogue and exercises, role-playing, “homework,” and the
liberal use of visuals and graphics. Features
of this new module will include: Ø
Understanding
the culture of violence that underlies crises, and offering openings that can
facilitate the emergence of a peace culture for the populations involved,
including the military, police and civilian community. Ø
Skills-development
for rapid situation assessment and needs-identification that are crucial for
early response, management of interventions and the mitigation of impact. Ø
An emphasis
on behavioral issues that underlie the structural nature of the risk environment. Ø
The
management of risk reduction and preventing the progression of any particular
crisis through the use of peer educators for all of the population groups caught
up in any complex emergency. FIELD-TESTING
will be conducted according to the same rationale and procedures that have
guided testing procedures for Modules 1-5 and will also guide the field-testing
of Module 6. Of the two types of field test that are available (PROCESS
testing and OUTCOME testing), process testing is financially and logistically
most feasible for these training modules. Process testing means subjecting
the completed module to a series of in
situ training situations. This
approach has already been used for Modules 1-5, involving training sessions
organized in Turin (Italy), Rockville (Maryland, USA), Pretoria (South Africa),
and Sessvollmoen (Norway). This
rich experience of testing has permitted useful adjustments to be made to the
modules. Testing has also
demonstrated the ability of the modules to be “fine-tuned” on each occasion
for comprehension and improved expectation of behavioral change, especially when
follow-up “booster” training is administered at periodic intervals. Preliminary
testing of Module 7 will be accomplished, within the budget and timeline that we
have specified, from 1-30 September 2000. Considering the logistical and
financial constraints that affect the development of Module 7, it is impossible
to consider outcome testing. To pursue outcome testing, a highly
formalized application of the module would be required, complete with
experimental and control groups and a detailed follow-up of individual trainees
and control-group members at specified time intervals into the future.
This follow-up would require (a) self-reported data, (b) accurate data on
behavior change (measured, e.g., through cognitive testing and in condom usage)
and on infection patterns within both subject and object populations.
This procedure is virtually impossible in Africa, especially under
pre-crisis, crisis, and immediate post-crisis circumstances. The
overarching goal of the module will remain true to the objectives of the overall
teaching curriculum, to reduce risk of STD/HIV/AIDS infections as a matter of
enlightened self-interest to subject populations, and of their responsibility to
protect object populations with whatever tools can be mustered (e.g., appeals to
fighters based on their own self-protection and, through transference, reference
to object populations as including people like their own loved ones).
Possibilities will also be raised of peer-educational alternatives for active
and demobilized military and paramilitary personnel. THE
PROGRAMME OF ACTION
will consist of several phases, to be undertaken and supervised by the
Civil-Military Alliance to Combat HIV and AIDS.
These phases will include: 1.
Use of consultant and CMA staff time to develop the new module on Crisis
Prevention and Management. 2.
Under the provisions of the preceding sections, field-testing this module
in the context of training-of-trainers. The
CMA will involve one of its three African networks (probably Anglophone West
Africa) in the scope of this initial testing protocol, with the possibility of
its eventual extension to other CMA African and non-African networks (see
Appendix II). 3.
Contributing consultant and CMA staff expert services in the further
evolution of the approach taken, and in the actual leading of
training-of-trainer exercises using this and the other modules. 4.
Final editing, printing, translating and distributing the module. 5.
Further collaboration in policy analysis and program development as the
comparative advantages of the CMA and CERTI further emerge in this effort. OVERALL
OBJECTIVES FOR THE TRAINING MODULE AND THE FULL CURRICULUM
1.
To establish HIV/STD infections as long-term threats to development and
to national and international peace and security, that may help to precipitate,
exacerbate, and prolong short-term crises, and to render more difficult the
transition from crisis to post-crisis situations. 2.
To set as an ultimate goal not merely a return to pre-crisis rates of
HIV/STD incidence and prevalence, rather the achievement of incidence and
prevalence rates that are progressively lower in the post-crisis period. 3.
To effect HIV/STD-related behavior change within the uniformed services,
including national armed forces, international peacekeeping contingents,
national and international police forces, and recently demobilized military and
police personnel. 4.
To reduce the risk of HIV/STD infection to members of national and
international military, peacekeeping, and police services, and, through them, to
populations that are especially vulnerable to STDs and HIV.
These populations include: (1) refugees and internally displaced men,
women, and children; (2) uniformed women (3) civilian women; (4) children and
adolescents; (5) other specific groups that are particularly vulnerable under
pre-crisis conditions of civil unrest, during periods of armed conflict, and in
immediate post-conflict situations, e.g., “child soldiers,” humanitarian and
relief workers, and women and children who are drawn into prostitution during
these complex humanitarian emergencies. 5.
To accomplish these goals using a formative evaluation process to develop,
field test, and refine a training module that builds upon six existing training
modules for the uniformed services which cover the following topics: a.
Defining HIV and its Impact on the Military b.
HIV Prevention c.
Substance Abuse, HIV and STDs d.
HIV Risk Assessment and Prevention Strategies e.
Review of HIV Prevention and Behavior Change Issues f.
Women in Crisis 6.
Through the training module, to encourage active-duty and demobilized
uniformed-services personnel to serve as peer educators of their comrades and
vulnerable civilian populations, motivated by their sense of duty to preserve
and protect civilian society, by their concerns for their own families and
communities, and by their own enlightened self-interest. 7.
In pre-crisis situations of poverty, hunger, ill-health, and increasing
social unrest, to encourage active-duty and demobilized uniformed-services
personnel to serve as “early-warning” sentinels of local increases in
public-health problems and other indicators of socio-economic and political
breakdown; i.e., to serve as the first line of crisis prevention and response
through communication linkages made possible by national chains of command and
by international civil-military networks of information exchange and resource
sharing.* *For
example, the three African sub-regional networks of the Civil-Military Alliance
to Combat HIV and AIDS, for Anglophone West Africa (5 countries), Eastern and
Southern Africa (15 countries), and Francophone Africa (20 countries). SPECIFIC
OBJECTIVES FOR TRAINING MODULE PARTICIPANTS 1.
To provide basic information on how HIV is transmitted, how it affects
the human immune system, and about AIDS. 2.
To define the particular threat of HIV/AIDS in pre-crisis, crisis, and
post-crisis situations, both to peacekeepers and other uniformed-service
personnel, and to disrupted and vulnerable local populations with which they
come in contact. 3.
To increase participants’ awareness of their duty to protect themselves
and vulnerable civilian populations not only from immediate physical harm, but
also against the hidden threat of HIV. 4.
To increase participant awareness of the efficacy of using male and
female condoms. 5.
To increase participant knowledge and skill in the use of male and female
condoms. 6.
To increase participant knowledge of the negative effects that alcohol
and other drugs can have on personal decision-making, and how these substances
can increase the likelihood of involvement in risky behaviors for STD/HIV
transmission. 7.
To review guidelines for professional conduct by national military,
international peacekeeping, and police personnel, and their implications for STD/HIV
prevention – under the especially stressful conditions of complex humanitarian
emergencies and their immediate aftermath. 8.
To explore the heightened relationship between sexual activity and
sexually transmitted diseases, and HIV transmission during periods of conflict
and post-conflict recovery. 9.
To reinforce participants’ knowledge of the risk factors for STD/HIV
infection; their awareness of their personal risks for STD/HIV infection; and
their knowledge and skill in preventing the spread of HIV and other STDs. 10.
To encourage participants to make a personal commitment to reduce their
risk for HIV and other STDs and to reduce risk for vulnerable civilian
populations which it is their duty to protect. 11.
To increase participants’ awareness of the elements of an effective HIV
prevention message, and to encourage them to share effective HIV prevention
messages with others. In particular,
to encourage participants to serve as peer educators by extending the awareness,
knowledge, and skills gained in this training module to their comrades-in-arms
and to non-combatants among whom they are deployed. 12.
To encourage participants to learn how to become early-warning sentinels
in pre-crisis situations - alert to deteriorating public-health, socio-economic,
and political conditions in the areas to which they are assigned, and with ready
access to communication channels that extend upward in their command structures. Appendix I
The Civil-Military Alliance to Combat
HIV and AIDS, a Collaborating Centre of the Joint United Nations Programme on HIV/AIDS (UNAIDS) The
Civil-Military Alliance to Combat HIV and AIDS (CMA) is an unincorporated
association, a world-wide interest group of interested professional
agencies, federations, ministries, and individuals addressing HIV/AIDS
prevention and training in the military, peacekeeping, police, prisons, and
maritime sectors. It maintains
technical support networks in Africa, Asia, and Eastern Europe, and less-formal
ties in Central and South America and the Caribbean. Purpose
The
purpose of the Alliance is to promote inter-sectoral co-operation in combating
HIV/AIDS and closely related diseases, sexually transmitted infections, and
tuberculosis B
though the promotion of effective health and prevention policies, strategies,
and training programs in both civilian populations and the uniformed services. The
Alliance supports HIV/AIDS prevention and care in institutional and sectoral
settings that are among the various “uniformed
services.” The uniformed services encompass military, security, police,
paramilitary, and peacekeeping forces (at home and during deployment on foreign
soil); personnel of the maritime, seafarer, and seaport sector; and the prison
services (prison staff and prisoners), and their families and communities. Membership Membership
in the Alliance is open to organizations, ministries and individuals active in
and concerned about co-operation in combating HIV/AIDS. Short
Term Objectives: to
collect, analyse and disseminate information useful in the control of STDs and
HIV in the uniformed services; to
encourage a prevention focus on STD/HIV/AIDS in all these uniformed services; to
develop an advocacy for a commitment to STD and AIDS prevention and care; to
support and co-ordinate operational research and epidemiology necessary to reach
these goals; to
assemble and adapt documentation resources, planning and program management
material, teaching modules, research reports and data, and printed articles; to
gather and make available policy recommendations; to
facilitate the exchange of such information among key military, maritime,
prison, police, and civil bodies; and to
provide culturally specific HIV/AIDS prevention education to uniformed forces
personnel - including medical, nursing and training officers of UN Peacekeeping
Forces - at home and during foreign deployment and travel. Long
Term Objectives: 1.
Collaboration between the uniformed services and national AIDS programs
to facilitate co-operation between the national (civilian) AIDS program
and the AIDS programs of the military/uniformed services in all countries;
to encourage examination of cultural and behavioral risk factors that
contribute to HIV transmission;
to work on the specific issues that concern each branch of the uniformed
services;
to encourage education, prevention, and care programs for uniformed
personnel; and
to examine how demobilization can contribute to the national struggle
against STDs/HIV and AIDS. 2.
Sharing Assistance within the Sectors
to encourage leaders in the uniformed services to exchange useful
information on how successful prevention and behavior-change programs are
structured, and
to suggest policy options that are appropriate for the wider communities
in which they live. 3.
AIDS Prevention in Peacekeeping Settings to
encourage prevention of HIV transmission involving UN/multinational peacekeeping
personnel. 4.
Long-term Policies and Regional Stability to
focus attention on long-term strategic implications - such as the potential for
contributing to regional instability through the erosion of military
preparedness, loss of experienced seafaring officers and crews, and the return
of sick prisoners to their home communities – which are by-products of
widespread HIV infection in these personnel; to support an open examination of the policy issues that are critical for a rational approach to HIV/AIDS prevention and care in uniformed settings Accomplishments Training
and policy seminars, workshops and Conference round tables
have been held in Africa, Asia, Eastern Europe and Latin America, in
collaboration with WHO’s
Global Programme on AIDS and with UNAIDS:
Satellite seminar on “HIV/AIDS
in Military Populations,”
at the 9th World AIDS Conference, Berlin, 1993 Round
table forum at the International Congress on Military Medicine, Augsburg, 1994 Planning
Conference of the Steering Committee of the CMA B
Washington, DC, 1994 One
week “AIDS
in the Military”
Seminar, Harare, 7 African countries, 1995 One
week “AIDS
in the Military”
Seminar, ChaAm, Thailand, 6 Asian countries, 1995 Papers
presented at Asian, African, LAC Regional Conferences on AIDS, 1993, 1995, 1996,
1997, 1999 One
week Policy Workshop for 13 countries of Eastern/Southern Africa, Mangochi,
Malawi, 1996 Seminar
for NATO & Partnership for Peace countries, Brussels, 1996 Track
D Forum “AIDS
in the Military”
at the 11th International Conference on AIDS, Vancouver, 1996 Policy
Seminar in Washington DC, and a Forum for UN and foundations in New York, 1996 Plenary
panel at International Congress on Military Medicine, Beijing, 1996 One
week Military Seminar for 15 nations of Eastern and Southern Africa, Namibia,
1997 Alliance/UNAIDS
Team visits to Namibia, Botswana, Zambia, Lesotho, Namibia Military
Seminar for 13 countries of Latin America/Caribbean, Honduras, 1997 Inter-Agency
Consultation on the Prevention of HIV/AIDS in the Maritime, London, 1997 Three-day
“AIDS
in the Military”
seminar for 7 countries of Eastern Europe, Milan, 1997 One
week “AIDS
in the Military”
seminar for 18 Francophone West/Central Africa countries, Dakar, 1997 Technical
support missions to Egypt, Chile, Peru, Panama, Thailand, Vietnam, Philippines,
Russia, 1998 Satellite
seminar on “AIDS and the Maritime” at the 12th International
Conference on AIDS, Geneva, 1998 Three-day
“AIDS
in the Military”
seminar for 13 countries of Eastern Europe, Sofia, 1998 Three-day
Strategic Planning Seminar for 7 countries of West Africa, Dakar, 1998 Four-day
Philippine National Seminar on HIV/AIDS Prevention in the Uniformed Services,
Manila, 1998 Participation
in the Forum on Health & Human Security in Conflict & Transition
Settings, Harare, 1999 Release
of the 5-module Peacekeeping Training Curriculum on HIV Prevention &
Behaviour Change, 1999 Participation
in the Seminar on the “Silent
Emergency: HIV/AIDS in Conflict & Disasters,”
London, 1999 Technical
support missions to Cambodia, Ukraine, South Africa and the Lao PDR in 1999 Participation
in Maritime Infectious Diseases Research Group/International Maritime Health
Assn, Antwerp, 1999. Participation
in the 3rd All Africa Congress of Armed Forces and Police Medical
Services, Pretoria, 1999 Activities
foreseen for 2000/2001 Technical
support and training support missions for the uniformed services in countries of
Africa, Eastern Europe, and Asia; participation in the 33rd
International Congress on Military Medicine, Helsinki, and the 13th
International AIDS Conference, Durban; training seminars on HIV/AIDS issues in
peacekeeping missions; strengthening of the technical support networks for the
uniformed services in Africa, Asia and Eastern Europe; development of additional
policy, planning and training documentation for the uniformed services in
English, French, Russian & Spanish: consultations on the development of
interventions in the maritime sector; research in the military, maritime and
prisons sectors; and the search for best practice case studies for wider
dissemination. Recent
Publications
Newsletter 4 times a year 1995-1999, occasional papers, speeches,
articles, reports of regional meetings “Winning
the War against HIV and AIDS: A Handbook on Planning, Monitoring and Evaluation
of HIV Prevention and Care Programmes in the Uniformed Services,”
1999
CD-ROM Technical Reference Library 1999, for “Winning
the War against HIV and AIDS: A Handbook on Planning, Monitoring and Evaluation
or HIV Prevention and Care in the Uniformed Services,”
1999
“HIV
Prevention and Behavior Change in International Military Populations,”
a 5-hour Curriculum produced by CMA for the UN Department of Peacekeeping
Operations, 1999
AIDE-MÉMOIRES, Policy Guidelines for Military Planners and Commanders (developed
by the Civil-Military Alliance to Combat HIV and AIDS for the UN Department of
Peacekeeping Operations), 1999 “International
Military HIV/AIDS Policies and Programs: Strengths and Limitations in Current
Practice,” by Yeager R, Hendrix C, and Kingma S, Military
Medicine 165, Feb, 2000: 87-92. Executive
officers
Norman
Miller, Ph.D., Administrator 4
West Wheelock Street, Hanover,
NH 03755, U.S.A. Tel:
+1 802 649 5296
Fax: +1 802 649 2331 E-mail:
norman.n.miller@dartmouth.edu
Appendix
II The Civil-Military
Alliance to Combat HIV and AIDS
Regional Networks A. Eastern and Southern Africa – established in
1997 – 15 countries Angola,
Botswana, Eritrea, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, South
Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe --
Regional Network Coordinator is a member of the Zambian Defence Force B. Francophone Africa – established in 1997 – 20 countries Algeria,
Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo
(Brazzaville), Côte d’Ivoire, Democratic Republic of Congo (Kinshasa), Gabon,
Guinea, Mali, Mauritania, Morocco, Niger, Rwanda, Sénégal, Togo and Tunisia --
Regional Network Coordinator is a member of the Army of Sénégal C. Anglophone West Africa – established in 1998
– 5 countries The
Gambia, Ghana, Liberia, Nigeria and Sierra Leone -- Regional
Network Coordinator is a member of the Army of Ghana D.
Asia – to
be launched in the year 2000 – 7
countries Cambodia,
Indonesia, Lao PDR, Malaysia, Philippines, Thailand, Viet Nam E. Eastern and South Eastern Europe – not yet
fully established – 20 countries Albania,
Bosnia-Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Estonia, Greece,
Hungary, Italy, Latvia, Lithuania, Former Yugoslav Republic of Macedonia,
Moldova, Poland, Romania, Slovakia, Slovenia, Turkey and the United Republic of
Yugoslavia – Regional Network
Coordinator for 1999 is in the Hellenic Navy F.
Russian-speaking Eastern Europe & Central Asia – proposed – 11
countries Armenia,
Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Russian Federation,
Tajikistan, Turkmenistan, Ukraine, Uzbekistan |
|
|