Michael Grillo

Prevalence of PTSD and Depression, and Associated Sexual Risk Factors, among Male Rwanda Defense Forces Military Personnel

To assess depression and PTSD prevalence among the Rwanda Defense Forces (RDF) and evaluate whether sexual risk behaviour, STIs, HIV and alcohol use were significantly higher among those who screened positive.

Sexually transmitted infections and sexual behaviour of deploying shipboard US military personnel: a cross-sectional analysis

Objectives Sexually transmitted infection (STI) prevalence and risk behaviour may differ at different phases of deployment. We examined STI prevalence and sexual behaviour in the predeployment time period (12 months prior) among recently deployed shipboard US Navy and Marine Corps military personnel. Methods Data were collected from 1938 male and 515 female service members through an anonymous, self-completed survey assessing sexual behaviours and STI acquisition characteristics in the past 12 months. Cross-sectional sex-stratified descriptive statistics are reported. Results Overall, 67% (n=1262/1896) reported last sex with a military beneficiary (spouse, n=931, non-spouse service member, n=331). Among those with a sexual partner outside their primary partnership, 24% (n=90/373) reported using a condom the last time they had sex and 30% (n=72/243) reported their outside partner was a service member. In total, 90% (n=210/233) reported acquiring their most recent STI in the USA (88%, n=126/143 among those reporting ≥1 deployments and an STI ≥1 year ago) and a significantly higher proportion (p<0.01) of women than men acquired the STI from their regular partner (54% vs 21%) and/or a service member (50% vs 26%). Conclusions Findings suggest a complex sexual network among service members and military beneficiaries. Findings may extend to other mobile civilian and military populations. Data suggest most STI transmission within the shipboard community may occur in local versus foreign ports but analyses from later time points in deployment are needed. These data may inform more effective STI prevention interventions.

Military HIV Policy Assessment in Sub-Saharan Africa

While HIV/AIDS continues to inflict a heavy toll on African militaries, the military commitment and leadership response has been inconsistent, as reflected by variable presence of a written HIV policy. The Department of Defense HIV/AIDS Prevention Program collaborates with most sub-Saharan military HIV/AIDS programs. In 2010, 28 invited countries (80%) completed a self-administered survey describing their program, including policy. Descriptive and nonparametric measures were calculated. The majority (57%) of respondents reported having a written military HIV policy. Of these, 86% included HIV testing, 88% required recruit testing, and 96% denied entry for those testing HIV-positive. Mandatory HIV testing was reported by 71%, occurring before deployments, peacekeeping missions, foreign training, and when clinically indicated. Southern African militaries were most likely to require HIV testing. The majority of militaries allowed deployment of HIV-positive personnel in-country, whereas few allowed foreign deployment. Most sub-Saharan militaries screen applicants for HIV and other diseases to determine duty fitness, resulting in near universal HIV negative recruit cohorts. No militaries discharge personnel from service if they acquire HIV. Legal challenges to military HIV policies may hinder finalization and dissemination of policies. Lack of HIV policies impedes routine testing and earlier care and treatment for HIV-infected personnel.

Self-Reported HIV-Positive Status But Subsequent HIV-Negative Test Result Using Rapid Diagnostic Testing Algorithms Among Seven Sub-Saharan African Military Populations

HIV rapid diagnostic tests (RDTs) combined in an algorithm are the current standard for HIV diagnosis in many sub-Saharan African countries, and extensive laboratory testing has confirmed HIV RDTs have excellent sensitivity and specificity. However, false-positive RDT algorithm results have been reported due to a variety of factors, such as suboptimal quality assurance procedures and inaccurate interpretation of results. We conducted HIV serosurveys in seven sub-Saharan African military populations and recorded the frequency of personnel self-reporting HIV positivity, but subsequently testing HIV-negative during the serosurvey. The frequency of individuals who reported they were HIV-positive but subsequently tested HIV-negative using RDT algorithms ranged from 3.3 to 91.1%, suggesting significant rates of prior false-positive HIV RDT algorithm results, which should be confirmed using biological testing across time in future studies. Simple measures could substantially reduce false-positive results, such as greater adherence to quality assurance guidelines and prevalence-specific HIV testing algorithms as described in the World Health Organization’s HIV testing guidelines. Other measures to improve RDT algorithm specificity include classifying individuals with weakly positive test lines as HIV indeterminate and retesting. While expansion of HIV testing in resource-limited countries is critical to identifying HIV-infected individuals for appropriate care and treatment, careful attention to potential causes of false HIV-positive results are needed to prevent the significant medical, psychological, and fiscal costs resulting from individuals receiving a false-positive HIV diagnosis.

Voluntary Medical Male Circumcision among Rwanda Defense Force Members

INTRODUCTION Strong scientific evidence supports voluntary medical male circumcision as part of an overall HIV prevention strategy, but self-report information on circumcision status may be inaccurate. The study objectives were to obtain estimates of male circumcision within the Rwanda Defense Force (RDF), to assess the ability of soldiers to correctly report their own circumcision status, and to document the uptake of voluntary medical male circumcision (VMMC) in the RDF. METHODS Data were collected from members of the Rwandan military during their annual physical examination. A self-administered questionnaire collected demographic and circumcision characteristics. Self-reported circumcision status was compared with the medical exam evaluation. RESULTS Using questionnaires with complete data (n = 579), 69% of the study participants were circumcised by physical examination and there was a strong agreement with self-reported circumcision status (κ = 0.97). Almost half (44%) of all circumcisions had been performed within the past 2 years. DISCUSSION These results suggest that self-report is an appropriate method to collect information on circumcision status in the Rwandan military. Many of the circumcisions occurred within the last 2 years, possibly as an effect of the successful scale-up of voluntary medical male circumcision in the Rwandan military utilizing effective messaging, demand creation, and positive news reported by the media.

Short-Term Transfer of Knowledge Assessment in the Military International HIV Training Program (MIHTP)

Background: The Military International HIV Training Program (MIHTP) was established in 2002 to address the overwhelming needs of international military personnel concerning HIV and AIDS prevention, care, and treatment. The purpose of this study was to determine short-term knowledge transfer in trainees attending the MIHTP by comparing data collected from pre-training and posttraining knowledge assessments. Methods: We used identical 40-question multiple choice pre-training and post-training assessments to determine the short-term transfer of knowledge of international HIV military physicians attending the MIHTP. Results: Findings revealed a statistically significant increase in short-term transfer of knowledge of HIV prevention, care, and treatment in a population of international military physicians, nurses, and auxiliary medical personnel from 47 developing countries (n=136). Trainees had significantly higher post-test scores (67.9%) compared with pre-test scores (50.5%, p<0.001). Trainees showed a similar level of HIV knowledge as assessed by pre-training evaluations (F=1.38). Conclusion: We found significant increases in acquired individual knowledge after a 4-week HIV training program. Results of this study are important as many developing countries rely heavily on international training programs to aid in the development of health care systems in an ever-changing infrastructure.

HIV and Syphilis Prevalence and Associated Risks in the Cameroonian Armed Forces

BACKGROUND Continued surveillance of the HIV epidemic is critical to monitor changes in trends and risk behaviors. A 2005 study in the Cameroonian Armed Forces (CAF) found an HIV prevalence of 11.3% among male and female service members. The purpose of the current study is to determine the 5-year change in the HIV prevalence, estimate the prevalence of syphilis, and examine factors associated with infection in the CAF. METHODS Participants were male and female service members 18 years of age or older who were stationed at one of the 10 military garrisons selected for participation. The military garrisons included in this study were proportionally representative of the CAF by geographic region. Military companies and individuals within the selected garrisons were randomly chosen to participate in the study. Demographic and behavioral risk data were collected from September-November 2011 using personal interviews. Blood was collected for HIV and syphilis testing. RESULTS Of 2,523 participants tested, 6.0% screened positive for HIV [includes 5.3% who screened positive for HIV only and 0.7% who screened positive for both HIV and syphilis], and 3.1% screened positive for syphilis only. Analyses examining risk factors associated with HIV/syphilis infection (i.e., infected with HIV, infected with syphilis, or co-infected with both HIV and syphilis) were restricted to 2,255 men who reported ever having sex. In a multivariate logistic regression model, the odds of testing positive for HIV/syphilis were higher among men who were separated, divorced, or widowed (adjusted odds ratio [AOR]=3.13, 95% confidence interval [CI]: 1.24-7.89), had sex with sex workers (AOR=1.64, 95% CI: 1.19-2.27), and reported a genital sore/ulcer in the past 12 months preceeding the survey (AOR=1.73, 95% CI: 1.05-2.86). Higher HIV knowledge was protective against HIV/syphilis infection (AOR=0.73, 95% CI: 0.54-0.99). While the overall HIV prevalence in this sample of military personnel was lower than previously reported (6.0% [95% CI: 5.12-6.97] in 2011 vs. 11.3% [95% CI: 10.01-12.68] in 2005; confidence intervals do not overlap), several factors associated with HIV/syphilis infection were identified including being separated, divorced, or widowed, having sex with a sex worker, and reporting a genital sore/ulcer in the past 12 months. CONCLUSION HIV and syphilis education among all military personnel as they enter service and proceed forward is important to reinforce prevention methods and practices.