HIV Prevention Research With U.S. Military Service Members: A Systematic Review

Female-Specific Health Care of Military Female-Designated Service Members and Veterans: A Systematic Overview of Reviews

INTRODUCTION

Since the War in Afghanistan began in 2001, service members have faced significant health effects related to service during war, with female-designated service members facing unique challenges. Numerous high-quality review articles have been published on the health and care of female-designated service members and veterans. Given the increasing volume of literature, we completed an overview of reviews on the health and health care of female-designated military populations. Our objective was to conduct an overview of reviews on the obstetrics and gynecologic health and health care of female-designated military populations since 2000 to understand female-specific health consequences of military service during war and make clinical recommendations.

MATERIALS AND METHODS

On May 10, 2022, a medical librarian performed a comprehensive search across five databases (Ovid Medline, Embase, CINAHL, PsycINFO, Ovid All EBM Reviews, and Web of Science) for all relevant reviews published from 2000 to May 10, 2022. Results were limited to English language. After the removal of duplicates, 2,438 records were reviewed, and 69 studies were included in the final review. The search strategy and methods were registered with PROSPERO and are reported according to the Preferred Reporting Items for Overviews of Reviews (PRIOR) guidelines. Two independent reviewers conducted title and abstract screening and subsequent full text review using Covidence Systematic Review Software. Reviews addressing female-specific and obstetrics and gynecologic health of female-designated service members or veterans, utilizing a clear and systematic methodology, were eligible for inclusion. Quality assessment was conducted by teams of two reviewers.

RESULTS

A total of 69 studies were included in the final review. Themes included mental health and impact of sexual assault on service members or veterans, veteran health care, issues of menstruation, pregnancy, and urogenital concerns. Areas with few reviews included occupational risks of military service and impact on obstetric outcomes, eating disorders, and menopause. There were insufficient or no reviews on the impact of military service on fertility, access to abortion care, reproductive health outcomes of lesbian, bisexual and transgender service members, surgical treatment of gynecologic conditions, and screening and treatment for breast, gynecologic, and non-pelvic organ cancers.

CONCLUSIONS

Female-designated military populations serving during periods of war face unique health challenges that should be considered in screening practices and the delivery of trauma informed care. Further research and reviews are needed for female-specific oncology, fertility, abortion access, and sexual and non-binary and expansive gender identities to better capture female-designated service member and veteran health during wartime and beyond.

U=U: "Undetectable Equals Untransmittable" Perceptions Among Men Who Have Sex With Men Active Duty Service Members: A Cross-Sectional Study

ABSTRACT

Undetectable = Untransmittable (U=U) is a key message emphasizing that antiretroviral therapy suppresses HIV and prevents its sexual transmission. However, dissemination of U=U varies among health care providers, potentially leading to knowledge gaps among patients. Little research exists on the understanding of U=U among active duty men who have sex with men (MSM) in the U.S. military. Our cross-sectional, online study examines 222 active duty MSM to determine prevalence of accurate knowledge of U=U and demographic predictors of misinformation. Participants received a pre-exposure prophylaxis (PrEP) overview and were asked to indicate if the statement "Undetectable equals Untransmittable" was true or false. Although the majority accurately understood U=U (70%; n = 156), approximately 30% did not (n = 66); a binary logistic regression revealed lower U=U understanding among White, bisexual, unmarried, and Marines/Navy participants. Standardized education on U=U is crucial for resolving knowledge gaps and combating stigmas surrounding HIV treatment.

PrEP Prescription Among MSM U.S. Military Service Members: Race and Sexual Identification Matter

An estimated 20.9% of U.S. service members report a high risk of HIV infection; however, only 2,000 service members had accessed HIV pre-exposure prophylaxis (PrEP) as of 2017. This study used a cross-sectional design to explore PrEP prescription predictors among service members who identify as a man who have sex with other men (MSM) (n = 354). Logistic regression was performed to assess the influence of four predictor variables: partner HIV status, race/ethnicity, primary partner gender, and sexual orientation on the odds participants' report being prescribed PrEP. A majority identified as gay (n = 246, 69.5%) and 23.4% (n = 83) identified as bisexual. Bisexual participants were 2.1 times (p = <.04) less likely to be prescribed PrEP. Accordingly, those who identify their primary sex partner as female were 5.1 times less likely to be prescribed PrEP (p < .001). MSM service members who had a partner disclose their HIV-positive status were 4.1 times more likely to have been prescribed PrEP (p = .013). Finally, participants who identify as Black were 3 times more likely (p = .001), and Latinx MSM were 3.6 times more likely (p = .003) to have been prescribed PrEP.