The South African Security Forces Union is probably quite pleased with itself, having forced the SANDF to change its policy in respect of people with HIV.
In reality, the union has done us all, and its members in particular, a grave disservice; one that will sooner or later cost someone his or her life.
Advocate Gilbert Marcus is quoted as having told the Pretoria High Court, in arguing against the army’s exclusion of HIV-positive soldiers, that “this case is not about the relevance of HIV in the military context. The case is about the exclusion from recruitment, deployment and promotion of HIV-positive people, without any individual assessment of the state of their health”.
Mark Heywood of the Aids Law Project is quoted as saying, “It’s not like everyone loves combat, it’s that for many people, the military is a job”.
They both make a fundamental mistake: The key issue should have been the relevance of HIV in the military context; and military service is not “just a job”.
There is much that differentiates the military from other employment:
o Military personnel are subject to operational deployment;
o Military personnel are at risk of being wounded;
o Military personnel are expected to provide immediate aid to a comrade who is wounded.
It is primarily these factors that make HIV an issue that goes somewhat beyond any individual health assessment.
Deployment
Consider the realities of operational deployment.
Logistic support is always a difficult matter, and can be a nightmare in Africa: the distance to the theatre of operations and the distances within that theatre can be immense, which is complicated by road networks that are grossly inadequate at best and often an almost complete lack of infrastructure and little availability of even ordinary goods.
It will, therefore, not be a simple matter to ensure that there is a ready supply of ARVs and any related medication available at every base to which an HIV-positive soldier might be deployed.
It could also be extremely difficult to arrange quick replacement of medicines lost in an accident or to theft.
Supply flights are not a daily occurrence, are costly and can take time to arrange.
It is also not just a matter of getting the medicine from South Africa to the logistic hub of the peacekeeping force. It must still get from there to the South African unit, which will depend on priorities set by the Mission Headquarters and not by the unit, and then to the forward patrol base where the soldier is stationed.
All of that can prove to be an effectively impossible task if the weather closes the only available airfield, or if the one road to the base becomes insecure because of rebel ambushes and raids.
There can also be other difficulties. The Sudanese government, for example, will only allow medicines approved by their own authorities to be delivered to units serving with the AU/UN force in Darfur.
Worse, they require the complete waybill of every flight two weeks ahead of time, and will not allow even minor changes.
Let us assume for the moment that the actual supply of medication can be assured. We must now still ensure that the soldier always has sufficient medication with him. But patrols and operations often run longer than anticipated and move into areas outside the original planning.
Moving to a worst case situation, what happens when a patrol is ambushed and must abandon its personal kit?
In such circumstances it is not unusual for soldiers to be on their own for several days before being able to rejoin their own forces.
What happens to the HIV-positive soldier whose medication is lying in his abandoned pack? Even in a case where the soldiers win the fight and return to their kit, it may well by then have been picked up by the opposing forces or stolen by local civilians.
One might, of course, argue that HIV-positive soldiers could be held back in the bases and not sent on patrol. That would be grossly unfair to the other soldiers.
It would also not be the perfect solution: not so long ago a Nigerian Army company was forced out of its base in Darfur by guerrillas, some of its soldiers being dispersed for several days before being rescued by other patrols.
Clausewitz said that “everything in war is simple, but simple things are very difficult to do”.
In theory, it is a simple matter to ensure that an HIV-positive soldier always has his medication to hand. In practice it may not be so simple at all.
There are other aspects: How to ensure that the deployed soldier sticks religiously to his medication regimen? How to deal with unexpected side-effects of the medicines?
What is the impact of stress, irregular and poor diet, extreme temperature gradients and lack of personal hygiene?
Those are all problems that are normal during operations.
There is also, of course, another potential problem: what happens to the HIV-positive soldier who is captured?
That does happen, even in peace support operations. If he is captured by regular forces there will be some chance of ensuring access to medication once he is away from the front area. If he is being held by bandits, rebels or terrorists, the chance of that is close to zero.
Wounds
By far the greatest danger, however, lies in the little technical problem that the soldier is at risk of being wounded.
The first step is always “buddy aid”, his comrades stop the bleeding, cover the wound to keep dirt out, and so on.
Will they be willing to do that for a soldier known to carry HIV?
Bear in mind that real wounds can be very different from those shown in the movies. The effects of high-velocity bullets, large artillery fragments and blast can be very messy indeed. Large, open wounds and massive bleeding are not unusual.
Worse, most of the soldiers around the victim are likely to have minor injuries, ranging from cuts caused by moving fast through rough terrain, through bullet splash and small splinter wounds, to small but quite bad burn injuries.
The soldier rushing to aid a wounded comrade is not going to have latex gloves and other protective equipment. He runs a very real risk of his open wounds being soaked with the wounded soldier’s blood and body fluids.
That is before we even consider mouth-to-mouth resuscitation for a soldier who may have been wounded in the face, neck or lungs.
It gets worse: It is not unusual in heavy combat for a soldier to be hit by a spray of blood from a wounded comrade, or even by pieces of tissue of a soldier blown up by a shell or mine.
Again, there is no protective clothing and there is no mask to keep blood out of eyes and mouth.
There is also the question of getting a wounded and perhaps burned soldier out of a knocked-out combat vehicle. That will at times be impossible to do without becoming covered in the blood and tissue of other crew members who may have been killed by the shell that hit the vehicle.
Evacuation
Nor will the medical orderlies that work directly with the troops be much better off. Yes, the medic will have latex gloves, a resuscitation device and perhaps even a face mask. But will there always be time to pull the gloves on? More to the point, will he have time to change gloves between treating different wounded soldiers, or will he be transferring blood, fluids and tissue from one wounded soldier to another?
Evacuating wounded soldiers under combat pressure can also be messy. There will be times when wounded soldiers are piled higgledy-piggledy into whatever vehicle is at hand, to get them out of the contact area and to where they can be treated. They will be lying in each other’s blood and fluids.
It is all very well to complain that the SANDF’s policy is unconstitutional, and to say “this case is not about the relevance of HIV in the military context”, but we need to be clear in our minds that the changes that are being forced on the SANDF will kill some of our soldiers sooner or later.
The union and its lawyers may enjoy their posturing now, but will they be there to stand up and explain when someone asks why their son or daughter was infected with HIV while helping a wounded comrade?
Or why that son or daughter died bleeding and screaming on the ground because no one would take the risk of infection and help them?
Or why a son or daughter died because the essential medication could not be supplied, or because unexpected side-effects could not be treated?
I expect not.
As a country we must take a more responsible view. We have a responsibility to our soldiers not to risk their health and their lives unnecessarily.
Putting someone who is HIV-positive into a situation where essential medication cannot be guaranteed, where there is a real risk of him or her being wounded, is not responsible. That is placing the health and life of that soldier and those of his or her comrades at unnecessary risk.
And that is immoral.