Strengthening the Demining Sector Response to HIV/AIDS in Sub-Saharan Africa

by Dr. Martin Chitsama [ Demining HIV/AIDS Service Foundation ]

In this article, the author explores how HIV/AIDS affects deminers in the African areas where the disease is most prevalent. He considers how deminers’ lifestyles make them especially susceptible to HIV/AIDS and suggests mobile HIV/AIDS programs can effectively combat this growing threat.

Demining began in Sub-Saharan Africa in the early 1990s, incidentally commencing just a decade after the HIV/AIDS pandemic started calling on the human race.1 According to the 2007 and 2009 Landmine Monitor Reports and national mine-action centers in Africa, at least 50 national and international demining organizations currently conduct landmine-clearance operations in Sub-Saharan Africa, collectively employing more than 10,000 deminers.2 Angola's National Demining Institute alone has a contingent of 4,000 deminers organized into 18 brigades that are demining across the heavily mined southern African country.2

Considering that all the African States Parties to the Ottawa Convention are lagging behind their targets under Article 5 and are continually calling for extensions, deminers in Africa are set to clear landmines on the continent for many more years. As reported in 2009 by the Joint United Nations Programme on HIV/AIDS (UNAIDS), the region is also “more heavily affected by HIV and AIDS than any other region of the world.” All in all, “an estimated 22.4 million people are living with HIV in the region—around two thirds of the global total.”3 As a result, large numbers of deminers in Africa are at a significant risk of contracting HIV/AIDS for many reasons, including worker mobility, expatriate labor, extended separation from spouses, remoteness and demining security.

For a deminer, the work-leave cycle provides for limited family time in a year. There is so much to catch up on when families reunite after long separation periods that the question of checking on a spouse’s HIV status is hardly a priority.

Demining crews always have medical teams onsite. Medics could be trained to run workplace HIV/AIDS-Advocacy programs.
Demining crews always have medical teams onsite. Medics could be trained to run workplace HIV/AIDS-Advocacy programs.
All photos courtesy of Joseph Kilino, MDD Handler, VDS Angola

The demining-site remoteness means that deminers are cut off from mainstream public-health campaigns, including HIV/AIDS programs. Health workers fear traveling to suspected-mined regions in Africa, which also leaves deminers isolated in terms of outreach programs. Furthermore, deminers are usually 20 to 49 years old, sexually active and tend to have capital to spend while interacting with war-torn communities whose sexually active youths often engage in commercial sex due to limited economic options.

To compound the situation, most demining operators in Sub-Saharan Africa only have informal HIV/AIDS policies, and financial and human resource constraints hamper the transformation of these policies into workplace programs. The inherent risk associated with demining further puts deminers at risk of occupational exposure to HIV transmission when a landmine casualty occurs. All personnel on the demining site are involved if an incident occurs and occupational exposure is probably during the handling of the injured party. Additionally, antiretroviral post-exposure prophylaxis4 is largely absent in the demining industry.

Deminers and HIV/AIDS: An International Perspective

In May 2002, the Interagency Coalition on AIDS and Development made observations regarding the relationship between deminers and HIV/AIDS risk and recommended that intervention programs be implemented for the sector. The Accelerated Demining Programme in Mozambique claims that while it has lost only one deminer to a mine accident, it has lost 10 to HIV/AIDS.5

The labor laws in some countries, such as Mozambique, demonstrate the difficulties that demining companies face regarding HIV tests and can result in demining operators facing legal problems. For instance, in 2005, Mozambican Labour Minister Helena Taipo rejected an appeal by the U.S.-based demining company RONCO Consulting Corporation against a fine imposed for violating Mozambique's ban on compulsory HIV tests. In June 2005, the Labour Ministry discovered that when selecting Mozambican sappers to go on a demining mission to Afghanistan, RONCO required them to take HIV tests. Similarly, ArmorGroup was fined in Mozambique for allegedly hiring deminers destined for Cyprus on the basis of HIV results. In addition, Zimbabwe’s Southern Africa Demining Services Agency had to compensate deminers loaned to BACTEC International for South Lebanon operations in 2002 when the deminers were denied deployment on the basis of HIV tests.

Demining Control Points could carry HIV/AIDS Advocacy banners, reaching out to millions of people using roads being cleared of landmines in Africa.
Demining Control Points could carry HIV/AIDS Advocacy banners, reaching out to millions of people using roads being cleared of landmines in Africa.

The Solution

The World Health Organization, UNAIDS and the United Nations Population Fund recommend the implementation of mobile HIV/AIDS services targeting hard-to-reach populations, including deminers. The mobile-service efficacy for hard-to-reach populations has been demonstrated by the Uganda Program for Human and Holistic Development, the success of voluntary counseling and testing in United States Agency for International Development’s outreach services in Ethiopia, New Start Centres in Zimbabwe, and through the Journal of Acquired Immune Deficiency Syndrome’s report on increased voluntary counseling and testing uptake in mobile clinics as compared to “stand alone” clinics in Nairobi, Kenya. Similarly, the Tanzanian Military reports success stories for its four mobile HIV clinics established with the U. S. Military HIV Research Program in 25 camps along Tanzania’s Lake Zone.6

Feasibility and Benefits of Mobile HIV/AIDS Programs for Deminers

Having worked with thousands of deminers as a medical doctor from 1998 to the present, I have interacted with deminers in Luena and Menongue (Angola); Shilalo (Eritrea); Mukumbura (Mozambique); Garowe and Hargeisa (Somalia); Ed Damazin, Juba and Rumbek (Sudan); and the Gonarezhou National Park and the Zambezi Basin (Zimbabwe). I recommend implementing mobile HIV/AIDS programs for deminers for the following reasons:

Call for Mobile HIV/AIDS Services for Deminers in Sub-Saharan Africa

Motivated by the success stories of mobile HIV/AIDS services programs targeting hard-to-reach groups and the feasibility of an HIV/AIDS program for deminers, a group comprised of demining experts and medical doctors who had worked in demining for the past decade formed an initiative called The Demining HIV/AIDS Service Foundation in 2009. The Foundation, a nonprofit trust based in South Africa, was specifically created to mitigate the HIV/AIDS pandemic in Sub-Saharan Africa’s demining sector.

The Foundation is calling the mine-action community to partner with it in building up and implementing the following programs for deminers and landmine- impacted communities in Sub-Saharan Africa:

The author is grateful for the advice he received from Robert Kingsley of the Demining HIV/AIDS Service Foundation; LifeWorks (South Africa); the U.S. Centers for Disease Control; Cal Keagle of RONCO Consulting Corporation; Andy Smith of nolandmines.com; Trevor Thompson of Security Devices; Temba Kanganga of Southern Africa Demining Services Agency; Barry Vermeulen, Steve du Preez and Thinus Putter of Vanguard Demining Services Angola; and Johannes Van der Merwe of the World Bank and his wife, Hendrina Chitsama.

Endnotes

  1. “The origin of AIDS and HIV and the first cases of AIDS.” Avert. http://www.avert.org/origin-aids-hiv.htm. Accessed 2 November 2010.
  2. Landmine Monitor Report. 2007 (October 2007) and 2009 (October 2009). http://the-monitor.org. Accessed 19 October 2010.
  3. “Sub-Saharan Africa.” Aids Epidemic Update 2009 (November 2009). http://data.unaids.org/pub/Report/2009/
    JC1700_Epi_Update_2009_en.pdf
    . Accessed 19 October 2010.
  4. “Post exposure prophylaxis and pre-exposure prophylaxis.” Averthttp://www.avert.org/pep-prep-hiv.htm. Accessed 2 November 2010.
  5. “Landmine Removal: Restoring Land, Restoring Lives.” United Methodist Committee on Relief. http://gbgm-umc.org/umcor/stories/landmineremoval.stm. Accessed 29 October 2010.
  6. “Barrick Gold’s Tanzanian Corporate Health Responsibility: The Lake Zone Health Initiative.” Republic of Mining. Home to nine million residents, Tanzania’s Lake Zone wraps around Lake Victoria and spans seven regions, including the Kahama and Mara districts. http://www.republicofmining.com/2010/06/10/barrick-gold%E2%80%99s-collective-action-in-tanzania-the-lake-zone-health-initiative/. Accessed 2 November 2010.
  7. “Circumcision Gains Ground as Anti-AIDS Measure.” AolNews. http://www.aolnews.com/world/article/
    circumcision-gains-ground-as-anti-aids-measure/19280517
    . Accessed 24 September 2010.
  8. “Male Circumcision for HIV Prevention.” World Health Organization. : http://www.who.int/hiv/topics/malecircumcision/en/index.html. Accessed 2 November 2010.
  9. IMAS 10.40. Safety & occupational health - Medical support to demining operations, First Edition.UNMAS (1 October 2001). http://www.mineactionstandards.org/fileadmin/user_upload/MAS/documents/imas-international-standards/english/series-10/IMAS-10-40-Ed1-Am1.pdf Accessed 2 November 2010.

References

  1. Mine Action Centers Angola, Mozambique, DRC, Sudan, Chad
  2. Interagency Coalition on AIDS and Development
  3. UNAIDS HIV/AIDS Report 2009

Biography

Martin ChitsamaDr. Martin Chitsama is a medical doctor who holds Bachelor of Medicine and Bachelor of Surgery degrees and Executive HIV/AIDS Project Management qualifications. For the past 10 years, he has been Medical Adviser to demining operations in Eritrea, Mozambique, Somalia, Sudan and Zimbabwe. He also has experience in field operations with several international companies. Dr. Chitsama is currently the Senior Medical Adviser for Vanguard Demining Services in Angola.

 

Contact Information

Martin Chitsama, M.D
Senior Medical Adviser for Vanguard Demining Services in Angola
Demining HIV/AIDS Service Foundation
39 Paddock Way
Port Elizabeth / South Africa
Tel: +2786633681
Mobile: +002 449 2984 7110
Email: deminingdr(at)gmail.com
Website:  www.demininghivaids.com