Alcohol use and its association with sexual risk behaviors in the Armed Forces of the Republic of the Congo

Background

Previous research has shown alcohol misuse amplifies the risk of acquiring sexually transmitted infections [STIs], including HIV, by increasing high risk sexual behaviors. Military populations are particularly vulnerable to both alcohol misuse and STIs due to the unique conditions of military service. This study estimated the prevalence of probable hazardous and harmful alcohol use and examined associations with transactional sex, sex with a sex worker, and multiple sexual partners among military personnel in the Armed Forces of the Republic of the Congo (FAC).

Methods

A secondary analysis of data collected from a 2014 seroprevalence and behavioral epidemiology risk survey was performed. Participants included 703 active duty male service members 18 years of age or older who reported ever having sex. Patterns of harmful and hazardous drinking were measured with the Alcohol Use Disorders Identification Test (AUDIT). Participants with an AUDIT score ≥ 8 (indicative of probable hazardous and harmful alcohol use, and possible alcohol dependence) were compared to those with an AUDIT score ≤ 7.

Results

A total of 15.8% received a score of 8 or higher on the AUDIT. These participants were more likely to be lower educated and of lower military rank. In separate multivariable models, an AUDIT score ≥ 8 was significantly associated with higher odds of sex with a commercial sex worker and having multiple sexual partners.

Conclusions

Study results emphasize the need to address patterns of harmful and hazardous alcohol use in the FAC and integrate alcohol misuse education into the HIV prevention program. The development of military-specific interventions to reduce alcohol-related risky sexual behaviors are also needed. Lastly, implementing policies such as restricting alcohol availability and sales on military bases, and adding warning labels to advertisements and containers may provide a more comprehensive response to reduce problematic alcohol use.

HIV and Syphilis Prevalence and Associated Risks in the Cameroonian Armed Forces

BACKGROUND

Continued surveillance of the HIV epidemic is critical to monitor changes in trends and risk behaviors. A 2005 study in the Cameroonian Armed Forces (CAF) found an HIV prevalence of 11.3% among male and female service members. The purpose of the current study is to determine the 5-year change in the HIV prevalence, estimate the prevalence of syphilis, and examine factors associated with infection in the CAF.

METHODS

Participants were male and female service members 18 years of age or older who were stationed at one of the 10 military garrisons selected for participation. The military garrisons included in this study were proportionally representative of the CAF by geographic region. Military companies and individuals within the selected garrisons were randomly chosen to participate in the study. Demographic and behavioral risk data were collected from September-November 2011 using personal interviews. Blood was collected for HIV and syphilis testing.

RESULTS

Of 2,523 participants tested, 6.0% screened positive for HIV [includes 5.3% who screened positive for HIV only and 0.7% who screened positive for both HIV and syphilis], and 3.1% screened positive for syphilis only. Analyses examining risk factors associated with HIV/syphilis infection (i.e., infected with HIV, infected with syphilis, or co-infected with both HIV and syphilis) were restricted to 2,255 men who reported ever having sex. In a multivariate logistic regression model, the odds of testing positive for HIV/syphilis were higher among men who were separated, divorced, or widowed (adjusted odds ratio [AOR]=3.13, 95% confidence interval [CI]: 1.24-7.89), had sex with sex workers (AOR=1.64, 95% CI: 1.19-2.27), and reported a genital sore/ulcer in the past 12 months preceeding the survey (AOR=1.73, 95% CI: 1.05-2.86). Higher HIV knowledge was protective against HIV/syphilis infection (AOR=0.73, 95% CI: 0.54-0.99). While the overall HIV prevalence in this sample of military personnel was lower than previously reported (6.0% [95% CI: 5.12-6.97] in 2011 vs. 11.3% [95% CI: 10.01-12.68] in 2005; confidence intervals do not overlap), several factors associated with HIV/syphilis infection were identified including being separated, divorced, or widowed, having sex with a sex worker, and reporting a genital sore/ulcer in the past 12 months.

CONCLUSION

HIV and syphilis education among all military personnel as they enter service and proceed forward is important to reinforce prevention methods and practices.

Comparisons of reported sexual behaviors from a retrospective survey versus a prospective diary in the Botswana Defence Force

This study compares self-reported sexual behaviors from a retrospective survey and a prospective diary among Botswana Defence Force (BDF) personnel. One hundred sixty-one male participants, aged 18-30, completed two weekly prospective diaries and a retrospective survey querying them about behaviors reported during the same time frame as the diaries. Most reported behaviors were similar between the two data collection methods. However, there was low agreement for reporting sex with a spouse and exchanging material goods for sex with a casual partner; frequency of sex and condom use rates (CURs) among married participants also differed. When comparing survey condom use frequencies to diary CURs, the level of agreement diminished from the always to occasionally condom use categories. Inconsistencies in reporting may be due to the frequency of the sexual behavior, question sensitivity, the data collection setting, and the interpretation of response categories. Further research is needed to improve accurate reporting of sexual behaviors.

An intervention study examining the effects of condom wrapper graphics and scent on condom use in the Botswana Defence Force

Free condoms provided by the government are often not used by Botswana Defence Force (BDF) personnel due to a perceived unpleasant scent and unattractive wrapper. Formative work with the BDF found that scented condoms and military-inspired (camouflage) wrapper graphics were appealing to personnel. A non-randomized intervention study was implemented to determine whether condom wrapper graphics and scent improved condom use in the BDF. Four military sites were selected for participation. Two sites in the south received the intervention condom wrapped in a generic wrapper and two sites in the north received the intervention condom wrapped in a military-inspired wrapper; intervention condoms were either scented or unscented. Two hundred and eleven male soldiers who ever had sex, aged 18-30 years, and stationed at one of the selected sites consented to participate. Sexual activity and condom use were measured pre- and post-intervention using sexual behavior diaries. A condom use rate (CUR; frequency of protected sex divided by the total frequency of sex) was computed for each participant. Mean CURs significantly increased over time (85.7% baseline vs. 94.5% post-intervention). Adjusted odds of condom use over time were higher among participants who received the intervention condom packaged in the military wrapper compared with the generic wrapper. Adjusted odds of condom use were also higher for participants who reported using scented vs. unscented condoms. Providing scented condoms and condoms packaged in a military-inspired wrapper may help increase condom use and reduce HIV infection among military personnel.

Condom use behaviours and correlates of use in the Botswana Defence Force

Preventing HIV infection is a priority for militaries. HIV prevention research is needed to monitor existing programme, identify areas for modification, and develop new interventions. Correct and consistent condom use is highly effective against HIV. However, use among soldiers is lower than ideal. This study describes condom use behaviours and examines correlates of use in the Botswana Defence Force (BDF). Analyses were based on 211 male BDF personnel, aged 18-30, who completed a cross-sectional survey that collected baseline data for an intervention study. Results showed that 51% of participants reported always using condoms, 35% used condoms most times, and 14% used condoms occasionally/never. Condom use varied by partner type and was typically higher with casual partners in comparison to regular partners. After adjustment for age and marital status, factors associated with lower condom use included excessive alcohol use, perception that using condoms reduce sexual pleasure, and having a trusted partner. However, higher levels of HIV knowledge and reports of being circumcised were protective against lower condom use. HIV interventions aimed at increasing condom use in the BDF should address condom perceptions, alcohol abuse, and issues of trust. Innovative ways to increase condom use in this population should also be explored.