The U.S. Defense Department's newest regional military headquarters, U.S. Africa Command, is set to streamline a range of operations and step up health care services in a part of the world where national security and infectious disease are inextricably linked.

Declared a full unified command October 1, U.S. Africa Command has a mission--"sustained security engagement"-- which it will carry out "with other U.S. agencies and international partners," a fact sheet says, through military-to-military programs, military-sponsored activities and other operations that support U.S. foreign policy by promoting a stable and secure Africa.

Until October 1, U.S. military involvement on the continent was divided among the U.S. European Command in Germany, Central Command in Florida and Pacific Command in Hawaii. AFRICOM is responsible for U.S. military operations in Africa and military relations with 53 African nations, with the exception of Egypt.

"AFRICOM was created out of the belief that the key to long-term success and stability of African partners is a strong, independent and loyal military structure," said Erik Threet, of the AFRICOM Strategy, Plans and Programs Directorate during a September 23 panel discussion in Washington, "one that understands its role is to support civilian rule rather than dominate it."

U.S. agencies involved with AFRICOM include the U.S. Agency for International Development and the departments of State, Treasury, Homeland Security and Justice. The command is currently based in Stuttgart, Germany.

BEFORE AND AFTER HIV/AIDS

Military health programs have been helping people on the African continent since 1946, when the U.S. Naval Medical Research Unit No. 3 (NAMRU-3) began operations in Cairo, Egypt, working closely with the Egyptian Ministry of Health to study typhus and other endemic diseases that affected deploying service members.

Today, NAMRU-3 is a regional reference laboratory for viral disease diagnostics for the World Health Organization and is home to three public health officers from the U.S. Centers for Disease Control and Prevention who are expanding surveillance for acute respiratory illness in several Egyptian hospitals.

NAMRU-3 also has a detachment in Accra, Ghana, said Captain Sybil Tasker of NAMRU-3, and a smaller detachment in Afghanistan.

The U.S. Army Medical Research Unit-Nairobi opened in 1969 at the invitation of the Kenyan government as a special foreign activity of the Walter Reed Army Institute of Research in Maryland. Through a cooperative agreement with the Kenya Medical Research Institute, scientists there conduct research on malaria and other diseases.
Sub-Saharan Africa has just more than 10 percent of the world's population but is home to more than 60 percent of all people living with HIV, the virus that causes AIDS.
"The Department of Defense HIV/AIDS Prevention Program, otherwise known as DHAPP," said Theresa Whelan, DOD deputy assistant secretary for African affairs, "has been in existence since the late 1990s, when Congress first authorized the department to expend dollars specifically in Africa to address the problem of HIV/AIDS" among African military members.

The concern, she said, was that HIV/AIDS was being addressed in civilian but not military populations.

ROOT CAUSE

Since 2002, said Colonel Jerome Kim of the Walter Reed Army Institute of Research, "the spread of HIV and its impact on [African] nations has been viewed by the U.S. national security strategy as a humanitarian and a national security priority. With the inception of the President's Emergency Plan for AIDS Relief [PEPFAR], the U.S. military has participated in HIV prevention, care and treatment activities in targeted countries."

When PEPFAR began working in Africa in 2004, Tasker said, the DHAPP program already was working closely with militaries throughout PEPFAR's 15 focus countries, 13 of which are in Africa.

"We engage through the office of military cooperation in the U.S. embassies in each country," Tasker said, "then often execute programs through grants or contracts at universities or local and international nongovernmental organizations [NGOs]."
In 2007, DHAPP had a budget of $68 million and was working with military organizations in 70 countries. In Africa alone in 2007, DHAPP reached just under 500,000 military members and family members with comprehensive prevention messages and trained more than 7,000 peer trainers.

More than 100,000 people were tested for HIV and received counseling, and nearly 18,000 women received maternal-to-child transmission prevention services that included testing. Sixty-three laboratories received equipment or laboratory chemicals and nearly 19,000 patients are on anti-retroviral therapy through military hospitals.
"In the region," Tasker said, "militaries are sometimes the only providers of health care, especially away from capitals and major cities. In many countries, military hospitals have more beds or care delivery than ministry of health facilities do. They also have security and logistical capability that may enable health care to be delivered in times of conflict."

Service members who return home to remote rural villages or inner-city communities, Tasker added, often can bring prevention messages into places where access may be difficult or impossible for NGOs.

In Africa, the Defense Department partners with traditional health care delivery agencies, including academia and NGOs, to make use of their technical expertise in social marketing and preventive health education.
"Militaries, even some foreign military leaders that you wouldn't expect," Tasker said, "realize that the root cause of HIV in their military force that is keeping their soldiers sick and unable to do their jobs is poverty, hunger, gender inequity and lack of education. [Addressing such problems] is where the NGO and academic communities have expertise."