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HIV Seroprevalence, Associated Risk Behavior, and Alcohol Use Among Male Rwanda Defense Forces Military Personnel

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Abstract

A cross-sectional study was conducted among active-duty male soldiers, aged ≥21 years, in the Rwanda Defense Forces (RDF) and included an anonymous behavioral survey and HIV rapid testing to determine risk factors associated with HIV seroprevalence. Overall prevalence was 2.6 % (95 % CI: 1.84–3.66); personnel who were divorced, separated or widowed, served ≥6 years, never deployed, uncircumcised, reported STI symptoms, had ≥6 lifetime sex partners, or screened positive for harmful alcohol use (via Alcohol Use Disorders Identification Test) had higher HIV prevalence. Ever being divorced, separated or widowed (OR = 29.8; 95 % CI: 5.5–159.9), and STI symptoms (OR = 3.4; 95 % CI: 1.5–7.6) were significantly associated with infection, after multivariable adjustment, while circumcision was protective (OR = 0.4; 95 % CI: 0.2–0.9). Despite mobility and other factors that uniquely influence HIV transmission in militaries, RDF prevalence was similar to the general population. A reason for this finding may be conservative sexual behavior combined with effective leadership-supported prevention programs. Data suggest a concentrated rather than generalized epidemic, with targets identified for intervention.

Resumen

Se realizó un estudio transversal en soldados de género masculino en servicio activo, mayores de 21 años de edad, en las Fuerzas de Defensa de Ruanda (RDF, por sus siglas en inglés), y se incluyó una encuesta anónima sobre comportamiento y pruebas rápidas de VIH para determinar los factores de riesgo asociados con la sero-prevalencia de VIH. La sero-prevalencia global fue de 2.6 % (IC al 95 % 1.84–3.66); el personal divorciado, separado o viudo, que hayan servido más de seis años, que nunca hayan sido enviados a zonas alejadas, no circuncidados, que hayan reportado síntomas de ITS, que hayan tenido más de 6 compañeros sexuales en toda su vida, o que hayan resultado positivos en el tamizaje de problemas de alcoholismo (en base a la Prueba de Identificación de Trastornos Debidos al Uso de Alcohol) mostraron una prevalencia de VIH mas alta. El haber sido divorciado/separado/viudo (OR = 29.8; 95 % CI: 5.5–159.9), y el haber tenido sintomas de ITS (OR = 3.4; 95 % CI: 1.5–7.6) fueron factores asociados significativamente con la infección por VIH luego de haber ajustado por las demás variables, mientras que la circuncisión resultó tener un efecto protector (OR = 0.4; 95 % CI: 0.2–0.9). A pesar de la movilidad y otros factores que afectan de manera única la transmisión de VIH en militares, la prevalencia de VIH en RDF fue similar a la población general. Una razón que explique este hallazgo puede ser el comportamiento sexual conservador combinado con los programas efectivos de prevención basada en apoyo de los grupos líderes. Los datos sugieren una epidemia concentrada, más que generalizada, con objetivos identificados para intervenciones.

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Acknowledgments

The authors would like to thank the Rwanda Ministry of Defense for the opportunity to collect these data and support of this study. We thank Population Services International (PSI) for providing highly qualified and knowledgeable staff to provide the HIV testing for this study and feedback on the study design. Also we would like to thank Karen Cheng for generous provision of her time to provide feedback on the questionnaire and guidance during protocol development, which directly improved the quality of this study. This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Department of Defense HIV/AIDS Prevention Program (DHAPP) and HIV/AIDS Program Component under work unit number 60546. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government. Approved for public release; distribution is unlimited. This research was conducted in compliance with all applicable federal regulations governing the protection of human subjects (Protocol NHRC.2008.0033).

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Authors and Affiliations

  1. Naval Health Research Center, Department of Defense HIV/AIDS Prevention Program, 140 Sylvester Road, San Diego, 92106, CA, USA

    Judith Harbertson, Michael Grillo, Stephanie Brodine & Richard Shaffer

  2. Department of Epidemiology and Threat Assessment, US Military HIV Research Program, Henry Jackson Foundation, Rockville, MD, USA

    Judith Harbertson

  3. US Embassy, Kigali, Rwanda, Africa

    Eugene Zimulinda

  4. Rwanda Defense Forces, Kigali, Rwanda, Africa

    Charles Murego & Marcellin Sebagabo

  5. Department of Biostatistics, University of Washington, Seattle, WA, USA

    Susanne May

  6. Department of Family and Preventive Medicine, University of California, San Diego, CA, USA

    Maria Rosario G. Araneta

  7. Department of Psychology, San Diego State University, San Diego, CA, USA

    Terry Cronan

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  1. Judith Harbertson
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  2. Michael Grillo
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  3. Eugene Zimulinda
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  4. Charles Murego
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  7. Marcellin Sebagabo
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  8. Maria Rosario G. Araneta
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  9. Terry Cronan
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  10. Richard Shaffer
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Correspondence to Judith Harbertson.

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Harbertson, J., Grillo, M., Zimulinda, E. et al. HIV Seroprevalence, Associated Risk Behavior, and Alcohol Use Among Male Rwanda Defense Forces Military Personnel. AIDS Behav 17, 1734–1745 (2013). https://doi.org/10.1007/s10461-012-0343-6

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  • DOI: https://doi.org/10.1007/s10461-012-0343-6

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