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United States General Accounting Office: 
GAO: 

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: 

Contents: 

Letter: 

Results in Brief: 

Background: 

Department of Peacekeeping’s Policy Discourages but Does Not Preclude 
Deployment of HIV-Positive Peacekeepers: 

The United Nations Does Not Know How Many Peacekeepers Have HIV: 

U.N. Efforts to Address the Impact of HIV/AIDS on Peacekeepers Face 
Challenges: 

U.N.’s Effort to Provide HIV/AIDS Assistance to Civilians Affected by
Conflict Faces Difficulties: 

Conclusions: 

Recommendations for Executive Action: 

Agency Comments: 

Appendixes: 

Appendix I: Objectives, Scope, and Methodology: 

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

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

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

Appendix V: Comments From the Department of State: 

Appendix VI: Comments From UNAIDS: 

Appendix VII: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Acknowledgments: 

Figures: 

Figure 1: Ongoing U.N. Peacekeeping Missions: 

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

Tables: 

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

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 Organization: 

[End of section] 

United States General Accounting Office: 
Washington, D.C. 20548: 

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: 

[See PDF for image] 

This figure is a map of the world, indicating the location of ongoing 
U.N. Peacekeeping Missions. The following missions are depicted: 

Location: Middle East; 
Beginning date of mission: 1948. 

Location: India & Pakistan; 
Beginning date of mission: 1949. 

Location: Cyprus; 
Beginning date of mission: 1964. 

Location: Golan Heights; 
Beginning date of mission: 1974. 

Location: Lebanon; 
Beginning date of mission: 1978. 

Location: Iraq/Kuwait; 
Beginning date of mission: 1991. 

Location: Western Sahara; 
Beginning date of mission: 1991. 

Location: Georgia; 
Beginning date of mission: 1993. 

Location: Bosnia & Herzegovina; 
Beginning date of mission: 1995. 

Location: Croatia; 
Beginning date of mission: 1996. 

Location: Kosovo; 
Beginning date of mission: 1999. 

Location: East Timor; 
Beginning date of mission: 1999. 

Location: Democratic Republic of the Congo; 
Beginning date of mission: 1999. 

Location: Sierra Leone; 
Beginning date of mission: 1999. 

Location: Ethiopia & Eritrea; 
Beginning date of mission: 2000. 

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

[End of figure] 

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. [Footnote 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. [Footnote 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 Peacekeeping’s Policy Discourages but Does Not Preclude
Deployment of HIV-Positive Peacekeepers: 

DPKO recommends that countries contributing to U.N. peacekeeping
operations should not send HIV-positive individuals on peacekeeping
missions for three reasons. First, medical treatment available during 
the peacekeeping mission may not be adequate to meet the special
requirements of peacekeepers with HIV. Second, peacekeepers may have
to undergo predeployment vaccinations and may be exposed to diseases
during deployment, both of which pose additional risks to their health.
Third, the presence of HIV-positive peacekeepers poses the risk of 
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. [Footnote 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 Does Not Know How Many Peacekeepers Have HIV: 

The United Nations does not know how many peacekeepers have HIV/AIDS
because it opposes mandatory HIV testing before, during, or after 
deployment to a peacekeeping mission and because contributing countries
either do not test or do not share test results with the United Nations.
Officials remain concerned that peacekeepers with the infection may be
deployed on peacekeeping operations, especially the approximately 14 
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 Not Collect Data on the HIV Status of 
Peacekeepers: 

The United Nations opposes mandatory testing of peacekeepers for HIV
before, during, or after deployment to a peacekeeping operation. It
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 [Footnote 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. 
[Footnote 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 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 From Countries With High HIV Prevalence Rates: 

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

U.N. peacekeeping operation: Sierra Leone; 
Total number of peacekeepers as of Sept. 2001: 16,630; 
Number of peacekeepers from countries with prevalence greater than 5 
percent: 5,267; 
Percentage of peacekeepers from countries with prevalence greater than 
5 percent: 32%. 

U.N. peacekeeping operation: Ethiopia and Eritrea; 
Total number of peacekeepers as of Sept. 2001: 3,920; 
Number of peacekeepers from countries with prevalence greater than 5 
percent: 674; 
Percentage of peacekeepers from countries with prevalence greater than 
5 percent: 17%. 

U.N. peacekeeping operation: East Timor; 
Total number of peacekeepers as of Sept. 2001: 9,562; 
Number of peacekeepers from countries with prevalence greater than 5 
percent: 335; 
Percentage of peacekeepers from countries with prevalence greater than 
5 percent: 4%. 

U.N. peacekeeping operation: Kosovo; 
Total number of peacekeepers as of Sept. 2001: 4,305; 
Number of peacekeepers from countries with prevalence greater than 5 
percent: 213; 
Percentage of peacekeepers from countries with prevalence greater than 
5 percent: 5%. 

U.N. peacekeeping operation: Democratic Republic of Congo; 
Total number of peacekeepers as of Sept. 2001: 2,393; 
Number of peacekeepers from countries with prevalence greater than 5 
percent: 185; 
Percentage of peacekeepers from countries with prevalence greater than 
5 percent: 8%. 

U.N. peacekeeping operation: Western Sahara; 
Total number of peacekeepers as of Sept. 2001: 258; 
Number of peacekeepers from countries with prevalence greater than 5 
percent: 16; 
Percentage of peacekeepers from countries with prevalence greater than 
5 percent: 6%. 

U.N. peacekeeping operation: Iraq/Kuwait; 
Total number of peacekeepers as of Sept. 2001: 1,097; 
Number of peacekeepers from countries with prevalence greater than 5 
percent: 8; 
Percentage of peacekeepers from countries with prevalence greater than 
5 percent: less than 1%. 

U.N. peacekeeping operation: Bosnia/Herzegovina; 
Total number of peacekeepers as of Sept. 2001: 1,672; 
Number of peacekeepers from countries with prevalence greater than 5 
percent: 7; 
Percentage of peacekeepers from countries with prevalence greater than 
5 percent: less than 1%. 

U.N. peacekeeping operation: Croatia; 
Total number of peacekeepers as of Sept. 2001: 26; 
Number of peacekeepers from countries with prevalence greater than 5 
percent: 2; 
Percentage of peacekeepers from countries with prevalence greater than 
5 percent: 8%. 

U.N. peacekeeping operation: Lebanon; 
Total number of peacekeepers as of Sept. 2001: 4,470; 
Number of peacekeepers from countries with prevalence greater than 5 
percent: 0; 
Percentage of peacekeepers from countries with prevalence greater than 
5 percent: 0. 

U.N. peacekeeping operation: Cyprus; 
Total number of peacekeepers as of Sept. 2001: 1,272; 
Number of peacekeepers from countries with prevalence greater than 5 
percent: 0; 
Percentage of peacekeepers from countries with prevalence greater than 
5 percent: 0. 

U.N. peacekeeping operation: Golan Heights; 
Total number of peacekeepers as of Sept. 2001: 1,036; 
Number of peacekeepers from countries with prevalence greater than 5 
percent: 0; 
Percentage of peacekeepers from countries with prevalence greater than 
5 percent: 0. 

U.N. peacekeeping operation: Middle East; 
Total number of peacekeepers as of Sept. 2001: 153; 
Number of peacekeepers from countries with prevalence greater than 5 
percent: 0; 
Percentage of peacekeepers from countries with prevalence greater than 
5 percent: 0. 

U.N. peacekeeping operation: Georgia; 
Total number of peacekeepers as of Sept. 2001: 106; 
Number of peacekeepers from countries with prevalence greater than 5 
percent: 0; 
Percentage of peacekeepers from countries with prevalence greater than 
5 percent: 0. 

U.N. peacekeeping operation: India and Pakistan; 
Total number of peacekeepers as of Sept. 2001: 45; 
Number of peacekeepers from countries with prevalence greater than 5 
percent: 0; 
Percentage of peacekeepers from countries with prevalence greater than 
5 percent: 0. 

U.N. peacekeeping operation: Total; 
Total number of peacekeepers as of Sept. 2001: 46,945[A]; 
Number of peacekeepers from countries with prevalence greater than 5 
percent: 6,707; 
Percentage of peacekeepers from countries with prevalence greater than 
5 percent: 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. 

[End of table] 

Conditions Are Conducive to the Spread of HIV/AIDS in Peacekeeping 
Operations: 

Peacekeepers operate in an environment where exposure to HIV is more
likely. Because peacekeepers often have money to spend, commercial sex
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. [Footnote 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 Impact of HIV/AIDS on Peacekeepers Face 
Challenges: 

The United Nations has initiated a number of activities to address the
impact of HIV/AIDS on the health of peacekeepers. However, these
prevention efforts face immediate obstacles that may impact their
implementation. In addition, the long-term success of U.N. efforts will 
be 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. 

Implementation of U.N. Efforts Faces Immediate Obstacles: 

DPKO has focused its HIV/AIDS efforts on three interventions: (1) 
development and distribution of an HIV/AIDS awareness card, (2) training
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 HIV/AIDS Awareness Card: 

Figure 2 displays the HIV/AIDS awareness card for peacekeepers.
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: 

[See PDF for image] 

This figure is an illustration of the front and back of the HIV/AIDS 
Awareness Card for U.N. Peacekeepers. The information on the card is as 
follows: 

Front of Card: 

HIV/AIDS Awareness Card For Peacekeeping Operations: 

Basic Facts About HIV/AIDS: 

* AIDS is a deadly disease. 

* AIDS is caused by the HIV virus. HIV destroys the body's ability to 
fight off infections and diseases, which ultimately lead to death. 
Currently, medication can only slow down the disease, not cure IADS. 

* HIV can be passed from person to person through sexual fluids, blood, 
contaminated needles, and sharp instruments. Infected women can pass 
the virus to their babies during pregnancy, birth, and breastfeeding. 

* HIV is transmitted mainly through unprotected sex. Using condoms 
correctly every time you have sex can protect you and stop the spread 
of HIV and other sexually transmitted infections. 

UNAIDS: 
UNICEF; 
UNDP; 
UNFPA; 
UNDCP; 
UNESCO; 
WHO; 
World Bank. 

Back of Card: 

Code of Conduct for Uniformed Services: 

1. Have pride in your position as a peacekeeper and never abuse or 
misuse your power of authority. 

2. Show respect for the law, customs and traditions of the people you 
protect. 

3. Show special consideration for the most vulnerable - including women 
and children. 

4. Respect your fellow peacekeepers. 

5. Limit your alcohol intake and stay away from drugs. 

Inside of Card: 

Protect Yourself and Others: 

The HIV virus can be present anywhere in the world. 

You do not know who is infected with HIV. Only and HIV blood test can 
determine if a person is infected. 

If you feel you are at risk, it is strongly recommended that you seek 
HIV counseling and testing at the earliest. 

To protect yourself and others from transmission of HIV, condoms should 
be used for all types of sexual acts. 

After sex, condoms should be carefully removed to avoid spillage and 
disposed of. 

Condoms should never be reused. 

In An Emergency: 

If possible, protect yourself against contact with the other person's 
blood. Cover any cuts or wounds on your hands or arms with bandage. 

Be careful when handling sharp instruments and use sterilized needles. 

Wash yourself with soap and water before and after attending to the 
injured person. 

* If the injured person is not breathing, clear the airways and perform 
mouth to mouth resuscitation. After you have finished, rinse your mouth 
immediately several times, if possible, with antiseptic mouth wash. 

* If vomiting occurs, place the injured on the side to prevent choking. 

* Control bleeding by applying pressure on the bleeding part, except on 
the throat. 

* Bandage and immobilize injured parts. 

* Call a doctor as soon as possible. 

[End of figure] 

Gaps in Curriculum Challenge the Effectiveness of DPKO’s HIV/AIDS 
Prevention Training: 

As part of its train-the-trainer program, DPKO provides senior officers 
from contributing countries with an intensive 2- to 3-week peacekeeper 
training program. [Footnote 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 Make Condoms Readily Available to 
Peacekeepers: 

DPKO provides contingents with five condoms per troop per week. DPKO
procures condoms for peacekeepers primarily from the U.N. Population
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 
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 Be Difficult to Determine: 

The long-term effectiveness of the awareness card, HIV prevention 
training, 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 HIV/AIDS Assistance to Civilians Affected by
Conflict Faces Difficulties: 

The United Nations has begun to address the spread of HIV/AIDS among
civilians affected by armed conflict; [Footnote 8] however, according 
to U.N. officials, it does not give adequate priority to this effort 
and faces challenges obtaining funding. Furthermore, the United Nations 
has taken little action to target populations specifically at risk of 
HIV transmission from peacekeepers. 

U.N.’s Effort to Address HIV/AIDS in Emergencies Is Inconsistent and 
Faces Funding Obstacles: 

Although U.N. agencies are implementing programs to provide HIV/AIDS
education and care to populations affected by armed conflict, according 
to U.N. officials, the United Nations has not consistently given these 
programs 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 [Footnote 
9] noted that HIV/AIDS programs have been underfunded because of a lack 
of response from U.N. member states. 

The United Nations Has Taken Little Action to Assist Populations at 
Risk of Contracting HIV From Peacekeepers: 

Efforts to assist civilian populations at risk of contracting HIV from
peacekeepers are a subset of the U.N.’s overall effort to address
populations affected by armed conflict. While the United Nations has
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 Expert Strategy Meeting on HIV/AIDS and peacekeeping in December
2000, [Footnote 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 [Footnote 11] even though there is 
no written policy requiring this participation. 

UNAIDS has agreed to help fund personnel to serve as HIV/AIDS policy
officers in each of the five largest peacekeeping operations. [Footnote 
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 Executive Action: 

To improve the United Nation’s ability to (1) measure the effectiveness 
of 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; 

* 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, 

Singed by: 

Joseph A. Christoff, Director: 
International Affairs and Trade: 

[End of section] 

Appendix 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, 2001-2005, 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. 

[End of section] 

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

Country: Bangladesh; 
Total number of peacekeepers: 6,048. 

Country: Pakistan; 
Total number of peacekeepers: 5,552. 

Country: Nigeria; 
Total number of peacekeepers: 3,446. 

Country: India; 
Total number of peacekeepers: 2,852. 

Country: Jordan; 
Total number of peacekeepers: 2,728. 

Country: Ghana; 
Total number of peacekeepers: 2,116. 

Country: Kenya; 
Total number of peacekeepers: 2,080. 

Country: Australia; 
Total number of peacekeepers: 1,580 

Country: Ukraine; 
Total number of peacekeepers: 1,538. 

Country: Portugal; 
Total number of peacekeepers: 1,134. 

Country: Poland; 
Total number of peacekeepers: 1,035. 

Country: Zambia; 
Total number of peacekeepers: 871. 

Country: Fiji Islands; 
Total number of peacekeepers: 849. 

Country: Guinea; 
Total number of peacekeepers: 795 

Country: Thailand; 
Total number of peacekeepers: 789. 

Country: Philippines; 
Total number of peacekeepers: 763. 

Country: U.S.A.; 
Total number of peacekeepers: 732. 

Country: United Kingdom; 
Total number of peacekeepers: 688. 

Country: France; 
Total number of peacekeepers: 673. 

Country: Ireland; 
Total number of peacekeepers: 670. 

Country: New Zealand; 
Total number of peacekeepers: 668. 

Country: Senegal; 
Total number of peacekeepers: 641. 

Country: Morocco; 
Total number of peacekeepers: 617. 

Country: Slovak Republic; 
Total number of peacekeepers: 610 

Country: Argentina; 
Total number of peacekeepers: 581. 

Country: Austria; 
Total number of peacekeepers: 511. 

Country: Uruguay; 
Total number of peacekeepers: 491. 

Country: Germany; 
Total number of peacekeepers: 473. 

Country: Republic of Korea; 
Total number of peacekeepers: 471 

Country: Finland; 
Total number of peacekeepers: 356. 

Country: Russian Federation; 
Total number of peacekeepers: 334. 

Country: Nepal; 
Total number of peacekeepers: 329. 

Country: Canada; 
Total number of peacekeepers: 317. 

Country: Italy; 
Total number of peacekeepers: 308. 

Country: Egypt; 
Total number of peacekeepers: 264. 

Country: Tunisia; 
Total number of peacekeepers: 257. 

Country: Malaysia; 
Total number of peacekeepers: 232. 

Country: Spain; 
Total number of peacekeepers: 191. 

Country: Turkey; 
Total number of peacekeepers: 185. 

Country: Singapore; 
Total number of peacekeepers: 173. 

Country: Hungary; 
Total number of peacekeepers: 161; 

Country: Bulgaria; 
Total number of peacekeepers: 150; 

Country: Sweden; 
Total number of peacekeepers: 145; 

Country: Romania; 
Total number of peacekeepers: 119. 

Country: China; 
Total number of peacekeepers: 111. 

Country: South Africa; 
Total number of peacekeepers: 104. 

Country: Brazil; 
Total number of peacekeepers: 101. 

Country: Denmark; 
Total number of peacekeepers: 101. 

Country: Zimbabwe; 
Total number of peacekeepers: 84. 

Country: Gambia; 
Total number of peacekeepers: 74. 

Country: Netherlands; 
Total number of peacekeepers: 74. 

Country: Norway; 
Total number of peacekeepers: 73. 

Country: Benin; 
Total number of peacekeepers: 55. 

Country: Indonesia; 
Total number of peacekeepers: 54. 

Country: Chile; 
Total number of peacekeepers: 51. 

Country: Czech Republic; 
Total number of peacekeepers: 47. 

Country: Samoa; 
Total number of peacekeepers: 40. 

Country: Malawi; 
Total number of peacekeepers: 37. 

Country: Switzerland; 
Total number of peacekeepers: 35. 

Country: Sri Lanka; 
Total number of peacekeepers: 34. 

Country: Japan; 
Total number of peacekeepers: 30. 

Country: Niger; 
Total number of peacekeepers: 26. 

Country: Tanzania; 
Total number of peacekeepers: 24. 

Country: Vanuatu; 
Total number of peacekeepers: 24. 

Country: Bosnia/Herzegovina; 
Total number of peacekeepers: 22. 

Country: Cameroon; 
Total number of peacekeepers: 22. 

Country: Belgium; 
Total number of peacekeepers: 20. 

Country: Algeria; 
Total number of peacekeepers: 19. 

Country: Greece; 
Total number of peacekeepers: 19. 

Country: Slovenia; 
Total number of peacekeepers: 19. 

Country: Croatia; 
Total number of peacekeepers: 15. 

Country: Mozambique; 
Total number of peacekeepers: 15. 

Country: Paraguay; 
Total number of peacekeepers: 13. 

Country: Honduras; 
Total number of peacekeepers: 12. 

Country: Namibia; 
Total number of peacekeepers: 12. 

Country: Bolivia; 
Total number of peacekeepers: 11. 

Country: Burkina Faso; 
Total number of peacekeepers: 11. 

Country: Lithuania; 
Total number of peacekeepers: 9. 

Country: Mali; 
Total number of peacekeepers: 8. 

Country: Peru; 
Total number of peacekeepers: 6. 

Country: Iceland; 
Total number of peacekeepers: 5. 

Country: Kyrgyzstan; 
Total number of peacekeepers: 4. 

Country: Venezuela; 
Total number of peacekeepers: 4. 

Country: El Salvador; 
Total number of peacekeepers: 3. 

Country: Cape Verde; 
Total number of peacekeepers: 2. 

Country: Estonia; 
Total number of peacekeepers: 2. 

Country: Albania; 
Total number of peacekeepers: 1. 

Country: Côte d' Ivoire; 
Total number of peacekeepers: 1. 

Country: Total; 
Total number of peacekeepers: 46,957. 

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

[End of table] 

[End of section] 

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

Concern: Peacekeepers with HIV being deployed; 
Confirmed cases: Six HIV cases in East Timor and six in Kosovo were 
confirmed; it is unclear if peacekeepers were deployed with HIV or if 
they contracted the infection while on deployment; 
Other evidence: Data on HIV prevalence for samples of uniformed forces 
in three contributing countries show HIV prevalence above 5 percent. 
Contributing countries' HIV testing policies vary for uniformed forces
being sent to peacekeeping operations. Fourteen percent of peacekeepers
come from countries with high civilian prevalence. 
Estimates: Defense Intelligence Agency estimates 10-20 percent 
prevalence for the Nigerian military, 15-30 percent for the Tanzanian 
military, and 10-20 percent for the military in Côte d'Ivoire. Sexually 
transmitted infection rates are estimated to be two to five times 
higher among military personnel than in civilian populations, suggesting
higher HIV rates as well. 

Concern: Peacekeepers spreading HIV while on deployment; 
Confirmed cases: DPKO confirmed that one civilian member of a 
peacekeeping mission spread the infection while on deployment.
Other evidence: The rapid spread of HIV/AIDS in Cambodia coincided with 
the U.N. peacekeeping mission. Increased rates of HIV infection in
East Timor coincided 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 war-affected 
populations. 
Estimates: None. 

Concern: Peacekeepers contracting HIV while on deployment; 
Confirmed cases: Ten Uruguayan peacekeepers in Cambodia tested negative 
prior to deployment and positive upon return to Uruguay. DPKO confirmed 
that two Bangladeshi peacekeepers contracted HIV in Cambodia and one in 
Mozambique. 
Other evidence: Prevalence rates are high among samples of prostitutes 
in three countries where peacekeeping operations are ongoing: 27 percent
in Sierra Leone; 29 percent in Congo; 73 percent in Ethiopia. HIV/AIDS 
prevalence among a sample of war-affected local populations in Sierra 
Leone was found to be 16 percent in 1995, although rates in the sample 
prior to the conflict are not known. 
Estimates: None. 

Concern: Peacekeepers spreading HIV to their family or community upon 
return; 
Confirmed cases: None; 
Other evidence: None; 
Estimates: None. 

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. 

[End of table] 

[End of section] 

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

Agency: U.N. High Commissioner for Refugees (UNHCR); 
Mission: Leads and coordinates international action for the worldwide 
protection of refugees and the resolution of refugee problems.
Role in emergencies: Provides shelter, food, water, medicine, and other 
basic necessities to refugees and other displaced persons.
HIV/AIDS priorities: Supports programs to prevent and care for HIV/AIDS 
and sexually transmitted infections in refugee settings; provides 
technical assistance to partners.
Funding for HIV/AIDS activities: UNHCR reports facing budgetary 
constraints that may limit its capacity to address HIV/AIDS among its
beneficiaries.
Selected planned & ongoing emergency HIV/AIDS programs: Disseminates
information on HIV/AIDS. Implemented an HIV/AIDS education program for 
young refugees in southern Africa, in cooperation with other agencies. 

Agency: United Nations Children’s Fund (UNICEF); 
Mission: Advocates for children’s rights to help meet their basic needs 
and to expand their opportunities to reach their full potential.
Role in emergencies: Provides humanitarian assistance and protection to 
children in emergencies.
HIV/AIDS priorities: Develops and supports actions to reduce the 
vulnerability of children at high risk of HIV/AIDS, including those
affected by conflict. Ensures protection and support for orphans and 
children in families vulnerable due to HIV/AIDS.
Funding for HIV/AIDS activities: $600 million projected for 2001-2005.
Selected planned & ongoing emergency HIV/AIDS programs: Training 
adolescent refugees to be peer HIV/AIDS educators. Developing a training
module for peacekeepers on gender and child protection. 

Agency: United Nations Development Programme (UNDP); 
Mission: Helps to eradicate poverty through sustainable human 
development activities.
Role in emergencies: Provides logistic, communications, and other 
support for international relief agencies and focuses on the relief-to-
development transition.
HIV/AIDS priorities: Supports the U.N. response to HIV/AIDS through
advocacy, capacity building, and training.
Funding for HIV/AIDS activities: $600 million projected for 2001-2005.
Selected planned & ongoing emergency HIV/AIDS programs: [Empty]. 

Agency: World Food Programme (WFP); 
Mission: Leads the fight against global hunger through food 
distribution in emergencies and helps support social and economic 
development.
Role in emergencies: Meets the food needs of vulnerable populations. 
HIV/AIDS priorities: Attempts to mitigate HIV/AIDS’ impact on food 
security by improving the longer-term food security of families and 
groups affected by HIV/AIDS.
Funding for HIV/AIDS activities: No information available.
Selected planned & ongoing emergency HIV/AIDS programs: Makes its 
logistics services and food distribution sites available for HIV/AIDS 
prevention activities by other U.N. agencies. Requires its truck
drivers in Ethiopia to take 2-month HIV-prevention course. 

Agency: World Health Organization (WHO); 
Mission: Attempts to ensure that all people obtain the highest 
attainable level of health. 
Role in emergencies: Mobilizes expertise and resources for rapid 
response. Gives high priority to assisting vulnerable groups, such as
commercial sex workers and persons in emergency situations.
HIV/AIDS priorities: Aims to strengthen the health sector’s response to
HIV/AIDS and to provide technical assistance to countries to improve 
their HIV/AIDS prevention and care interventions.
Funding for HIV/AIDS activities: $146 million projected for 2002-2003. 
Selected planned & ongoing emergency HIV/AIDS programs: Developing a 
project for HIV/AIDS assistance to refugees, internally displaced 
persons, and returnees from Angola, Democratic Republic of Congo, and 
Sierra Leone. Producing a basic supply package for HIV/AIDS assistance
in emergencies. 

Agency: U.N. Fund for Population Activities (UNFPA); 
Mission: Aims to ensure universal access to high-quality reproductive 
health services to all couples and individuals by 2015.
Role in emergencies: Provides reproductive health kits, trains service 
providers to diagnose and treat sexually transmitted infections, and
conducts information activities.
HIV/AIDS priorities: Advocates for HIV prevention and the integration 
of HIV prevention into national reproductive health programs. Aims to 
strengthen its emergency HIV/AIDS activities.
Funding for HIV/AIDS activities: $254 million projected for 2001-2005.
Selected planned & ongoing emergency HIV/AIDS programs: Provided health 
kits and technical support in Bosnia, East Timor, Eritrea, Ethiopia, 
Kosovo. Provided training on HIV/AIDS prevention and care for health
providers working with Eritrean refugees in Sudan. 

Agency: Office of the Coordinator for Humanitarian Affairs (OCHA); 
Mission: Coordinates the international humanitarian response in complex 
emergencies, supports the humanitarian community in policy development, 
and advocates on humanitarian issues.
Role in emergencies: Monitoring/early warning, contingency planning, 
interagency needs assessment, field coordination, and development of
interagency funding appeals.
HIV/AIDS priorities: Advocates for the inclusion of HIV/AIDS programs
into U.N. emergency appeals for funding.
Funding for HIV/AIDS activities: No information available.
Selected planned & ongoing emergency HIV/AIDS programs: Provided 
training for other U.N. agencies on incorporating HIV/AIDS and other
factors into U.N. emergency appeals. 

Agency: Joint United Nations Programme on HIV/AIDS (UNAIDS): 
Mission: Supports HIV/AIDS prevention and care, helps reduce the 
vulnerability of individuals and communities, and assists in 
alleviating the pandemic’s impact.
Role in emergencies: [Empty]; 
HIV/AIDS priorities: Provides strategic guidance to the U.N. system on 
HIV/AIDS, mobilizes partners and resources, and assists partners in
information activities. UNAIDS’ 132 country-level “theme groups” on 
HIV/AIDS coordinate the U.N. response to HIV/AIDS at the country level.
Funding for HIV/AIDS activities: $305 million projected for 2001-2005.
Selected planned & ongoing emergency HIV/AIDS programs: Created a
humanitarian unit to address HIV/AIDS and security issues, including
peacekeeping. Funded a study to be conducted by the U.N. Children’s Fund
to improve HIV/AIDS interventions for children in conflict. Together 
with DPKO, plans to deploy five high-level HIV/AIDS officers to five
peacekeeping operations. 

Agency: United Nations Development Fund for Women (UNIFEM); 
Mission: Promotes women’s human rights, economic security, and 
political participation; promotes U.N. efforts to support women’s
empowerment and to incorporate gender into U.N. policies and programs.
Role in emergencies: Advocates for increased gender sensitivity in U.N.
programs operating in complex emergencies.
HIV/AIDS priorities: Attempts to increase understanding of the links 
between human rights, gender, and HIV/AIDS. Advocates for a revised 
code of conduct for peacekeepers and for greater gender awareness in
peacekeeper HIV/AIDS training.
Funding for HIV/AIDS activities: $8 million projected for 2001-2005. 
Fifty percent of UNIFEM’s HIV/AIDS resources are assigned to programs in
Africa.
Selected planned & ongoing emergency HIV/AIDS programs: Produced a joint
manual on gender, human rights, and HIV/AIDS. Plans to deploy a gender 
adviser in Sierra Leone, in conjunction with UNAIDS. Developing a guide
for women on negotiating safer sex. 

Source: GAO analysis of U.N. documents. 

[End of table] 

[End of section] 

Appendix V: Comments From the Department of State: 

United States Department of State: 
Chief Financial Officer: 
Washington, D.C. 20520-7427: 

November 28, 2001: 

Dear Ms. Westin: 

We appreciate the opportunity to review your draft report, "U.N. 
Peacekeeping: United Nations Faces Challenges in Responding to the 
Impact of HIV/AIDS on Peacekeeping Operations," GAO-02-194, GAO Job 
Code 320046. 

The Department's comments are enclosed for incorporation, along with 
this letter, as an appendix to the GAO final report. Technical comments 
were provided to your staff separately. 

If you have any questions regarding this response, please contact 
Roberta Newell, Deputy Director, Office of Peacekeeping, Bureau of 
International Organization, on (202) 736-7788. 

Sincerely, 

James L. Millette: 
Acting: 

Enclosure: 

As stated. 

cc: GAO/IAT - Mr. Christoff: 
State/OIG - Mr. Atkins: 
State/IO/PHO - Mr. Imbrie: 

Ms. Susan S. Westin: 
Managing Director: 
International Affairs and Trade: 
U.S. General Accounting Office: 

Department of State Comments on GAO Draft Report U.N. Peacekeeping: 
United Nations Faces Challenges in Responding to the Impact of HIV/AIDS 
on Peacekeeping Operations (GAO-02-194 HIV/AIDS and U.N. Peacekeeping): 

The Department of State will continue to consult with U.N. agencies 
involved in HIV/AIDS programs and peacekeeping operations. The United 
States Mission to the United Nations will continue to encourage U.N. 
programs aimed at raising the level of HIV/AIDS awareness and reducing 
risky behaviors among U.N. peacekeepers, as well as efforts to measure 
the effectiveness of programs already in place. 

The Department of State will continue to encourage efforts the U.N. has 
undertaken to address the spread of HIV/AIDS among target populations 
at risk of HIV transmission in situations of violence and instability. 

We will provide technical comments and corrections separately to GAO 
staff. 

[End of section] 

Appendix VI: Comments From UNAIDS: 

UNAIDS: 
Joint United Nations Programme on HIV/AIDS: 
20, avenue Appia: 
CH-1211 Geneva 27: 
Switzerland: 
Tel. (+41)22 791 3666: 
Fax (+41)22 791 4187: 
e-mail : 
[hyperlink, http://www.unaids.org]: 

Reference: HMN/PDC: 

Mr. Joseph A Christoff: 
Director: 
International Affairs and Trade: 
U.S. General Accounting: 
Washington DC 20548: 

27 November 2001: 

Dear Mr. Christoff: 

Thank you for the opportunity to comment on the Draft GAO Report to the 
Chairman, Committee on International Relations, House of 
Representatives. We commend you and your team on this thorough report 
addressing HIV/AIDS and peacekeeping, an area which has been given high 
priority by UNAIDS during this past year. 

We understand that the UN Department of Peacekeeping Operations (DPKO) 
will be responding directly to you on the major findings and 
recommendations contained within the report with respect to UN policies 
and guidance on the use and deployment of peacekeepers with HIV, the 
data available on HIV prevalence rates among peacekeepers, and the 
actions the United Nations is taking to limit the spread of HIV among 
peacekeepers and civilians affected by armed conflict, including groups 
who may come into contact with peacekeepers. Therefore, we will limit 
our comments to actions the United Nations has taken to help assure 
that its overall efforts are consistent and to highlight several areas 
of direct UNAIDS collaboration with DPKO. In addition, we have attached 
the technical comments of the UNAIDS secretariat to the draft GAO 
report. 

1. Actions the United Nations has taken to help assure that its overall 
efforts are consistent. 

While we would agree with the report finding that the overall effort of 
the UN to address HIV/AIDS in peacekeeping operations has faced funding 
obstacles, we would disagree that those overall efforts continue to be 
inconsistent. We would also note that the significant efforts 
undertaken over the course of the last 18 months to make these efforts 
more consistent have included a focus on action to assist populations 
specifically at risk for contracting HIV from peacekeepers. These 
efforts have included: 

* UNAIDS-DPKO Cooperation Framework. As a follow up to UN Security 
Council Resolution 1308, the UNAIDS Secretariat organised an Expert 
Strategy Meeting to address HIV/AIDS in Peacekeeping Operations in 
December 2000. Participants included experts from relevant UNAIDS 
Cosponsors and partners, donor governments, and from military, medical 
and civil society. This meeting focused on three main groups affected 
by UN Peacekeeping operations, including uniformed peacekeepers, 
humanitarian workers and vulnerable populations. It resulted in a set 
of recommendations addressing each group and has led to several 
initiatives within and between UNAIDS and DPKO in several specific 
areas of cooperation including training, code of conduct, testing, 
civilian and military cooperation, resource information and best 
practice material, in addition to the overall objective of integrating 
an HIV/AIDS policy within DPKO. 

* UNAIDS Steering Committee on HIV/AIDS and Security. Following the 
meeting in December 2000, the UNAIDS Secretariat initiated a multi-
agency Steering Committee on HIV/AIDS and Security to examine issues 
relating to HIV/AIDS and security, notably international security, of 
which DPKO has been an active member. 

* UN System Strategic Plan on HIV/AIDS. The UNAIDS Secretariat has 
assisted DPKO in elaborating its plans within the UN Strategic Plan on 
HIV/AIDS in order to better involve and integrate the HIV-related 
efforts of the Department with those of other UN partners most relevant 
to the special circumstances that the DPKO operates within. 

* UNAIDS Expert Panel on HIV Testing in UN Peacekeeping Operations. The 
UNAIDS Executive Director informed the Security Council in January 2001 
that he would convene, in collaboration with DPKO, an expert panel to 
address the issue of HIV Testing in UN peacekeeping operations. A 
preparatory meeting was held in June to identify and outline key 
issues. The formal meeting scheduled to take place on 17-18 September 
2001 in New York was postponed due to the terrorist attacks in the USA. 
The UNAIDS Expert Panel on HIV Testing in UN Peacekeeping Operations 
will be convened in Bangkok on 28-30 November 2001. The Panel will be 
chaired by an Australian High Court judge and will include 
representation from the US Centre for Disease Control, military 
officials from peacekeeping-contributing countries and other military, 
medical and legal experts in this area. 

2. Areas of direct UNAIDS collaboration with DPKO efforts to limit the 
spread of HIV among peacekeepers and to limit the impact of HIV/AIDS on 
civilians affected by armed contact, including groups who may come into 
contact with peacekeepers 

A major focus of UNAIDS collaboration with DPKO - as expressed in the 
Cooperation Framework - is at country level. UNAIDS and DPKO agreed to 
focus cooperation and efforts initially within the five main UN 
peacekeeping missions currently in operation. These include UNMEE 
(Ethiopia/Eritrea), UNAMSIL (Sierra Leone), MONUC (Democratic Republic 
of Congo), UNMIK (Kosovo) and UNTAET (East Timor). Highlights of UNAIDS 
and DPKO cooperation efforts within these five main UN peacekeeping 
missions are outlined in Annex 1. UNAIDS has also been encouraging UN 
Theme Groups on HIV/AIDS to include the UN peacekeeping operation in 
each relevant country. So far this has been accomplished with UNMEE, 
UNAMSIL, MONUC, UNMIK and UNMIBH. 

In addition, examples of specific areas of collaboration at country and 
global level include: 

* Financing collaborative action. Through funds raised by UNAIDS, a 
trust fund of $500,000 is currently being established in DPKO. These 
funds will be used to (i) support operational budgets of HIV/AIDS 
Policy Officer posts; and (ii) organise workshops with relevant medical 
and training staff of DPKO on ways to respond to HIV/AIDS. 

* HIV/AIDS Policy Officers. DPKO has agreed to establish an HIV/AIDS 
Policy Officer to the Special Representative of the Secretary-General 
(SRSG) initially within each major UN peacekeeping operation, including 
UNAMSIL (Sierra Leone), UNMEE (Ethiopia/Eritrea), MONUC (Democratic 
Republic of Congo), UNMIK (Kosovo) and UNTAET (East Timor). Recruitment 
is ongoing. 

* Awareness Training. As part of the global awareness strategy for 
uniformed services developed by the UNAIDS Secretariat, an HIV/AIDS 
Awareness Card for Peacekeeping Operations was created together with 
DPKO. The Awareness Card is part of UNAIDS' prevention strategy to 
increase awareness of HIV/AIDS amongst peacekeepers, but also national 
uniformed services. As of October 2001, the cards have been produced 
and distributed in English, French and Russian. They are currently 
being produced in Kiswahili, Urdu, Bengali, Arabic, Spanish, Portuguese 
and Hindi, covering approximately 90% of the nationalities serving in 
peacekeeping operations world-wide. 

* Integrated Gender Approach. As a follow up to UN Security Council 
Resolution 1325, an important section dealing with integrating a gender 
approach in the training for peacekeepers was outlined in the 
Cooperation Framework signed between UNAIDS and UNIFEM in May 2001. As 
a follow up to this agreement and the joint mission to Sierra Leone, 
which included UNIFEM, an HIV/AIDS Gender Advisor is being recruited by 
UNIFEM and financed by UNAIDS in order to respond to the needs of women 
affected by HIV/AIDS and conflict, including peacekeeping operations. 
This joint project is also being envisaged in other conflict areas. 

In closing I would add that we are in general agreement with your 
concluding recommendations that behavioral survey of UN peacekeeping 
contingents should be carried out to gather baseline and follow-up data 
on the HIV/AIDS knowledge and awareness and sexual behavior of UN 
peacekeepers; and that this information should be analysed and used to 
measure the effectiveness of current efforts and to better target 
further efforts. We will be following up directly with the DPKO to 
determine where UNAIDS might be assistance to them in their efforts in 
this regard. 

Again, thank you for the opportunity to comment on your draft report. I 
hope this and the attached information will be helpful to your 
finalising the report. If there is any further information or 
clarifications we can offer, please don't hesitate to call on us. 

Yours Sincerely, 

Signed by: 
Jim Sherry: 
Director: 
Programme Coordination and Development Group: 

Annex 1: 

Highlights of UNAIDS and DPKO cooperation efforts within the five main 
UN peacekeeping missions currently in operation. 

UNMEE (Ethiopia/Eritrea): 

Since January 2001, and in follow up to a joint mission in October 
2000, UNAIDS has supported UNMEE in responding to HIV/AIDS in the 
following ways: 

1. Formal establishment of the UNMEE HIV/AIDS Task Force on 26 January 
2001, with representatives from all main contingents, UNMEE FHQ, as 
well as UNAIDS, NACP/MOH and the EDF (Eritrean Defence Force) Health 
Service. 

2. All four sessions of the HIV/AIDS Awareness training for over 100 
UNMEE HQ staff (February-March 2001) were facilitated by UNAIDS. 

3. Following request by UNAIDS Eritrea, the UNAIDS Humanitarian Office 
fielded a four-week technical assistance mission to Eritrea on HIV and 
Military Populations to assist with (i) the launching of the 2"d Phase 
of the EDF Project "Accelerating Prevention Activities and Developing 
Care and Support Programmes in the Eritrean Defense Force" (UNAIDS PAF) 
and (ii) the formulation and implementation of a comprehensive HIV/AIDS 
programme for UNMEE. The mission, which effectively took place from 15 
April to 13 May 2001, helped devise a strategy to develop UNMEE 
HIV/AIDS programme. 

4. Following suggestion by UNAIDS Eritrea, UNMEE participated in the 
Planning & Consensus Workshop for the launching of the 2nd Phase of the 
EDF Project held in Asmara from 8 to 10 May 2001. 

5. UNAIDS provided technical assistance for the organization and 
facilitation of a planning workshop on 15 June, attended by 
representatives from each contingent and UNMEE FHQ, and subsequently 
for drafting the UNMEE HIV/AIDS programme. The UNMEE HIV/AIDS Programme 
developed during this planning workshop was formally approved by UNMEE 
HIV/AIDS Task Force during its meeting of 10 July. 

6. Following the approval of the Programme, 13 representatives of UNMEE 
various contingents and FHQ participated in the Training of Trainers on 
Peer Facilitation organized by the Eritrean Defense Force during the 
period 23 to 28 July 2001, with the support and technical assistance of 
UNAIDS (including a financial contribution of US$3,300 from UNAIDS 
Humanitarian Unit) and Family Health International (FHI). Following 
this initial training of trainers, peer leadership training is ongoing 
in INDBAT, JORBAT, KENBAT and the Bangladesh COY. 

7. UNAIDS drafted the Terms of Reference for UNMEE HIV/AIDS Task Force 
which were approved in August. 

8. Following request from UNAIDS, participation of UNMEE in the 
planning and implementation of World AIDS Day activities, as well as in 
the funding of activities (contribution of US$6,500 through its quick 
impact fund). 

9. Improvement by UNMEE of its condom distribution system. 

10. Through UNAIDS, organization and facilitation of a Training of 
Trainers Workshop on Peer Leadership for the Ethiopian Armed Forces 
(EAF) and UNMEE staff in Addis Ababa (October 2001). 

11. In November, UNAIDS drafted a Statement by the UNMEE HIV/AIDS Task 
Force on HIV/AIDS concerning the Availability of Voluntary Counseling 
and Testing (VCT) Services in the Mission Area. 

12. UNAIDS is in the process of developing a Best Practice Collection 
on HIV Prevention and Care in Military and Peacekeeping Situations 
using Eritrea as a case study. 

UNAMSIL (Sierra Leone): 

1. The UNAIDS Secretariat initiated a joint UN mission to Sierra Leone 
(UNAMSIL) in February 2001 including representatives from the UNAIDS 
Secretariat, DPKO Medical Unit, UNFPA and UNIFEM which resulted in a 
work plan to address HIV/AIDS within the Mission and in relation to the 
host population including national entities and civil society groups. 

2. In follow up to this, UNAIDS through UNIFEM has recruited an 
HIV/AIDS Gender Advisor in Sierra Leone for an initial two years to 
work with women and girls affected by the conflict in the region. 

3. As part of the overall strategy to increase awareness within 
peacekeeping personnel, the HIV/AIDS Awareness Card is currently being 
tested in UNAMSIL and coordinated by the appointed HIV/AIDS focal point 
in the mission. 

UNTAET (East Timor): 

1. UNAIDS undertook a field mission to UNTAET (East Timor) in November 
2000 which resulted in recommendations and follow up actions within the 
mission and the relevant entities in the region. 

2. Follow up to these recommendations have been partially met with the 
ongoing collaboration between UNAIDS and DPKO at the policy level in 
order to increase awareness and response within each missions. 

MONUC (Democratic Republic of Congo): 

1. Following the visit of the UNAIDS Executive Director to the 
Democratic Republic of Congo (DRC) in August 2001, a UNAIDS mission was 
undertaken to follow up outstanding issues including the role of MONUC 
in addressing HIV/AIDS within its mission. 

2. MONUC has recently been included in the UN Theme Group on HIV/AIDS 
in DRC. 

3. A joint mission is planned for the DRC before the end of the year. 

UNMIK (Kosovo)/UNMIBH (Bosnia I Herzegovina): 

1. A joint in-country mission with representatives from UNAIDS, UNFPA, 
UNICEF and DPKO was undertaken in UNMIK and UNMIBH in November 2001 
with the objective of identifying ways to coordinate efforts in order 
to respond to HIV/AIDS within the UN operations and in relation to the 
host population which the UN missions are administering at different 
levels. 

2. The work plan in follow up to this mission is currently being 
developed. 

cc: Mark Pedersen, DPKO: 
Christen Halle, DPKO: 

[End of section] 

Appendix 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. 

[End of section] 

Footnotes: 

[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. 

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

[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. 

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

[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. 

[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. 

[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). 

[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. 

[End of section] 

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