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Communicable diseases and gender norms in the Sierra Leone Armed Forces
Djibo, Audrey Marie-Delphine
BACKGROUND: Communicable diseases affecting military personnel in subSaharan Africa impact the overall health of soldiers and their contacts, and include human immunodeficiency virus (HIV) and syphilis infections. Understanding the risks of acquisition and transmission of sexually transmissible infections, particularly of HIV, is critical in shaping effective prevention interventions among soldiers in Sierra Leone. Sexual behaviors including partner types and condom use, as well as other behaviors such as alcohol use and gender-specific beliefs surrounding female genital mutilation/cutting (FGM/C) were investigated in order to determine their influence on HIV and syphilis transmission risk. METHODS: This cross-sectional study recruited soldiers from the Sierra Leone Armed Forces using random systematic sampling in 2013. Participants were individually interviewed using a structured computer-assisted questionnaire. The seroprevalence of HIV and syphilis was assessed using rapid testing algorithms. Alcohol-related sexual disinhibition (ARSD) was examined among male soldiers living in Eastern Sierra Leone. Opinions towards the influence of FGM/C on partner selection, STI protection, and condom use were evaluated. Demographic and behavioral characteristics associated with these beliefs were analyzed. RESULTS: We found that female gender, unplanned sex after alcohol use, using a condom at last sex, having multiple concurrent sexual partnerships, and HIV testing outside of military clinics were positively associated with HIV status (p<0.05). Positive syphilis serology was associated with older age, and HIV-infection. Secondly, ARSD was significantly associated with cohabitating with a sexual partner, paying for sex, no previous HIV testing, and acquiring an STI. Overall, 1 in 6 men believed that FGM/C affected their choice in sexual partner, that the practice was protective against STIs and the justification for unprotected sex. Similarly, 1 in 4 women reported the same beliefs. Attitudes on partner selection were associated with lower education and low knowledge of HIV transmission pathways among men. Among women participants, believing that FGM/C protected from STIs was positively associated with being HIV-positive. CONCLUSION: This research demonstrated several behaviors and beliefs that expose soldiers to STIs. These behaviors should be addressed among soldiers through integrated interventions covering education on HIV transmission, alcohol use reduction, and sensitization on the adverse outcomes of FGM/C.
Health and Human Services
Doctor of Philosophy (Ph.D.) University of California, San Diego and San Diego State University, 2015
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