Communicable Diseases and Gender Norms in the Sierra Leone Armed Forces

BACKGROUND: Communicable diseases affecting military personnel in sub- Saharan 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