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 Cï¿½te 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. Cï¿½te 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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GAO United States General Accounting Office

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

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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

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