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. 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. 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. 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. 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. 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/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 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 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. 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. 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. 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.