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.

Sexual and Gender-Based Violence Attitudes and Experiences among Nine Sub-Saharan African Militaries.

INTRODUCTION: While sexual and gender-based violence (SGBV) is recognized as an important factor driving the HIV epidemic in sub-Saharan Africa, attitudes toward and prevalence of SGBV within sub-Saharan African military populations are unknown. Data on SGBV were collected from military service members of nine sub-Saharan African militaries. Attitudes related to SGBV and characteristics of those who commit and experience SGBV are reported. METHODS: Data for 8815 service members (8165 men and 650 women) aged 18 years or older who voluntarily participated in the Seroprevalence and Behavioral Epidemiology Risk Surveys from 2009 to 2014 were included in this secondary data analysis. Data were collected on demographics, HIV prevalence, SGBV attitudes, and experiences. Descriptive and bivariate statistical analyses were performed. RESULTS: 5% of men and 9% of women reported experiencing SGBV, and 6% of men reported they had ever committed SGBV. Men and women who had experienced SGBV were significantly more likely to agree with negative gender attitudes toward SGBV, and the majority of those who reported experiencing SGBV reported that SGBV was committed by someone outside of the military. CONCLUSION: This is the first study to examine SGBV in sub-Saharan military populations during periods of limited conflict. It provides evidence that SGBV is experienced by both male and female service members at rates not typically found in previous research examining SGBV in other military populations. A better understanding of SGBV in sub-Saharan military service members is necessary to ensure appropriate services and interventions are part of the military infrastructure.