Evaluation of a Prevention Intervention to Reduce HIV Risk among Angolan Soldiers

Drew CARES, Institute for Community Health Research, Department of Psychiatry and Human Behavior, Charles Drew University of Medicine and Science, 1731 East 120th Street, Building N, Los Angeles, CA 90059, USA.
AIDS and Behavior (Impact Factor: 3.49). 06/2008; 12(3):384-95. DOI: 10.1007/s10461-008-9368-2
Source: PubMed


We developed and evaluated a military-focused HIV prevention intervention to enhance HIV risk-reduction knowledge, motivation, and behaviors among Angolan soldiers. Twelve bases were randomly assigned to HIV prevention or control conditions, yielding 568 participants. HIV prevention participants received training in preventing HIV (4.5 days) and malaria (0.5 days). Control participants received the reverse. Monthly booster sessions were available after each intervention. We assessed participants at baseline, 3 and 6 months after the training. HIV prevention participants reported greater condom use and less unprotected anal sex at 3 months, as well as greater HIV-related knowledge and perceived vulnerability at 3 and 6 months. Within-group analyses showed HIV prevention participants increased condom use, reduced unprotected vaginal sex, and reduced numbers of partners at both follow-ups, while control participants improved on some outcomes at 3 months only. A military-focused HIV prevention intervention may increase HIV-related knowledge, motivation, and risk reduction among African soldiers.

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    • "Conversely, higher HIV prevalence has been detected among active duty troops than in general population groups, leading to the characterization of military populations as a high-risk group in some contexts [3,7,21]. With regard to risk behavior, some studies speculate that military populations have higher rates of risk behaviors, potentially decreasing ability to generalize prevalence of risk behaviors to a general population of young adults or have military populations serve as a sentinel group for risk behaviors [21]. The regular movement associated with postings and stress related to combat have been posited as reasons for military populations to engage in behaviors placing them at greater risk for STIs, including HIV [3,7,8,21]. "
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    ABSTRACT: Background Few data are available in Afghanistan to shape national military force health practices, particularly with regard to sexually-transmitted infections (STIs). We measured prevalence and correlates of HIV, syphilis, herpes simplex 2 virus (HSV-2), and hepatitis C virus (HCV) among Afghan National Army (ANA) recruits. Methods A cross-sectional sample of male ANA recruits aged 18–35 years were randomly selected at the Kabul Military Training Center between February 2010 and January 2011. Participants completed an interviewer-administered questionnaire and serum-based rapid testing for syphilis and hepatitis C virus antibody on-site; HIV and HSV-2 screening, and confirmatory testing were performed off-site. Prevalence of each infection was calculated and logistic regression analysis performed to identify correlates. Results Of 5313 recruits approached, 4750 consented to participation. Participants had a mean age of 21.8 years (SD±3.8), 65.5% had lived outside Afghanistan, and 44.3% had no formal education. Few reported prior marijuana (16.3%), alcohol (5.3%), or opiate (3.4%) use. Of sexually active recruits (58.7%, N = 2786), 21.3% reported paying women for sex and 21.3% reported sex with males. Prevalence of HIV (0.063%, 95% CI: 0.013- 0.19), syphilis (0.65%, 95% CI: 0.44 – 0.93), and HCV (0.82%, 95% CI: 0.58 – 1.12) were quite low. Prevalence of HSV-2 was 3.03% (95% CI: 2.56 - 3.57), which was independently associated with age (Adjusted Odds Ratio (AOR) = 1.04, 95% CI: 1.00 - 1.09) and having a television (socioeconomic marker) (AOR = 1.46, 95% CI: 1.03 – 2.05). Conclusion Though prevalence of HIV, HCV, syphilis, and HSV-2 was low, sexual risk behaviors and intoxicant use were present among a substantial minority, indicating need for prevention programming. Formative work is needed to determine a culturally appropriate approach for prevention programming to reduce STI risk among Afghan National Army troops.
    BMC Infectious Diseases 08/2012; 12(1):196. DOI:10.1186/1471-2334-12-196 · 2.61 Impact Factor
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    ABSTRACT: The argument that there is a link between conflict and the spread of HIV has become commonplace in both the academic and policy world. This is particularly so for sub-Saharan Africa given the combination of an HIV pandemic in the region and high levels of violent conflict and state instability. However the link is not straightforward. Crucially, despite significant risk factors indicating a relationship between conflict and the spread of HIV, empirical evidence exists that HIV does not always increase in times of conflict, and that in some conflicts prevalence has decreased. This suggests a more complex relationship than originally envisaged. This paper does four things. First, it examines the risk factors identified in the early years of this decade which indicated a relationship between conflict and the spread of HIV. Second, it discusses how empirical evidence began to emerge suggesting a more complex relationship and how a number of conflicts demonstrated reduced HIV prevalence despite these risk factors. The third section moves beyond risk factors to suggest a framework based on susceptibility and vulnerability which explains under what circumstances HIV might - and might not - be spread, despite the presence of risk factors. The final section examines four cases - Sierra Leone, Angola, Rwanda and the DRC - where conflict did not lead to a significant increase in the prevalence of HIV, using the previous framework as the basis to explain this phenomenon. The paper concludes that, despite the fears of a few years ago, conflict does not readily act as a vector for HIV, though the potential for this to occur does still exist under certain circumstances.
    Review of International Studies 04/2010; 37(2). DOI:10.1017/S0260210510000574 · 1.09 Impact Factor
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    ABSTRACT: We included eight studies with 11,164 participants but one study did not provide enough data to be useful. One study from Africa found a strong increase in uptake of Voluntary Counseling and Testing (VCT) to 51% when delivered on-site which was 14 times more compared to a voucher for off-site testing. However, VCT did not change HIV incidence in one study among African factory workers. In another study among HongKong truck drivers, VCTdecreased self-reported sexually transmitted diseases (STD) but VCT did not decrease unprotected sex significantly. Education was studied among soldiers in Nigeria, Angola and the US, truck drivers in India and factory workers in Thailand.. Education that was modelled after a motivational theory reduced STDs with 32%, decreased unprotected sex with a small amount, reduced sex with a commercial sex worker with 12% but did not decrease the number of partners or the habit of using alcohol before sex. We concluded that workplace interventions for preventing HIV are feasible and that it is possible to study them in a randomised controlled trial. Peer influence has a positive effect on VCT uptake and workplace interventions can change risky sexual behaviour to a moderate degree. More randomised trials are needed in high risk groups or in areas with high HIV prevalence to find more effective interventions.
    Cochrane database of systematic reviews (Online) 12/2011; 12(12):CD005274. DOI:10.1002/14651858.CD005274.pub3 · 6.03 Impact Factor
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