    U.N. Peacekeeping: United Nations Faces Challenges in Responding
    to the Impact of HIV/AIDS on Peacekeeping Operations (12-DEC-01,
    GAO-02-194).

    The United Nations (U.N.) Security Council passed a resolution in
    July 2000, expressing serious concerns that the increased risk of
    Human Immunoficiency Virus/Acquired Immunodeficiency Syndrome
    (HIV/AIDS) could adversely affect peacekeeping missions. The
    resolution noted that conflict and instability produce large
    movements of people and reduced access to medical care, which
    increases the risk of HIV transmission. The resolution encouraged
    member states to provide HIV prevention training to peacekeeping
    personnel, including those who may be HIV positive. The U.N.
    Department of Peacekeeping Operations' policies and guidance
    discourage, but do not preclude, countries from sending
    individuals who are HIV-positive on peacekeeping missions because
    they could potentially become a source of HIV infection for local
    populations. This is consistent with the U.N. peacekeeper's code
    of conduct to do no harm. The Department's policy does not
    preclude deployment of individuals with HIV, which is consistent
    with U.N. policy to opposes discrimination against HIV-infected
    individuals. The number of HIV-positive peacekeepers is unknown
    because (1) the U. N. opposes mandatory HIV testing and therefore
    collects no information on prevalence rates, and (2) countries
    that contribute peacekeepers either do not test or do not share
    test results with the U.N. The U. N. has attempted reduce the
    potential spread of HIV/AIDS during peacekeeping operations, but
    it faces immediate and long-term challenges. The U.N.'s effort to
    provide HIV/AIDS assistance to civilians affected by conflict
    also faces difficulties. Although the United Nations has begun to
    address the spread of HIV/AIDS among civilians affected by
    conflict, U.N. officials stated that it has not given adequate
    priority to this effort and has difficulty obtaining funding for
    HIV prevention activities. Furthermore, little action has been
    taken to assist civilian populations at risk of HIV transmission
    from U.N. peacekeepers.
    -------------------------Indexing Terms-------------------------
    REPORTNUM:   GAO-02-194
        ACCNO:   A02569
      TITLE:     U.N. Peacekeeping: United Nations Faces Challenges in
    Responding to the Impact of HIV/AIDS on Peacekeeping Operations
         DATE:   12/12/2001
      SUBJECT:   Acquired immunodeficiency syndrome
    	     Federal aid to foreign countries
    	     Foreign aid programs
    	     Health care programs
    	     International cooperation
    	     International organizations
    	     Program evaluation
    	     Reporting requirements
    	     Policy evaluation
    	     Foreign policies
    	     Peacekeeping
    	     Africa
    	     Joint United Nations Programme on
    	     HIV/AIDS
    	     Peacekeeping Operations Program
    	     UN Children's Fund
    	     UN Population Fund

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    GAO-02-194

    A

    Report to the Chairman, Committee on International Relations, House of
    Representatives

    December 2001 U. N. PEACEKEEPING United Nations Faces Challenges in
    Responding to the Impact of HIV/ AIDS on Peacekeeping Operations

    GAO- 02- 194

    Letter 1 Results in Brief 2 Background 3 Department of Peacekeeping?s Policy
    Discourages but Does Not Preclude Deployment of HIV- Positive Peacekeepers 5

    The United Nations Does Not Know How Many Peacekeepers Have HIV 6 U. N.
    Efforts to Address the Impact of HIV/ AIDS on Peacekeepers

    Face Challenges 10 U. N. ?s Effort to Provide HIV/ AIDS Assistance to
    Civilians Affected by Conflict Faces Difficulties 15

    Conclusions 17 Recommendations for Executive Action 17 Agency Comments 18

    Appendixes

    Appendix I: Objectives, Scope, and Methodology 20

    Appendix II: U. N. Peacekeepers by Country, September 2001 22

    Appendix III: Information Available on U. N. Peacekeeping Forces and HIV/
    AIDS 24

    Appendix IV: HIV/ AIDS Activities of U. N. Agencies 25

    Appendix V: Comments From the Department of State 28

    Appendix VI: Comments From UNAIDS 30

    Appendix VII: GAO Contact and Staff Acknowledgments 35 GAO Contact 35
    Acknowledgments 35

    Figures Figure 1: Ongoing U. N. Peacekeeping Missions 4 Figure 2: HIV/ AIDS
    Awareness Card for U. N. Peacekeepers 12

    Tables Table 1: Contribution Levels to U. N. Peacekeeping Operations From
    Countries With HIV/ AIDS Prevalence Greater Than 5 Percent 9

    Abbreviations

    AIDS Acquired Immunodeficiency Syndrome DOD Department of Defense DPKO
    Department of Peacekeeping Operations FHI Family Health International HIV
    Human Immunodeficiency Virus OCHA Office of the Coordinator for Humanitarian
    Affairs UNAIDS Joint United Nations Programme on HIV/ AIDS UNDP United
    Nations Development Programme UNFPA United Nations Fund for Population
    Activities UNHCR United Nations High Commissioner for Refugees UNICEF United
    Nations Children?s Fund UNIFEM United Nations Development Fund for Women
    USAID U. S. Agency for International Development WFP World Food Programme
    WHO World Health Organiztion

    Lett er

    December 12, 2001 The Honorable Henry J. Hyde Chairman, Committee on
    International Relations House of Representatives

    Dear Mr. Chairman: In July 2000, the United Nations Security Council passed
    a resolution expressing serious concern that the increased risk of Human
    Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome (HIV/ AIDS) in
    conflict situations could adversely affect peacekeeping missions. The
    Security Council resolution noted that an environment of conflict and
    instability produces large movements of people and reduced

    access to medical care, which increases the risk of HIV transmission. The
    resolution expressly encouraged member states to provide HIV prevention
    training to peacekeeping personnel, including those troops who may be HIV
    positive. In January 2001, the U. S. Ambassador to the United Nations

    expressed concern that the United Nations had not yet initiated an adequate
    response to the Security Council?s concerns and, in particular, the risk of
    transmission between peacekeepers and civilian populations. Given the
    importance of U. N. peacekeeping efforts to U. S. foreign policy goals and
    the approximately $700 million contributed to the United Nations by the
    United States for these efforts in fiscal year 2001, you expressed

    concern that HIV/ AIDS infection could undermine the effectiveness of U. N.
    peacekeeping operations. This report responds to your request that we
    examine U. N. efforts to mitigate the potential impact of HIV/ AIDS on its

    peacekeeping missions. In this report, we (1) analyze U. N. policies and
    guidance on the use and deployment of peacekeepers with HIV, (2) examine the
    data available on HIV/ AIDS prevalence rates among peacekeepers, (3) assess
    actions the United Nations is taking to limit the spread of HIV/ AIDS among
    peacekeepers, and (4) examine the actions the United Nations is taking to
    limit the impact of HIV/ AIDS on civilians affected by armed conflict,
    including groups who may come into contact with peacekeepers.

    As part of our review, we analyzed documents and interviewed key officials
    from the U. N. Department of Peacekeeping Operations, the Joint United
    Nations Programme on HIV/ AIDS, the World Health Organization, the United
    Nations Children?s Fund, the U. N. Population Fund, and other U. N.
    agencies. We also obtained perspectives on U. N. policies and activities

    from officials of the State Department and the Department of Defense. In
    addition, we researched and reviewed the limited data available on HIV
    prevalence rates for the uniformed services. Appendix I provides a more
    detailed description of our scope and methodology.

    Results in Brief The U. N. Department of Peacekeeping Operations? policies
    and guidance discourage, but do not preclude, countries from sending
    individuals who are HIV- positive on peacekeeping missions. The Department
    discourages

    the deployment of members of uniformed forces with HIV for a number of
    reasons, including the concern that peacekeepers could potentially become a
    source of HIV infection for local populations. This concern is consistent
    with the U. N. peacekeeper?s code of conduct to do no harm. The Department?s
    policy does not preclude deployment of individuals with HIV, which is
    consistent with U. N. policy that opposes discrimination against HIV-
    infected individuals. The number of HIV- positive peacekeepers is unknown
    because (1) the United Nations opposes mandatory HIV testing and therefore
    collects no information on prevalence rates, and (2) the countries that
    contribute peacekeepers either do not test or do not share test results with
    the United Nations. Without data on the HIV status of peacekeepers, the
    Department of Peacekeeping Operations is unable to determine if countries
    are

    following its recommendation that HIV- infected individuals should not
    become U. N. peacekeepers. Despite the absence of data, U. N. and U. S.
    government officials have expressed concern that peacekeepers may contract
    or transmit the virus during peacekeeping operations. According

    to U. N. officials, this concern is based on the belief that peacekeepers
    tend to be sexually active, engage in risky behaviors, and are likely to
    have contact with commercial sex workers, who are known to have high rates
    of HIV/ AIDS.

    The United Nations has taken a number of actions to reduce the potential
    spread of HIV/ AIDS during peacekeeping operations, but it faces immediate
    and long- term challenges to its initiatives. The Department of Peacekeeping
    Operations and the Joint United Nations Programme on HIV/ AIDS developed an
    HIV/ AIDS awareness card for peacekeepers to carry in their uniform pocket.
    The Department included HIV/ AIDS awareness in its peacekeeping train- the-
    trainer program and has provided contingents with five condoms per
    peacekeeper per week. However, it is not clear whether all U. N. contingents
    will adopt the awareness card as a permanent part of their uniform or
    whether current HIV/ AIDS awareness

    and prevention training is adequately sensitive to the cultural differences
    of contingents under U. N. command. In addition, the United Nations will be
    unable to evaluate the effectiveness of its initiatives because it does not
    collect baseline data on peacekeeping troops? knowledge and awareness of
    HIV/ AIDS or their sexual behavior.

    The U. N. ?s effort to provide HIV/ AIDS assistance to civilians affected by
    conflict also faces difficulties. Although the United Nations has begun to
    address the spread of HIV/ AIDS among civilians affected by conflict, U. N.
    officials stated that it has not given adequate priority to this effort and
    has had difficulty obtaining funding for HIV prevention activities.
    Furthermore, the United Nations has taken little action to assist civilian
    populations

    specifically at risk of HIV transmission from U. N. peacekeepers. This
    report makes recommendations to improve the U. N. ?s ability (1) to measure
    the effectiveness of activities aimed at reducing risky behaviors among
    peacekeepers and (2) to identify which contingents are at highest risk of
    transmitting or contracting sexually transmitted infections, including HIV,
    at each mission.

    We received comments on a draft of this report from the U. S. Department of
    Defense (DOD), the U. S. Department of State, and the Joint United Nations
    Programme on HIV/ AIDS (UNAIDS). DOD officials stated that the report
    accurately assesses the current situation with regard to HIV prevalence
    among U. N. peacekeepers and that they agreed with our recommendations. The
    Department of State summarized actions it is undertaking to respond to HIV/
    AIDS in conflict situations. UNAIDS agreed

    with our recommendations, however, they disagreed with our characterization
    of the U. N. ?s overall effort to address HIV/ AIDS in emergencies as
    inconsistent. Although UNAIDS considers meetings with its cosponsors that
    addressed vulnerable populations as demonstrating

    consistency in the U. N. ?s approach, few concrete actions have been taken
    to date. Background The U. N. Department of Peacekeeping Operations (DPKO)
    serves as the operational arm of the U. N. Secretary General for all U. N.
    peacekeeping

    operations and is responsible for conducting, managing, directing, planning,
    and preparing those operations. DPKO is currently operating 15 peacekeeping
    missions, as shown in figure 1, at a budgeted cost of approximately $2. 7
    billion for 2001. As of September 2001, 88 countries were contributing 46,
    957 military and civilian police personnel, and

    countries are reimbursed about $1, 000 per peacekeeper per month for
    contributing to these missions. (See app. II for a list of the countries
    contributing U. N. peacekeepers as of September 2001.) The United States

    currently contributes 732 peacekeepers and pays for 25 percent of the total
    cost of peacekeeping operations. Three U. N. peacekeeping missions are in
    sub- Saharan Africa, where more than 25. 3 million people have HIV/ AIDS.

    Figure 1: Ongoing U. N. Peacekeeping Missions India & Pakistan Western

    Bosnia & Croatia

    Lebanon 1949-

    Sahara Herzegovina

    1996- 1978- 1991-

    1995- Iraq/ Kuwait

    Kosovo Georgia

    1991- East Timor 1999-

    1993- 1999-

    Golan Heights 1974-

    Cyprus 1964-

    Middle East 1948-

    Sierra Democratic

    Ethiopia & Leone

    Republic of Eritrea

    1999- the Congo

    2000- 1999-

    Source: U. N. Department of Public Information, Aug. 2001.

    We recently reported that several challenges hinder the ability of the
    international community to address the growing HIV/ AIDS pandemic, including
    limited funding for programs, cultural impediments to program effectiveness,
    and weak national health care systems. 1 Conflicts exacerbate these
    challenges because the organizations that deliver

    HIV/ AIDS prevention and awareness programs are unable to function normally.
    In these situations, vulnerable populations- including refugees, internally
    displaced persons, orphans, ex- combatants, commercial sex workers, and war-
    affected local civilians- face increased risk of exposure to HIV. 2
    Refugees, internally displaced persons, and orphans are particularly
    vulnerable to HIV infection because they are at high risk of sexual violence
    and exploitation and because they may use sex as a commodity to survive.
    Peacekeeping missions bring peacekeepers in close proximity to these

    populations. In resolution 1308, passed in July 2000, the U. N. Security
    Council recognized that in conditions of conflict, violence, and instability
    there is increased risk of exposure to HIV. Resolution 1308 encouraged U. N.

    agencies to take action with member states to develop strategies to mitigate
    the spread of HIV/ AIDS in peacekeeping missions. In addition, the
    resolution directed the Secretary General to take additional steps to
    develop and provide training to peacekeepers on HIV/ AIDS awareness.

    Department of DPKO recommends that countries contributing to U. N.
    peacekeeping

    Peacekeeping?s Policy operations should not send HIV- positive individuals
    on peacekeeping missions for three reasons. First, medical treatment
    available during the Discourages but Does peacekeeping mission may not be
    adequate to meet the special Not Preclude requirements of peacekeepers with
    HIV. Second, peacekeepers may have Deployment of HIVPositive

    to undergo predeployment vaccinations and may be exposed to diseases during
    deployment, both of which pose additional risks to their health.
    Peacekeepers

    Third, the presence of HIV- positive peacekeepers poses the risk of 1 See
    Global Health: U. S. Agency for International Development Fights AIDS in
    Africa, but Better Data Needed to Measure Impact (GAO- 01- 449, Mar. 23,
    2001). 2 A refugee is a person who, owing to a well- founded fear of being
    persecuted for reasons of race, religion, nationality, membership in a
    particular social group, or political opinion, lives outside the country of
    his or her nationality. Internally displaced persons are those forced to
    flee their homes because of armed conflict and persecution but who remain in
    their own

    country.

    transmission to medical personnel, fellow peacekeepers, and the civilian
    population.

    DPKO officials point to the third factor as weighing heavily in their
    recommendation not to deploy HIV- positive individuals. The U. N. Code of
    Conduct for Peacekeepers, although it does not address specific sexual
    conduct, states that peacekeepers should do no physical, sexual, or
    psychological harm. To minimize the risk of spreading HIV to the local
    population in the peacekeeping zone, DPKO officials recommend that
    individuals with HIV not be sent on peacekeeping missions.

    While DPKO policy recommends against deploying individuals with HIV, its
    policy also states that those who do not show clinical manifestations of
    AIDS are not precluded from peacekeeping service. Therefore, DPKO

    policy is consistent with the overall policy of the United Nations, which
    has gone on record in several documents expressing its concern for the human
    rights of individuals with HIV/ AIDS and taking a stand against
    discrimination against such individuals. Specifically, the General Assembly
    in a December 1991 resolution (Res. A/ RES/ 46/ 203) urged U. N. member

    states to avoid taking discriminatory action against individuals with HIV in
    employment. In addition, the United Nations has stated that, in general, a
    public health exception to the principle of nondiscrimination, even in the
    case of HIV/ AIDS, is seldom a legitimate basis for restrictions on human
    rights. U. N. guidelines state that mandatory testing or registration for
    HIV status is not justified on public health grounds. 3 Finally, the U. N.
    ?s personnel policy states that (1) the only medical criterion for
    recruitment is

    fitness to work; (2) HIV infection does not, in itself, constitute a lack of
    fitness to work; (3) there will be no HIV screening of candidates for
    recruitment; and (4) there should be no obligation on the part of the
    employee to inform the employer about his or her HIV/ AIDS status.

    The United Nations The United Nations does not know how many peacekeepers
    have HIV/ AIDS

    Does Not Know How because it opposes mandatory HIV testing before, during,
    or after

    deployment to a peacekeeping mission and because contributing countries Many
    Peacekeepers either do not test or do not share test results with the United
    Nations. Have HIV

    Officials remain concerned that peacekeepers with the infection may be
    deployed on peacekeeping operations, especially the approximately 14

    3 See HIV/ AIDS and Human Rights: International Guidelines (New York and
    Geneva: United Nations, 1998).

    percent of peacekeepers that come from countries with high HIV/ AIDS
    prevalence rates, such as Nigeria and Kenya. Even if they are not infected
    before deployment, peacekeepers- like other military personnel- are likely
    to engage in behaviors such as unsafe sexual practices that increase the
    risk of contracting and spreading HIV. The United Nations Does The United
    Nations opposes mandatory testing of peacekeepers for HIV

    Not Collect Data on the HIV before, during, or after deployment to a
    peacekeeping operation. It Status of Peacekeepers

    therefore does not know whether countries are sending HIV- positive
    individuals to peacekeeping operations or how many individuals with HIV or
    AIDS make up its peacekeeping forces. As a result, while the media have
    reported a handful of cases of peacekeepers spreading or contracting HIV,
    there is little direct information on the extent of HIV transmission in
    peacekeeping operations. (See app. III for a description of the information

    available.) Furthermore, because the United Nations opposes mandatory
    testing 4 and because contributing countries retain control over their own
    forces, DPKO cannot direct countries to test or keep data on HIV prevalence
    among their peacekeeping forces. HIV testing policies vary widely among
    contributing countries. 5 Some contributing countries do not test their
    personnel for HIV and have no data to share with the United Nations. For
    example, according to DPKO and the Department of Defense (DOD), the United
    Kingdom, the Netherlands, and Nigeria, among other countries, do not screen
    military personnel for HIV. Also, Zambia?s military, which at one time
    conducted testing and screening

    for HIV, is no longer financially able to do so. Together, these four
    countries account for about 11 percent of current peacekeeping forces.

    Some militaries test their troops intermittently and may test peacekeepers
    before, during, or after a peacekeeping operation. However, data from these
    tests are not always shared with the United Nations. For example, according
    to DOD, South Africa has conducted HIV testing of its rapid

    deployment force used for peacekeeping operations, although it is unknown if
    any of these individuals were precluded from peacekeeping 4 The Executive
    Director of UNAIDS has requested an expert panel to revisit the issue of the
    U. N. policy on HIV testing in the context of peacekeeping operations, which
    will result in the publication of an updated policy and a report to the U.
    N. Secretary General.

    5 We were unable to determine the testing policies of all 88 contributing
    countries.

    service. According to a member of the UNAIDS Steering Committee on HIV/ AIDS
    and Security, countries may consider this information vital to national
    security because it could be considered a strategic weakness. In addition,
    countries might not release this information because doing so

    may jeopardize both their standing as peacekeeping contributors and the
    revenue they receive in return for their participation. On the other hand,
    an HIV/ AIDS expert at DOD, who works closely with militaries, stated that
    even those countries that test may not know the HIV/ AIDS prevalence rates

    of their militaries because they do not capture, store, or analyze the data
    that result from the tests. Some Peacekeepers Come

    Although the United Nations does not know how many peacekeepers have From
    Countries With High HIV, many come from countries with relatively high HIV
    prevalence among

    HIV Prevalence Rates the general population, leading to expectations of high
    prevalence among the military, including peacekeepers. UNAIDS estimates that
    military

    personnel are two to five times more likely than civilians to contract a
    sexually transmitted infection, including HIV. In addition, according to the
    National Intelligence Council, HIV prevalence in African militaries is
    considerably higher than that of the general population. For example, the
    Council estimates that between 10 and 20 percent of Nigeria?s military is

    HIV- positive, compared to a 5- percent prevalence rate for the general
    population. Nigeria is the largest African contributor to U. N. peacekeeping
    operations. More than 14 percent of peacekeepers come from countries where
    the adult HIV prevalence rate is greater than 5 percent (see table 1).
    According to public health experts, prevalence levels this high make it
    significantly more likely that uninfected persons in the population will be
    exposed to the infection. The higher the prevalence rate in a population,
    the more rapidly the infection will spread. The situation is most pronounced
    in Sierra Leone, where 32 percent of peacekeepers originate from countries
    with HIV prevalence rates greater than 5 percent.

    Table 1: Contribution Levels to U. N. Peacekeeping Operations From Countries
    With HIV/ AIDS Prevalence Greater Than 5 Percent

    Number of peacekeepers

    Percentage of from countries

    peacekeepers from Total number of

    with prevalence countries with

    U. N. peacekeeping peacekeepers

    greater than 5 prevalence greater

    operation as of Sept. 2001

    percent than 5 percent

    Sierra Leone 16, 630 5, 267 32% Ethiopia and Eritrea 3, 920 674 17 East
    Timor 9, 562 335 4 Kosovo 4, 305 213 5 Democratic Republic of

    2, 393 185 8 Congo Western Sahara 258 16 6

    Iraq/ Kuwait 1, 097 8 <1 Bosnia/ Herzegovina 1, 672 7 <1 Croatia 26 2 8
    Lebanon 4, 470 0 0 Cyprus 1, 272 0 0 Golan Heights 1, 036 0 0 Middle East
    153 0 0 Georgia 106 0 0 India and Pakistan 45 0 0

    Tot al 46, 945 a 6,707 14%

    a This total does not include the 12 peacekeepers remaining at the completed
    operation in Guatemala. Sources: UNAIDS Report on the Global HIV/ AIDS
    Epidemic, June 2000; DPKO's Monthly Summary of Military and Civilian Police
    Contribution to United Nations Operations for Sept. 30, 2001.

    Conditions Are Conducive Peacekeepers operate in an environment where
    exposure to HIV is more

    to the Spread of HIV/ AIDS in likely. Because peacekeepers often have money
    to spend, commercial sex Peacekeeping Operations

    workers, known to have high rates of HIV infection, migrate to areas where
    peacekeepers are deployed. For example, in Ethiopia, where a U. N.
    peacekeeping operation is ongoing, sex workers were found to have HIV
    prevalence rates exceeding 70 percent. In addition to the presence of
    commercial sex workers, peacekeeping operations are surrounded by
    populations of orphans, internally displaced persons, and refugees.
    According to UNAIDS, these populations may have sold sex to survive and

    may have been the victims of rape or sexual violence during the conflict
    preceding the peacekeeping operation. According to DPKO, there has been only
    one confirmed case of a member of a peacekeeping mission transmitting the
    HIV infection. At the same time, there have been a number of media reports
    of peacekeepers contracting HIV while on a peacekeeping mission. However,
    very few have been confirmed. According to DPKO, two Bangladeshi
    peacekeepers contracted the infection in Cambodia in 1993 and one in
    Mozambique in 1994. In addition, a medical study in 1995 found that 10
    Uruguayan peacekeepers had contracted HIV while on a U. N. peacekeeping
    mission in Cambodia. 6 Despite the absence of data, U. N. and U. S.
    government officials have expressed concern that peacekeepers may be
    transmitting or contracting

    the virus during peacekeeping operations. Surveys of military personnel
    indicate that many do not practice safe sex. For example, according to the
    U. N. Population Fund, a study of the Ukrainian military showed that only 10
    percent of the officers surveyed practiced safe sexual behavior- that is,
    consistent condom use and one faithful partner- while 28 percent of the
    officers surveyed reported having multiple sexual partners. In addition,
    according to DOD, on a 2000 training operation in South America, about 30
    percent of U. S. sailors reported having sexual contact while in ports of
    call,

    with about 15 percent of this group saying they did not always use a condom.
    In addition, according to UNAIDS, 45 percent of Dutch peacekeepers in
    Cambodia had sexual relations with commercial sex workers or members of the
    local population over a 5- month period in 1993, with approximately 11
    percent of that group saying they did not always use condoms.

    U. N. Efforts to Address The United Nations has initiated a number of
    activities to address the

    the Impact of HIV/ AIDS impact of HIV/ AIDS on the health of peacekeepers.
    However, these

    prevention efforts face immediate obstacles that may impact their on
    Peacekeepers Face

    implementation. In addition, the long- term success of U. N. efforts will be
    Challenges

    difficult to ascertain due to the lack of baseline data on the knowledge and
    awareness of HIV/ AIDS or on the sexual behavior of the contingents that
    make up its uniformed forces.

    6 ?Multiple Introductions of HIV- 1 subtype E into the Western Hemisphere,?
    The Lancet, Vol. 346, No. 8984 (Nov. 11, 1995), pp. 1197- 98.

    Implementation of U. N. DPKO has focused its HIV/ AIDS efforts on three
    interventions: (1)

    Efforts Faces Immediate development and distribution of an HIV/ AIDS
    awareness card, (2) training

    Obstacles in HIV/ AIDS prevention, and (3) the distribution of condoms.
    However, it is unclear if all contingents are implementing DPKO?s
    interventions, there are

    gaps in DPKO?s HIV/ AIDS training curriculum, and not all contingents may
    make condoms readily available to peacekeepers under their command.

    DPKO Begins Distribution of Figure 2 displays the HIV/ AIDS awareness card
    for peacekeepers. HIV/ AIDS Awareness Card

    Developed jointly with UNAIDS, as of September 1, 2001, the card was
    available in English, French, and Russian. The awareness card includes facts
    about the disease and contains a pocket for a condom. The card states that
    AIDS is a deadly disease caused by the HIV virus and describes methods of
    protection against the disease. The back of the card provides a code of
    conduct calling for pride, respect, and consideration for law, customs, and
    traditions. The card also states that peacekeepers should

    limit alcohol use and avoid illegal drugs because they impair judgment and
    can lead people to take risks they may not otherwise take.

    By September 2001, DPKO had distributed 15, 000 HIV/ AIDS awareness cards to
    peacekeeping contingents in Sierra Leone. According to DPKO, the official
    responsible for HIV/ AIDS activities in Sierra Leone gave the contingents a
    lecture on HIV awareness when the cards were delivered to

    each contingent. DPKO leaves it up to contingents to include a condom with
    the card. DPKO plans to distribute the HIV/ AIDS awareness card to U. N.
    peacekeeping operations in Ethiopia/ Eritrea, Congo, East Timor, and Kosovo.
    In addition to being written in English, French, and Russian, the card is
    expected to be produced in Kiswahili, Arabic, Hindi, Bengali, Urdu, Spanish,
    and Portuguese. These represent the primary languages of 90 percent of the
    nationalities serving in peacekeeping operations worldwide. Since the
    contributing countries are responsible for the conduct of their forces, DPKO
    officials stated they are not certain if all peacekeepers will carry the
    card.

    Figure 2: HIV/ AIDS Awareness Card for U. N. Peacekeepers

    Gaps in Curriculum Challenge As part of its train- the- trainer program,
    DPKO provides senior officers from

    the Effectiveness of DPKO?s contributing countries with an intensive 2- to
    3- week peacekeeper training HIV/ AIDS Prevention Training

    program. 7 The HIV/ AIDS training is comprised of several modules on the
    impact of HIV on the military; the link between HIV, other sexually
    transmitted infections, and substance abuse; HIV risk assessment; prevention
    strategies; and behavior change. The contributing countries are responsible
    for ensuring that peacekeepers receive training before and after deployment.

    Effective implementation of DPKO?s HIV/ AIDS training faces some immediate
    obstacles. First, the curriculum was developed in the United States and does
    not address issues specific to some cultures. For example, cultural
    practices in some parts of sub- Saharan Africa, such as social acceptance of
    multiple sex partners for males and females, increase the

    rates of sexually transmitted infections, including HIV/ AIDS. Therefore,
    according to the U. S. Agency for International Development (USAID),
    training should be adopted to specifically address the risky behaviors

    unique to peacekeepers in question. Second, although gender issues are
    broadly addressed in the train- the- trainer program, according to the U. N.
    Development Fund for Women, the current HIV/ AIDS training curriculum does
    not adequately address gender issues necessary to sensitize

    peacekeepers to respect girls and women rather than viewing them as sexual
    commodities. Third, according to UNAIDS, the training is too technical and
    requires trainers to have a medical background. In addition, HIV training
    competes with other training priorities, such as land mine awareness.
    Finally, because DPKO does not routinely monitor whether the contingents
    provide the training, it does not know whether peacekeepers received the
    training before and after being sent to the mission.

    Unclear Whether All Contingents DPKO provides contingents with five condoms
    per troop per week. DPKO Make Condoms Readily

    procures condoms for peacekeepers primarily from the U. N. Population
    Available to Peacekeepers

    Fund, delivers them to the commanders of each contingent, and makes them
    available in bathrooms, nightclubs, and other venues frequented by
    peacekeepers. DPKO relies on the commanders of each contingent to distribute
    the condoms to their contingents. However, universal distribution of condoms
    to all peacekeepers faces religious and cultural obstacles. According to
    DPKO, commanders from

    7 The training also includes U. N. policies for peacekeeping, land mine
    awareness, demobilization, and the cultural dynamics of the country in which
    the mission will operate.

    south Asia and the Middle East object to making condoms readily available to
    their uniformed forces because sex with prostitutes outside of marriage is
    against their religious beliefs and would indicate tacit approval of such
    behavior. In addition, because DPKO does not routinely monitor condom
    distribution, it does not know whether peacekeepers have access to condoms.

    Success of U. N. Efforts Will The long- term effectiveness of the awareness
    card, HIV prevention training, Be Difficult to Determine

    and condom distribution will be difficult to determine. UNAIDS and DPKO have
    not collected baseline data on troop knowledge and awareness of HIV/ AIDS or
    sexual behavior. Baseline data are essential to evaluating the impact of
    interventions such as the HIV/ AIDS awareness cards and training on
    peacekeeper knowledge and behavior. For example, U. N. officials recognized
    that the awareness card has not been tested or proven to be an effective
    HIV/ AIDS intervention. In spite of this, U. N. officials agreed to get the
    cards to the field as soon as possible in Sierra Leone, recognizing that the
    time spent pretesting and gathering data would delay the rollout.

    According to USAID, surveys of sexual behavior are needed for measuring
    condom use, which is expected to increase as a result of successful HIV
    awareness and training and serves as a proxy for estimating HIV
    transmission. Officials at DPKO stated that they are in discussions with the
    U. S. Centers for Disease Control and DOD on the development of a data
    collection instrument to gather baseline data on HIV/ AIDS knowledge and

    sexual behavior of peacekeepers. U. N. ?s Effort to Provide The United
    Nations has begun to address the spread of HIV/ AIDS among

    civilians affected by armed conflict 8 ; however, according to U. N.
    officials, it HIV/ AIDS Assistance to does not give adequate priority to
    this effort and faces challenges obtaining Civilians Affected by funding.
    Furthermore, the United Nations has taken little action to target

    Conflict Faces populations specifically at risk of HIV transmission from
    peacekeepers.

    Difficulties 8 In June 2001, as part of the U. N. General Assembly Special
    Session on HIV/ AIDS, the General Assembly adopted without reservation the
    Declaration of Commitment on HIV/ AIDS, which included specific targets and
    deadlines for addressing HIV/ AIDS in conflict situations.

    U. N. ?s Effort to Address Although U. N. agencies are implementing programs
    to provide HIV/ AIDS

    HIV/ AIDS in Emergencies Is education and care to populations affected by
    armed conflict, according to

    Inconsistent and Faces U. N. officials, the United Nations has not
    consistently given these programs Funding Obstacles

    priority and faces challenges in funding them. For example, the U. N.
    Children?s Fund?s (UNICEF) has trained young people in post- conflict
    situations to be peer educators on HIV/ AIDS, and the U. N. Population Fund

    has provided condoms and reproductive health kits in emergency situations
    (see app. IV for other efforts). According to U. N. officials, U. N.
    agencies that supply emergency assistance have not traditionally focused

    on HIV/ AIDS and have been reluctant to address HIV/ AIDS because they have
    not always viewed it as part of their mandate. U. N. officials also report
    that U. N. agencies have not consistently included HIV/ AIDS programs in
    their appeals for funding in complex emergencies. In addition, U. N.
    officials report that due to a lack of cooperation, different U. N. agencies
    work on small- scale, ad hoc projects that tend to cover similar areas while
    leaving program gaps in other areas. In regard to funding, participants at
    the 2001 Inter- Agency Task Team on HIV/ AIDS and Children in Conflict 9
    noted that HIV/ AIDS programs have been underfunded because of a lack of
    response from U. N. member states.

    The United Nations Has Efforts to assist civilian populations at risk of
    contracting HIV from Taken Little Action to Assist peacekeepers are a subset
    of the U. N. ?s overall effort to address Populations at Risk of populations
    affected by armed conflict. While the United Nations has Contracting HIV
    From recognized the importance of assisting groups that might be at risk of
    HIV

    transmission from peacekeepers, to date it has taken little action. At the
    Peacekeepers Expert Strategy Meeting on HIV/ AIDS and peacekeeping in
    December 2000, 10 delegates noted an urgent need to provide appropriate
    information and services to populations affected by peacekeeping operations.
    In response, DPKO now participates in some country- level HIV/ AIDS theme
    groups 11 even though there is no written policy requiring this
    participation.

    9 In August 2001, the Inter- Agency Task Team, composed of U. N. agencies
    and nongovernmental organizations, met to discuss how to best ensure that
    children in situations of conflict receive appropriate HIV/ AIDS prevention,
    care, and support.

    10 In response to Resolution 1308, the UNAIDS Secretariat convened an Expert
    Strategy Meeting in Sweden in December 2000 to address the issue of HIV/
    AIDS and peacekeeping. 11 UNAIDS? 132 country- level theme groups are
    UNAIDS? primary mechanism at the country level to coordinate the U. N.
    response to HIV/ AIDS and support host countries? efforts against HIV/ AIDS
    (see GAO- 01- 625, p. 13).

    UNAIDS has agreed to help fund personnel to serve as HIV/ AIDS policy
    officers in each of the five largest peacekeeping operations. 12 However,
    DPKO has only appointed a focal point in Sierra Leone, and DPKO and

    UNAIDS are still discussing whether this focal point will become the HIV
    officer for that operation.

    Conclusions The United Nations recognizes that HIV/ AIDS is a security issue
    that threatens the effectiveness of U. N. peacekeeping missions. DPKO
    policy, which discourages but does not preclude countries from sending
    individuals with HIV on peacekeeping missions, underscores the tension
    between the U. N. ?s peacekeeping policy and increased concern about the
    threat of HIV/ AIDS. Legitimate concerns have been raised regarding both the
    stigmatization of peacekeepers who may have HIV/ AIDS and the potential risk
    that they could transmit the disease to local populations. Because of the U.
    N?s opposition to mandatory HIV- testing and contributing countries? wide
    variance in testing potential peacekeepers for HIV, DPKO has no knowledge of
    the HIV/ AIDS prevalence rates among its contingents.

    Without this information, DPKO will find it difficult to focus interventions
    on the peacekeepers at highest risk of transmitting HIV. In fact, without
    routine monitoring of how the contingents implement DPKO?s efforts, DPKO
    does not know if peacekeepers receive training or have access to condoms.

    Recommendations for To improve the United Nation?s ability to (1) measure
    the effectiveness of

    Executive Action activities aimed at reducing risky behaviors among
    peacekeepers and (2) identify which contingents are at highest risk of
    transmitting or contracting

    sexually transmitted infections, including HIV, at each mission, we
    recommend to the Secretary of State and the U. S. Permanent Representative
    to the United Nations that they request the U. N. Secretary General and the
    Executive Director of UNAIDS to

     develop and conduct behavior surveys of U. N. peacekeeping contingents to
    gather baseline and follow- up data on peacekeepers? knowledge and awareness
    of HIV/ AIDS and their sexual behavior; and

    12 UNAIDS established terms of reference for the post of HIV/ AIDS Policy
    Officer in 2001. The policy officers? primary focus is to develop and
    implement a comprehensive mission strategy with DPKO to reduce the
    likelihood of HIV transmission to and by U. N.

    peacekeeping staff while deployed and upon repatriation.

     analyze information gathered from these surveys to measure the
    effectiveness of their efforts and to identify which contingents are at
    highest risk of transmitting or contracting sexually transmitted infections,
    including HIV, at each mission to better target resources.

    Agency Comments We received oral comments from DOD and written comments from
    the Department of State and UNAIDS. The written comments from the

    Department of State and UNAIDS are reprinted in appendixes V and VI. In
    addition, the Department of State and UNAIDS provided technical comments to
    update or clarify key information. We incorporated these comments where
    appropriate.

    DOD officials stated that the report was well written and that it accurately
    assessed the current situation with regard to HIV prevalence among U. N.
    peacekeepers. DOD agreed with our recommendations. The Department of State
    stated that it will continue to consult with U. N. agencies involved in HIV/
    AIDS programs and peacekeeping operations to encourage programs to raise the
    level of HIV/ AIDS awareness and reduce

    risky behaviors among U. N. peacekeepers, as well as efforts to measure the
    effectiveness of programs. The Department of State also said it would
    continue to encourage U. N. efforts to address the spread of HIV/ AIDS among
    target populations in situations of violence and instability. The Department
    of State did not comment on our recommendations.

    UNAIDS agreed with our recommendation that behavioral surveys should be
    carried out to gather baseline and follow- up data on U. N. peacekeepers?
    knowledge and awareness of HIV/ AIDS and their sexual behavior. UNAIDS
    disagreed with our characterization that the U. N. ?s overall effort to
    address HIV/ AIDS in emergencies is inconsistent. In their letter, UNAIDS
    lists a

    number of meetings in which concerns for vulnerable populations and
    peacekeeping are addressed. According to UNAIDS, these collaborative efforts
    demonstrate a consistency of approach that is contrary to our

    finding. While collaborative meetings are an important first step in efforts
    to assist vulnerable populations, U. N. agencies have undertaken few
    concrete actions to address this emerging problem. We found that that there
    has been a lack of consistency in U. N. actions to help vulnerable
    populations because emergency assistance agencies have tended not to

    include HIV/ AIDS programs in their requests for funds and generally do not
    view HIV/ AIDS prevention as part of their mandates.

    We are sending copies of this report to interested congressional committees,
    the Secretary of State, the Secretary of Defense, the Secretary General of
    the United Nations, the Executive Director of UNAIDS, and other interested
    parties. We will also make copies available to other parties upon request.

    If you or your staff have any questions concerning this report, please call
    me at (202) 512- 8979. Other GAO contacts and staff acknowledgments are
    listed in appendix VIII. Sincerely Yours,

    Joseph A. Christoff, Director International Affairs and Trade

    Appendi Appendi xes x I

    Objectives, Scope, and Methodology At the request of the Chairman of the
    House Committee on International Relations, we (1) analyzed U. N. policies
    and guidance on the use and deployment of peacekeepers with HIV; (2)
    examined the data available on HIV prevalence rates among peacekeepers; (3)
    assessed actions the United Nations is taking to limit the spread of HIV/
    AIDS among peacekeepers; and

    (4) examined the actions the United Nations is taking to limit the impact of
    HIV/ AIDS on civilians affected by armed conflict, including groups who may
    come in contact with peacekeepers. In analyzing U. N. policies and guidance
    on the use and deployment of peacekeepers with HIV, we interviewed officials
    from the U. N. Department of Peacekeeping Operations (DPKO), the Joint
    United Nations Programme

    on HIV/ AIDS (UNAIDS), the Department of State, and the Department of
    Defense (DOD). We also questioned these officials concerning the context in
    which the policies were formulated and DPKO?s intent in issuing the
    policies. Additionally, we examined U. N. documents such as DPKO?s medical
    manual to determine the precise wording of the policies and guidance, as
    well as U. N. Security Council Resolutions and U. N. General Assembly
    Resolutions regarding the U. N. ?s general policies on the rights of

    HIV- positive individuals in employment situations. In examining the data
    available on HIV prevalence among U. N. peacekeepers, we interviewed
    officials from DPKO, UNAIDS, USAID, DOD, and other officials to identify
    whether data collection is being conducted among peacekeepers. We also asked
    these officials to identify and discuss any other data sources, including
    medical research and academic studies. We conducted searches for reports of
    HIV transmission to and from peacekeepers, and we attempted to verify the
    validity of these reports through discussions with U. N. officials. To
    determine HIV/ AIDS prevalence

    among populations that may be chosen for U. N. peacekeeping duty, we
    examined the data available on HIV/ AIDS prevalence among uniformed forces
    and civilian adult populations for countries that contribute peacekeepers.
    This included collecting and analyzing information in the U. S. Census
    Bureau?s HIV/ AIDS Surveillance Data Base, June 2000; UNAIDS? report on the
    global HIV/ AIDS epidemic, June 2000; and DPKO?s monthly summary of troop
    contributors. For our review of the risk factors that peacekeepers face
    during peacekeeping operations, we examined documents from UNAIDS, the
    Civil- Military Alliance to Combat HIV/ AIDS, the International Crisis
    Group, and the National Intelligence Council. We also asked officials at
    DPKO, UNAIDS, DOD, Family Health International, and others to identify and
    discuss these risk factors.

    In assessing the actions the United Nations is taking to limit the spread of
    HIV/ AIDS among peacekeepers, we reviewed DPKO program documents, including
    the HIV/ AIDS Awareness Card. We also reviewed documentation from UNAIDS,
    including best practice studies. In addition, we spoke with senior officials
    at DPKO and UNAIDS about the development and implementation of the HIV/ AIDS
    Awareness Card and other initiatives. In our review of DPKO?s HIV prevention
    training, we examined the DPKO training manual and held discussions with
    DPKO?s senior medical advisor and the Director of the Civil Military
    Alliance who developed the HIV/ AIDS curriculum. We also discussed the
    current training with senior officials at the U. N. Population Fund, the U.
    N. Development Fund for Women, and the U. S. Naval Health Research Center
    responsible for HIV/ AIDS prevention training of foreign military personnel.
    With USAID contractors from the Measure Demographic and Health Survey and
    Family Health International

    (FHI), we discussed the use of sexual behavior surveys for measuring the
    progress of HIV/ AIDS prevention efforts to reduce risky behaviors and how
    information about condom use can be used as a proxy indicator for

    estimating risk of HIV transmission. In examining the actions the United
    Nations is taking to limit the impact of HIV/ AIDS on civilians affected by
    armed conflict, we interviewed officials from DPKO, the U. N. Children?s
    Fund, the World Health Organization, the

    U. N. Population Fund, the U. N. Coordinator for Humanitarian Affairs, the
    World Food Programme, and several other U. N. agencies to assess the
    effectiveness of U. N. efforts to provide HIV/ AIDS assistance in conflict
    and to determine the extent to which the United Nations has addressed groups
    at risk of contracting HIV/ AIDS from peacekeepers. We also reviewed
    documents from U. N. interagency meetings that analyzed U. N. efforts to
    limit the impact of HIV/ AIDS on civilians affected by conflict. To obtain

    information on U. N. agency programs and activities in combating HIV/ AIDS,
    we examined the U. N. System Strategic Plan for HIV/ AIDS, 20012005, and
    various U. N. Consolidated Interagency Appeals.

    We conducted our fieldwork in Washington, D. C.; New York, N. Y.; and
    Geneva, Switzerland. We performed our work from April 2001 through November
    2001 in accordance with generally accepted government auditing standards.

    U. N. Peacekeepers by Country, September

    Appendi x II

    2001 Total number of Total number of Country peacekeepers Country
    peacekeepers

    Bangladesh 6, 048 China 111 Pakistan 5,552 South Africa 104 Nigeria 3, 446
    Brazil 101 India 2, 852 Denmark 101 Jordan 2, 728 Zimbabwe 84 Ghana 2, 116
    Gambia 74 Kenya 2, 080 Netherlands 74 Australia 1, 580 Norway 73 Ukraine 1,
    538 Benin 55 Portugal 1, 134 Indonesia 54 Poland 1, 035 Chile 51 Zambia 871
    Czech Republic 47 Fiji Islands 849 Samoa 40 Guinea 795 Malawi 37 Thailand
    789 Switzerland 35 Philippines 763 Sri Lanka 34 U. S. A. 732 Japan 30 United
    Kingdom 688 Niger 26 France 673 Tanzania 24 Ireland 670 Vanuatu 24 New
    Zealand 668 Bosnia/ Herzegovina 22 Senegal 641 Cameroon 22 Morocco 617
    Belgium 20 Slovak Republic 610 Algeria 19 Argentina 581 Greece 19 Austria
    511 Slovenia 19 Uruguay 491 Croatia 15 Germany 473 Mozambique 15 Republic of
    Korea 471 Paraguay 13 Finland 356 Honduras 12 Russian Federation 334 Namibia
    12 Nepal 329 Bolivia 11 Canada 317 Burkina Faso 11 Italy 308 Lithuania 9
    Egypt 264 Mali 8 Tuni s i a 257 Per u 6

    (Continued From Previous Page)

    Total number of Total number of Country peacekeepers Country peacekeepers

    Malaysia 232 Iceland 5 Spain 191 Kyrgyzstan 4 Turkey 185 Venezuela 4
    Singapore 173 El Salvador 3 Hungary 161 Cape Verde 2 Bulgaria 150 Estonia 2
    Sweden 145 Albania 1 Romania 119 C�te d' Ivoire 1

    Tot al 46, 957

    Source: DPKO's Monthly Summary of Military and Civilian Police Contribution
    to United Nations Operations for Sept. 30, 2001.

    Information Available on U. N. Peacekeeping

    Appendi x I II

    Forces and HIV/ AIDS Concern Confirmed cases Other evidence Estimates
    Peacekeepers with

    Six HIV cases in East Timor and Data on HIV prevalence for samples Defense
    Intelligence Agency HIV being deployed six in Kosovo were confirmed; it of
    uniformed forces in three

    estimates 10- 20 percent prevalence is unclear if peacekeepers were
    contributing countries show HIV for the Nigerian military, 15- 30 deployed
    with HIV or if they prevalence above 5 percent.

    percent for the Tanzanian military, contracted the infection while on and
    10- 20 percent for the military in deployment. C�te d'Ivoire.

    Contributing countries' HIV testing Sexually transmitted infection rates
    policies vary for uniformed forces are estimated to be two to five times
    being sent to peacekeeping higher among military personnel than operations.
    in civilian populations, suggesting higher HIV rates as well.

    Fourteen percent of peacekeepers come from countries with high civilian
    prevalence.

    Peacekeepers

    DPKO confirmed that one The rapid spread of HIV/ AIDS in None spreading HIV
    while

    civilian member of a Cambodia coincided with the U. N. on deployment

    peacekeeping mission spread peacekeeping mission. the infection while on
    deployment.

    Increased rates of HIV infection in East Timor conincided with the presence
    of U. N. peacekeepers. Rates of sexually transmitted infections, which
    increase the risk of contracting HIV 5 to 20 times, are thought to be high
    among waraffected populations.

    Peacekeepers

    Ten Uruguayan peacekeepers in Prevalence rates are high among None
    contracting HIV while Cambodia tested negative prior

    samples of prostitutes in three on deployment

    to deployment and positive upon countries where peacekeeping return to
    Uruguay.

    operations are ongoing: 27 percent in Sierra Leone; 29 percent in Congo; 73
    percent in Ethiopia. DPKO confirmed that two

    HIV/ AIDS prevalence among a Bangladeshi peacekeepers

    sample of war- affected local contracted HIV in Cambodia and populations in
    Sierra Leone was one in Mozambique. found to be 16 percent in 1995, although
    rates in the sample prior to the conflict are not known.

    Peacekeepers

    None None None

    spreading HIV to their family or community upon return Source: GAO analysis
    of U. S. Census Bureau's June 2000 HIV/ AIDS Surveillance Data Base;
    interviews with DPKO, U. N., and U. S. officials; and U. N. documentation.

    Appendi x V I HIV/ AIDS Activities of U. N. Agencies Selected planned &
    Funding for ongoing HIV/ AIDS

    emergency Agency Mission Role in emergencies HIV/ AIDS priorities

    activities HIV/ AIDS programs

    U. N. High Leads and coordinates Provides shelter, food, Supports programs
    UNHCR reports

    Disseminates Commissioner international action for the

    water, medicine, and to prevent and care facing budgetary information on for
    Refugees worldwide protection of

    other basic for HIV/ AIDS and constraints that HIV/ AIDS.

    (UNHCR) refugees and the resolution of necessities to sexually transmitted

    may limit its refugee problems.

    refugees and other infections in refugee capacity to Implemented an
    displaced persons.

    settings; provides address HIV/ AIDS HIV/ AIDS education technical
    assistance among its

    program for young to partners.

    beneficiaries. refugees in southern Africa, in cooperation with other
    agencies.

    United Nations Advocates for children?s rights Provides Develops and

    $600 million Training adolescent Children?s to help meet their basic needs
    humanitarian

    supports actions to projected for

    refugees to be peer Fund and to expand their

    assistance and reduce the 2001- 2005. HIV/ AIDS educators. (UNICEF)

    opportunities to reach their protection to children vulnerability of full
    potential.

    in emergencies. children at high risk Developing a training of HIV/ AIDS,
    module for

    including those peacekeepers on affected by conflict.

    gender and child Ensures protection

    protection. and support for orphans and children in families vulnerable

    due to HIV/ AIDS. United Nations Helps to eradicate poverty

    Provides logistic, Supports the U. N. $600 million Development through
    sustainable human communications, and response to

    projected for Programme development activities.

    other support for HIV/ AIDS through 2001- 2005.

    (UNDP) international relief

    advocacy, capacity agencies and focuses

    building, and on the relief- to training.

    development transition. World Food Leads the fight against global

    Meets the food needs Attempts to mitigate No information

    Makes its logistics Programme hunger through food

    of vulnerable HIV/ AIDS? impact on available. services and food (WFP)

    distribution in emergencies populations. food security by distribution sites

    and helps support social and improving the longer available for

    economic development. term food security of

    HIV/ AIDS prevention families and groups activities by other affected by U.
    N. agencies. HIV/ AIDS.

    Requires its truck drivers in Ethiopia to take 2- month HIV- prevention
    course.

    (Continued From Previous Page)

    Selected planned & Funding for ongoing HIV/ AIDS

    emergency Agency Mission Role in emergencies HIV/ AIDS priorities

    activities HIV/ AIDS programs

    World Health Attempts to ensure that all Mobilizes expertise Aims to
    strengthen $146 million

    Developing a project Organization people obtain the highest

    and resources for the health sector?s projected for

    for HIV/ AIDS (WHO)

    attainable level of health. rapid response. Gives response to

    2002- 2003. assistance to high priority to HIV/ AIDS and to refugees,
    internally assisting vulnerable provide technical displaced persons,

    groups, such as assistance to and returnees from commercial sex countries to
    improve

    Angola, Democratic workers and persons their HIV/ AIDS Republic of Congo, in
    emergency prevention and care and Sierra Leone. situations.

    interventions. Producing a basic supply package for HIV/ AIDS assistance in
    emergencies.

    U. N. Fund for Aims to ensure universal Provides reproductive Advocates for
    HIV $254 million

    Provided health kits Population access to high- quality health kits, trains
    prevention and the

    projected for and technical Activities reproductive health services service
    providers to integration of HIV 2001- 2005.

    support in Bosnia, (UNFPA) to all couples and individuals

    diagnose and treat prevention into East Timor, Eritrea,

    by 2015. sexually transmitted national reproductive Ethiopia, Kosovo.

    infections, and health programs. conducts information Aims to strengthen
    Provided training on activities. its emergency HIV/ AIDS prevention HIV/
    AIDS activities.

    and care for health providers working with Eritrean refugees in Sudan.
    Office of the

    Coordinates the international Monitoring/ early Advocates for the

    No information Provided training for Coordinatorfor

    humanitarian response in warning, contingency inclusion of

    available. other U. N. agencies Humanitarian complex emergencies, planning,
    interagency

    HIV/ AIDS programs on incorporating Affairs (OCHA)

    supports the humanitarian needs assessment, into U. N. emergency HIV/ AIDS
    and other community in policy

    field coordination, and appeals for funding.

    factors into U. N. development, and advocates development of emergency
    appeals. on humanitarian issues.

    interagency funding appeals.

    (Continued From Previous Page)

    Selected planned & Funding for ongoing HIV/ AIDS

    emergency Agency Mission Role in emergencies HIV/ AIDS priorities

    activities HIV/ AIDS programs

    Joint United Supports HIV/ AIDS Provides strategic

    $305 million Created a Nations prevention and care, helps guidance to the U.
    N. projected for

    humanitarian unit to Programme on reduce the vulnerability of system on HIV/
    AIDS,

    2001- 2005. address HIV/ AIDS HIV/ AIDS

    individuals and communities, mobilizes partners

    and security issues, (UNAIDS)

    and assists in alleviating the and resources, and including pandemic?s
    impact.

    assists partners in peacekeeping. information activities. UNAIDS? 132 Funded
    a study to be

    country- level ?theme conducted by the groups? on HIV/ AIDS U. N. Children?s
    Fund coordinate the U. N. to improve HIV/ AIDS response to

    interventions for HIV/ AIDS at the

    children in conflict. country level.

    Together with DPKO, plans to deploy five high- level HIV/ AIDS officers to
    five peacekeeping

    operations. United Nations Promotes women?s human Advocates for Attempts to
    increase

    $8 million Produced a joint Development rights, economic security, and
    increased gender

    understanding of the projected for

    manual on gender, Fund for political participation; sensitivity in U. N.
    links between human

    2001- 2005. Fifty human rights, and Women

    promotes U. N. efforts to programs operating in rights, gender, and percent
    of HIV/ AIDS.

    (UNIFEM) support women?s

    complex HIV/ AIDS.

    UNIFEM?s empowerment and to emergencies.

    Advocates for a HIV/ AIDS Plans to deploy a

    incorporate gender into U. N. revised code of resources are

    gender adviser in policies and programs.

    conduct for assigned to Sierra Leone, in peacekeepers and programs in
    conjunction with for greater gender Africa.

    UNAIDS. awareness in peacekeeper

    Developing a guide HIV/ AIDS training. for women on negotiating safer

    sex. Source: GAO analysis of U. N. documents.

    Appendi x V Comments From the Department of State

    Appendi x VI Comments From UNAIDS

    Appendi x VII

    GAO Contact and Staff Acknowledgments GAO Contact Thomas Melito (202) 512-
    9601 Acknowledgments In addition to the person named above, key contributors
    to this report were Richard Boudreau, Lynn Cothern, Andrew Von Ah, Eve
    Weisberg, and Tom

    Zingale.

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    Page i GAO- 02- 194 HIV/ AIDS and U. N. Peacekeeping

    Contents

    Contents

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    Appendix I

    Appendix I Objectives, Scope, and Methodology

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    Appendix II

    Appendix II U. N. Peacekeepers by Country, September 2001

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    Appendix III

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    Appendix IV

    Appendix IV HIV/ AIDS Activities of U. N. Agencies

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    Appendix IV HIV/ AIDS Activities of U. N. Agencies

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    Appendix V

    Appendix V Comments From the Department of State

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    Appendix VI

    Appendix VI Comments From UNAIDS

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    Appendix VI Comments From UNAIDS

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    Appendix VI Comments From UNAIDS

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    Appendix VI Comments From UNAIDS

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    Appendix VII

    United States General Accounting Office Washington, D. C. 20548- 0001

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