LINKING COMPLEX EMERGENCY RESPONSE AND TRANSITION INITIATIVE

CERTI Crisis and Transition Tool Kit

 

HIV Prevention and Behavior Change in

International Military Populations

Training Module 7

HIV Prevention in Crisis Settings

 

 

Executive Summary

 

          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

 

September 2000

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This project was made possible through Cooperative Agreement Number HRN-A-00-96-9006 between the US Agency for International Development and Tulane University

 

Executive Summary

 

Background

 

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 profiles of many nations are undergoing fundamental changes because of civil wars, secessions of provinces, and border disputes.  Peacekeeping forces and humanitarian relief missions are increasingly deployed to address these crises along with the already complex task of defusing low-intensity 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 agenda of unexpected crisis events and to maintain their operational effectiveness over time.  This, in turn, requires training that is tailored to individual crisis circumstances and is socially and culturally appropriate to the personnel and local populations 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, HIV Prevention and Behavior Change in International Military Populations.  This curriculum is available in a version that specifically addresses the training needs of UN and regional peacekeeping forces.  It is available in four languages (English, French, Russian, and Spanish) and is fully supported by Instructors’ Notes, so that it forms both a training-of-trainers package and a training course that is readily adaptable to a wide range of settings.  The curriculum is readily convertible to a shorter version, or it can be spread over longer periods, and includes approaches to reinforcing “booster” sessions. 

 

A second four-language version of this curriculum is geared to national military and police forces.  Like the peacekeepers’ version, this edition addresses the structural nature of the HIV risk environment for military and police personnel, their families, and their surrounding communities.

 

A sixth training module is under development that will fit into both versions of the Curriculum.  It addresses Women's Issues in HIV Prevention and Behavior Change.  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

 

Under a partnership arrangement with CERTI, the Civil-Military Alliance to Combat HIV and AIDS has also undertaken the development and preliminary field testing of a seventh teaching module, complementary to the modules already in hand.  This new module, HIV Prevention in Crisis Settings, is designed to develop HIV prevention and management skills in the context of crisis prevention and response.  It recognizes 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 of Module 7 follows 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 include:

 

 

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), Sessvollmoen (Norway), Pristina (Kosovo), and Siem Reap (Cambodia).  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 process testing of Module 7 will be accomplished, within the budget and timeline that we have specified, in Ghana during October 2000.  The overarching goal will remain true to the objectives of the overall teaching curriculum - to create a reliable and effective means to reduce risk of STD/HIV/AIDS infections as a matter of professional responsibility and enlightened self-interest.  Possibilities will also be raised of extending the module to other national uniformed services (e.g., police and prisons) and to peer-educational alternatives for active and demobilized military and paramilitary personnel.

 

Further field testing of the entire CMA training curriculum is anticipated under the USAID-supported IMPACT (Implementing AIDS Prevention and Care) Project, administered by Family Health International.  In this setting, the curriculum will form an integrated part of a comprehensive package of HIV-prevention and care interventions designed for national military, police, and potentially other uniformed services.  Projected testing sites include Ghana, Nigeria, and Cambodia.

 

Ultimate Objectives of the Crisis-Management 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.*

 

Specific Objectives for Crisis-Management 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.

 


*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).