Context
The global HIV/AIDS epidemic continues to have a significant impact on the armed forces of many countries, compromising their operational capability, limiting deployment opportunities, and causing both physical and emotional repercussions for infected military personnel and their families. These challenges pose risks not only for military personnel, but also for the surrounding communities, which depend on the stability and security provided by our armed forces.
In 2000, several African armies were severely affected by HIV, with prevalence rates ranging from 15% to 60% among infected soldiers, posing a threat to global stability and security. In response, the United Nations adopted eight key resolutions, including resolutions 1308 and 1325 (2000), 1820 (2008), 1888, 1889 and 1894 (2009), 1960 (2010) and 1983 (2011), which address HIV/AIDS issues in armed forces, whether in external operations (OPEX) or internal operations (OPIN).
In response to this challenge, the U.S. Department of Defense (DoD), through the President's Emergency Plan for AIDS Relief (PEPFAR), has been committed since 2002 to supporting HIV/AIDS prevention and control initiatives in more than 50 countries, including Senegal. In 2020, the National Alliance of Communities for Health (ANCS) was chosen to ensure the technical and financial management of grants dedicated to the Senegalese Armed Forces, thus consolidating this strategic partnership.
HIV/AIDS Programme of the Senegalese Armed Forces
Since 2020, this collaboration between the Ministry of the Senegalese Armed Forces, the National Alliance of Communities for Health and PEPFAR has made it possible to implement innovative prevention and care strategies for military personnel living with HIV, while contributing to the national HIV response effort. The progress made is the result of an effective communication strategy aimed at promoting behavioural change, combined with a comprehensive, well-structured prevention and care policy supported by the military authorities and the gendarmerie.
In 2006, HIV prevalence in the Senegalese armed forces was 0.7%, compared with 0.74% in the general Senegalese population (EDS, 2006). By 2016, it had fallen to 0.3%, compared with 0.5% for the general population (ENSC, 2015). More recent data from screening activities indicate an even lower prevalence of 0.18% in 2021.
Objectives of the programme
The program aims to strengthen the institutional, technical and administrative capacity of the armed forces' health services to respond effectively to the HIV/AIDS epidemic. It also aims to improve the management of resources allocated to this fight, while strengthening military medical centers to offer quality services in HIV/AIDS prevention, care and treatment. The direct beneficiaries are soldiers and gendarmes, but also their families and the surrounding communities, who benefit from the services offered at the military sites.
System and areas of intervention
The HIV/AIDS Programme in the Armed Forces is based on the military health system, which is made up of Joint Medical Centres (CMIA), Garrison Medical Centres (CMG) and Social Medical Centres (CMS). Interventions are focused on four main areas:
- Prevention Promoting safer behaviour and distributing condoms.
- Screening Voluntary tests at the initiative of service providers and targeted at military sites.
- Treatment : Initiation and monitoring of antiretroviral (ARV) treatment and treatment maintenance.
- Strengthening the health system Improving the infrastructure and medical capabilities of the armed forces to provide better care for patients living with HIV...
The stakeholder sociogram below highlights all the players who interact in the implementation of the programme.
This system, supported by the partners, enables a coherent and effective response to the epidemic within the armed forces, thereby contributing to national public health.
Prevention component
Prevention activities targeted priority groups, including new military recruits, contingents awaiting deployment on external operations, and those operating in high-risk areas. At the same time, awareness-raising activities were carried out among military families, in collaboration with FEGAFFAMIS (Fédération des Épouses et Familles des Forces Armées du Sénégal).
In total, the talks and awareness sessions reached around 6,598 people each year at the Joint Medical Centres (JMCs) and Garrison Medical Centres (GMCs), both military and civilian. This figure represents almost 115% of the annual target set. In addition, every year, around 6,000 new recruits at the Bango camp, as well as 1,200 gendarmes from training schools and special units (GARSI and ESI), have benefited from awareness-raising campaigns on safer behaviour, accompanied by the distribution of condoms.
Screening component
The screening strategy is based primarily on index testing and provider-initiated screening. The CMIAs and CMGs play a central role in offering confidential screening services tailored to the needs of military personnel and people living in the vicinity of military sites.
The coverage rate for the screening indicator regularly exceeds 110% per year, demonstrating solid performance. This reflects the positive relationship between the number of people newly diagnosed as HIV-positive and the number of people who have received HIV screening services and their test results.
Achievement of military target indicators
In addition, the armed forces AIDS programme has fully achieved the UNAIDS ‘95’ targets: 95% of soldiers living with HIV know their status, 95% of those diagnosed receive treatment, and 95% of soldiers on treatment have an undetectable viral load.
Treatment component
The final target of the UNAIDS ‘95-95-95’ initiative, which aims for 95% of people on antiretroviral therapy (ART) to have their viral load sustainably suppressed by 2025, represents a major challenge for Senegal. This indicator is essential for assessing the extent of uptake and retention in ART programmes, and measures progress towards universal ART coverage for HIV-positive people.
Achieving this objective depends on strengthening medical capacity by increasing the supply of viral load measurement services at the peripheral level, as well as providing resources for storing and transporting samples.
Thanks to support from the Global Fund, reference laboratories meeting international standards have been set up at the Ouakam military hospital and the CMIA in Ziguinchor. These laboratories play an essential role in the management and monitoring of viral load at national level.
The results for people newly diagnosed and enrolled in treatment programmes are encouraging, with a 100% target achievement rate. This also includes the success of ‘linkage to care’, which ensures that newly diagnosed people initiate treatment in line with the ‘Test and Treat’ policy.
However, these achievements, while remarkable, remain fragile in the face of the increase in new infections in the general population. If this trend goes unchecked, it could ultimately have a negative impact on military barracks. It is therefore essential that we continue and intensify our efforts to maintain and build on the progress made to date.
