Assessing alternatives in managing HIV positive officer candidates under training in the South African Navy

Rezelman, Rens (Rens Jan) (2003-04)

Thesis (MPA)--University of Stellenbosch, 2003.

Thesis

ENGLISH ABSTRACT: South Africa has the world’s highest adult HIV infection rate in the world. Experts estimate that over 1 500 people are being infected with the HIV virus per day in South Africa. The virus is undoubtedly having a negative impact on the labour population of the country and will ultimately affect the productivity of South Africa. The Constitution of South Africa, Act 108 of 1996, firmly denounces any form of unfair discrimination. The White Paper on Defence charges the South African National Defence Force (SANDF) to be an operationally ready force. The potentially crippling effect HIV and AIDS can have on the effectiveness of SANDF is an area that needs to be researched. The military environment is unique in that it is considered to be a high-risk organisation in terms of HIV infection. Overseas deployment, male-dominated environments, risk-taking ethos and monthly income are all elements that accelerate the spread of HIV within the SANDF. The SANDF is a dominant member of the Southern African Development Community (SADC) and is involved in Peace Support Operations (PSO) throughout the African continent. This military intervention is predicted to increase with time. HIV in sub-Saharan Africa has infected over 30 million people – many with little or no primary health care. The South African coastline is nearly 3 000km in length with six world-class harbours. These are strategic points that contribute to South Africa’s economic prosperity on the African continent. It is the SA Navy’s role to ensure that these harbours are well-guarded. The personnel responsible for patrolling the waters of the South African coastline need to be exposed to the proper training to be competent at this task. Military training needs to prepare learners in the event of combat. This simulation of the combat environment may lead to injuries that heighten the threat of HIV transmission. SANDF training units traditionally discharge those members who are medically unable to complete the mental and physical requirements of the course. The Military Training for Officers Part One (MTO1) course of the SA Navy is no different. HIV has created a new dynamic in that medical confidentiality protects the status of those people who are infected. Current SANDF policy does not offer sufficient guidelines to training units when dealing with learners who are infected with HIV. Human rights are constitutionally protected and unfair discrimination of any form is prohibited. The SANDF still needs to be operationally deployable and uniform members with HIV hinder this requirement. The question really is: is it fair discrimination to disallow/remove uniform members from the MTO1 course if they are HIV positive? The purpose of this research is to establish what the best practises would be in managing HIV positive learners in the military training environment. The work environment would have to be researched to determine whether or not the threat of HIV transmission exists. Learners would be approached to determine if they felt they were at risk during training exercises. The training staff who execute the training exercises would need to be asked if they felt endangered or exposed to HIV infection during these exercises. Military medical personnel who deal with either training or HIV in their everyday jobs would then review this data. The social stigma surrounding HIV is one of the challenges within this research design. The ethics and legality of mandatory HIV testing in the SANDF is an area that has sparked reaction from human rights movements. The compromising of human rights for the sake national security is an area of proportionality that raises new debates with the advent of HIV. There are various alternatives of managing HIV within the SANDF that should be considered. The current SANDF HIV policy is, at best, vague when dealing with specific training issues. This research intends on making policy-makers within the SANDF aware of the need to make definitive policy decisions to ensure that HIV does not compromise the effectiveness of the SANDF.

AFRIKAANSE OPSOMMING: Die hoogste volwasse HIV infeksie in die wêreld, kom tans in Suid Afrika voor. Deskundiges is van mening dat daar daagliks in Suid Afrika meer as 1500 mense met die virus besmet word. Die virus het ‘n definitiewe negatiewe impak op die Suid Afrikaanse arbeidsmark, en sal onomwonde die produktiwiteit van Suid Afrika beinvloed. Die Suid Afrikaanse Grondwet, Wet 108 van 1996 verbied onomwende enige vorm van onbillike diskriminasie. Die Witskrif ten opsigte van Verdediging verwag van die Suid Afrikaanse Nasionale Weermag (SANW) om 'n operasioneel voorbereide mag te wees. Die potensiële krippelende effek wat HIV/VIGS op die effektiwiteit van die SANW kan hê is ‘n area wat indiringende navorsing benodig. Die militere omgewing is uniek in die opsig dat dit beskou word as ‘n hoë risisko organisasie in terme van HIV infeksie. Internationale ontplooiings, manlik-georiënteerde omgewings, risiko-bepalende faktore, en maandelikse inkomste is almal elemente wat die verspreiding van HIV binne die SANW verhoog. Die SANW is die dominante lid van die Suider Afrikaanse Ontwikkelings Gemeenskap en is betrokke in vredes ondersteunnings operasies binne Afrika. Die word in die vooruitsig gesien dat die bogenoemde intervensies met tyd sal toeneem. In die Sub-Saharastreek het die HIV virus reeds 30 miljoen mense geïnfekteer – baie met min, of geen primêre gesondheidsorg tot hul beskikking. Die Suid Afrikaanse kuslyn is bykans 3 000 km in lengte, met ses wereldstandaard hawens, geleë langs die kuslyn. Laasgenoemde is strategiese punte wat bydra tot die ekonomiese vooruitgang binne die Afrika kontinent. Dit is die SA Vloot se verantwoordelikheid om toe te sien dat die hawens goed bewaak word. Die personeel verantwoordelik vir die patrolering van die waters langs die Suid Afrikaanse kuslyn moet blootstelling kry aan voldoende opleiding om die taak te kan verrig. Militêre opleiding moet leerders voorberei vir die moontlikheid van konflik. Hierdie simulering van die gevegs/konflik omgewing mag lei tot beserings wat die risiko ten opsigte van HIV verspreiding mag verhoog. Die SANW opleidingseenhede, het tradisioneel lede ontslaan wat nie aan die fisiese en geestelike vereistes van die kursus kon voldoen nie. Die Militêre opleiding vir Offisiere Deel Een kursus (MOO1) binne die SA Vloot is presies dieselfde. HIV het ‘n nuwe dinamika veroorsaak naamlik, mediese vertroulikheid, wat die status van geaffekteerde lede beskerm. Huidige SANW beleid verskaf onvoldoende riglyne aan opleidingseenhede vir die hantering van leerders wat die HIV virus onder hande het. Mense-regte word konstitusioneel beskerm en enige vorm van diskriminasie word verbied. Daar word egter steeds van die SANW verwag om operasioneel ontplooibaar te wees, en uniform lede met HIV verhinder hierdie bepaling. Die vraag is: Is dit billike diskriminasie om lede wat HIV positief is van die MOO1 kursus te verwyder? Die doel van hierdie navorsing is om te bepaal wat die beste praktyke sou wees in die bestuur van HIV-positiewe leerders in die militêre opleidings omgewing. Die werksomgewing sal nagevors moet word om te bepaal of die bedreiging van HIV-verspreiding bestaan aldan nie. Leerders sal genader moet word om te bepaal of hul ter eniger tyd gedurende opleidingsoefeninge gevoel het dat die risisko van blootstelling te hoog was. Die opleidings staflede wat die opleidings oefeninge oorsien sal gevra moet word of hul ter enige tyd bedreig of blootgestel gevoel het tot HIV infeksie. Militêre mediese personeel wat daagliks met opleiding of deur middel van hul daaglikse werk met HIV te doen het sal die data hersien. Die sosiale stigma ten opsigte van HIV-toetsing is een van die uitdagings binne hierdie navorsings onderwerp. Die etiek en regsgeldigheid van verpligte HIVtoetsing binne die SANW is ‘n area wat geweldige reakise ontlok het van menseresgte bewegings. Die kompromittering van menseregte ten gunste van nasionale sekuriteit is ‘n area van proportionaliteit wat nuwe debatering openbaar in die koms van HIV. Daar is verskeie alternatiewe vir die bestuur van HIV binne die SANW, wat oorweeg kan word. Die huidige SANW HIV beleid is, ten beste, uiters vaag met die hantering van spesiefieke opleidingsgeleenthede. Die navorsing beoog om beleidsmakers binne die SANW bewus te maak van die behoefte om definitiewe besluite te verseker dat HIV nie die effektiwitet van die SANW beinvloed nie.

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