Research on sexual and condom use behaviors in the Botswana Defence Force

Background : Studies show inconsistent condom use is relatively common among military personnel. In an effort to increase condom use among soldiers, an intervention was implemented to examine the effects of condom scent and wrapper graphics on usage in the Botswana Defence Force (BDF). Current condom use behaviors and correlates of lower condom use were characterized, and differences in reporting behaviors from a retrospective survey and a prospective diary were also examined. Methods : From October 2010-April 2011, 211 sexually-active male BDF soldiers, aged 18-30, participated in the study. Participants at four military bases received condoms in a plain blue or camouflage wrapper, either scented or unscented. A baseline survey collected demographics and HIV risk behaviors. Pre- and post-intervention behaviors were measured with two diaries each. A retrospective survey was administered immediately after the post- intervention diaries, which queried participants about behaviors as reported in those diaries. Several participants were also randomly selected to participate in focus group sessions which included discussions about condoms, condom use, and reporting of sexual behaviors. Results : Only 51% of participants reported always using condoms at baseline. Lower condom use was associated with excessive alcohol use, reported trust for a sexual partner, and the perception that condoms make sex less enjoyable. Scented condoms and condoms packaged in a camouflage wrapper were found to increase condom use rates in the BDF. Most sexual behaviors reported in the survey and diary were similar, with the exception of behaviors associated with having a regular partner, reports of exchanging material goods for sex with a casual partner, and reports of some retrospective condom use categories. Conclusions : HIV interventions aimed at increasing condom use in the BDF should address alcohol abuse, beliefs about condoms, and issues of trust. The BDF should consider providing scented condoms and condoms packaged in a camouflage wrapper, coupled with messages of correct and consistent condom use, which may help increase usage. Results suggest that retrospective surveys are useful for measuring recent sexual behaviors, although prospective diaries may be more reliable in collecting routine and sensitive sexual practices in the BD