HIV and Current Status Awareness Among Men in the Military in Sub- Saharan Africa: A Comparison with the General Population and Associations with Transmission Knowledge, Stigma and Discrimination, and Testing Sites

BACKGROUND. The Global AIDS Strategy 2021-2026 called for more focus on the ‘missing’ men in areas with HIV to address the gender gap in testing and treatment. Men in the militaries of sub-Saharan Africa are a unique sub-population due to their culture and work environment and a priority for increasing HIV status awareness. METHODS. Data on active-duty men ages 18-49 years were combined from 20 Seroprevalence and Behavioral Epidemiology Risk Surveys conducted among militaries in sub-Saharan Africa from 2013-2020. Meta-analyses with sub-groups were used to compare HIV prevalence, HIV knowledge, condom use, and discriminatory attitudes with the general population. Associations of HIV knowledge, negative attitudes, perceived discrimination, and use of military HIV testing sites with HIV status awareness were determined using meta-regression analyses. Among men at higher-risk of acquiring HIV, imputation-based modeling was used to estimate the effect of changing identified associations on HIV status awareness at the population level. RESULTS. In Western/Central Africa, HIV prevalence and knowledge were higher in the military compared to the general population (2.7%vs1.3%). HIV status awareness was lower among men without correct HIV transmission knowledge, high perceived discrimination, and who didn’t use military testing facilities. Among high-risk men, the estimated difference in status awareness was +6.3% if 100% had correct HIV transmission knowledge, +3.8% if 100% had low perceived discrimination, and +2.7% if 100% used military testing. In Eastern/Southern Africa, HIV knowledge was higher in the military compared to the general population. Among high-risk men, only use of military testing was associated with status awareness with an estimated difference in awareness of +6.3% if 100% used military testing. CONCLUSIONS. The exposures related to military services may be putting men in the military in Western/Central Africa at increased risk of HIV. Identifying men living with HIV and getting them connected to treatment is vital for prevention of morbidity/mortality and transmission. Increasing HIV knowledge and use of military testing sites as well as decreasing perceived discrimination could increase overall status awareness among men at high-risk of acquiring HIV. Current military HIV programs should focus on proven interventions in these areas for HIV prevention and to increase status awareness