CAPE TOWN, South Africa (AP) - Across Africa, hospital wards are filling with military casualties. The cause: not another African conflict - but AIDS. More deadly than any of its wars, AIDS is hitting at Africa's ability to defend itself at a time when its countries are shouldering a growing share of peacekeeping.

"HIV and other diseases represent a readiness challenge to militaries throughout the world, and security for us all demands that we pay attention to this," US Deputy Assistant Secretary of Defence Theresa Whalen told a recent gathering of African military health officers.

Pretoria, South Africa - Private Andries Nhlengethwa works out at the gym in Pretoria on August 25, 2005. Nhlengethwa is one of the few South African soldiers living openly with the AIDS virus. (Photo: AP)

South Africa, which has more people infected with HIV than any other country, has responded with a ground-breaking clinical research programme in partnership with the United States that is investigating how best to manage the virus in a military setting and providing treatment to hundreds of infected members and their families.
Few of its neighbours, however, have the necessary funding, expertise or infrastructure to do likewise.

Sub-Saharan Africa is home to some 25 million of the world's nearly 40 million HIV-infected people.
Soldiers are in many ways at the forefront of the HIV and AIDS epidemic, South African Deputy Defence Minister Mluleki George said at the Cape Town conference. Their age, mobility and access to casual sex put them at high risk of catching and spreading the virus.

Few African militaries have even tried to produce reliable figures, but their infection rates are estimated to be up to twice those in the wider population, according to the Pretoria-based Institute for Security Studies.
The South African National Defence Force says 23 per cent of its 75,000 members are infected, on par with national adult prevalence. Seven out of every 10 military deaths are AIDS-related, according to figures presented to lawmakers in 2002, the most recent year for which statistics are available.

AIDS is also the biggest killer in the Ugandan armed forces, said Lt Col Kenneth Ochen, a military doctor in Kampala who lost 200 patients to the disease last year.
"They are dying. Oh, they are dying," he lamented.
While most militaries screen recruits for HIV, many soldiers are spending weeks, even months on sick leave, disrupting unit cohesion, availability for deployment and chains of command.

In Sierra Leone, at least four UN peacekeepers died and 10 others were sent home because of AIDS-related illnesses. Two African Union peacekeepers died of similar causes in Sudan.
The disease hits hardest at people in their late 20s and 30s, who have often risen to key positions. Their care places a burden on already stretched military budgets.

While President Thabo Mbeki's government has drawn criticism for its sluggish response to the crisis, his military first approached the United States for help setting up AIDS drug trials in 2002, long before the life-prolonging medicines became available through the public health system. The five-year collaboration began in 2003.

Members of the US National Institute of Allergy and Infectious Diseases are now working with their South African counterparts at five clinics, with one more on the way.

Two years into Project Phidisa - Prolong Life - the military is reporting progress getting critically ill members fighting fit.

More than 2,900 people have been tested. Those with HIV are monitored, while those with full-blown AIDS are put on one of four widely used combinations of drugs to compare their effectiveness, side effects and compliance levels.

Later, the study will consider the role of nutritional supplements and traditional medicines in delaying progression of the disease.
Such research is difficult in wealthier countries, which don't have large numbers of infected people who have never been on anti-retroviral drugs, said Dr Clifford Lane, head of clinical research at NIAID. Prior exposure can lead to resistance and influence the results.

While the initial focus is AIDS, both sides hope the infrastructure established and experience gained can later be turned to other diseases, such as malaria, a major problem in Africa.

Phidisa is providing AIDS drugs to 834 force members and their dependents. An extra 232 are getting medicines through separate US funding until the military can provide them.

Sergeant Philisiwe Ntshangase, 36, was in and out of hospital for months. She lost weight, started drinking and became suicidal.
Now she is the picture of health. Her main worry: how to shed those extra pounds she put on since starting on AIDS medicines.

"The medication made me a different person," said Ntshangase, a former anti-apartheid guerrilla who now advises other soldiers with HIV. "It reminded me what was my mission in the defence force: to take care of my beloved country."

This is of strategic importance to the South African government in view of the leading peacekeeping role it is playing, said George, the defence official. South Africa has some 1,250 troops in Burundi and 1,350 in Congo alone.

Now some of its neighbours are also scaling up treatment. The Zambian military has more than 1,000 people on AIDS drugs. But the stigma still associated with HIV is keeping more soldiers from seeking treatment.
Many countries are also struggling to train staff to care for their infected troops. The few with the skills are leaving for better paying jobs overseas. Others are themselves infected and dying.

Mozambique is still recovering from years of civil war and lacks even basic diagnostic equipment, said Major Agostinho Afonso, a doctor at the military hospital in Maputo. It has just 200 people on treatment and must concentrate on prevention.
"We need more help," he said.

Feeding the multitude

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