Knowledge, Attitudes, and Sexual Behaviour Among the Nigerian Military Concerning HIV/AIDS and STDs

Executive Summary

The first behavioural survey conducted in the Nigerian Armed Forces to elicit behavioural information that would contribute to a better understanding of the dynamics and underlying factors of the spread of sexually transmitted diseases (STDs) and HIV/AIDS in the military was carried out between May and August 2001.

The nationally representative survey was conducted amongst nearly 1,600 military personnel randomly selected from the three service arms of the Nigerian Armed Forces. Detailed information on the knowledge and attitudes regarding STDs and HIV/AIDS and on risky behaviour patterns was elicited. Also, information on some socio-demographic factors that could have possible explanatory value or confounding effects was obtained. The survey reveals that Nigerian military personnel are very educated and dedicated, with long-term career investments in the military that imply personal and professional hardships and risks. Of concern is that Nigerian military personnel find themselves in professional and personal situations that lead to engaging in high-risk behaviours that could put them at risk of contracting STDs, including HIV. Furthermore, in view of the fact that military personnel live with and interact freely with the civilian population, they could serve as a potential core transmission group for these infections to the larger population. This is of great concern and calls for prompt interventions. Whilst military personnel are more aware of HIV/AIDS than the general population, more could be done by the Nigerian military to protect their dedicated officers and men to the extent possible from the risks to which they are exposed.

Some of the risky behaviours engaged in by military personnel that were identified include multiple partnering, with 15.3 percent of the respondents reporting having hadat least two sexual partners over the last 12 months. Of these partners, one-third were non-regular sexual partners comprising casual acquaintances, girl/boyfriends, and paid sex partnerships. Although less than 5 percent of the study population admitted having paid for sex, only slightly more than half used a condom on that occasion.

A large proportion of respondents were aware that condoms could be used as protection against HIV/AIDS and other STDs, and most of the respondents (98%) knew where to acquire one. However, only half of the respondents claimed to use a condom regularly with their non-regular partners. In addition, only one-quarter of all respondents had ever received supplies of condoms from the Armed Forces, and of those who did, two thirds thought the supply inadequate.

Two-thirds of the respondents were married, but 17 percent did not cohabit with their partners because they were either on peace-keeping missions or had to leave for training, sometimes for periods in excess of six months, as was reported by 31.7 percent of the respondents. Almost half of the respondents who participated in the various peace-keeping operations admitted having sexual partners during the period away. The longer the time spent away, the higher the chances that they had sexual partners. With these sexual partners, only half of the respondents protected themselves by using a condom.

Many military personnel have little knowledge of STDs/HIV and poor understanding and low risk perception of HIV/AIDS. Less than 50 percent of male respondents knew at least two accurate male-specific symptoms of STDs and only 21.5 percent of male respondents knew at least two female-specific symptoms of STDs. Nearly 4 percent of those surveyed reported STD symptoms in the previous 12 months, and 10 percent of those did not seek modern health care treatment. Whilst nearly 40 percent of respondents had good HIV/AIDS transmission and prevention knowledge, one-quarter of those surveyed had poor knowledge of HIV/AIDS. Respondents' perception of their risk of contracting HIV was poor, as 41 percent felt they faced no risk of contracting HIV and 22 percent felt they had only a small risk. Respondents' condom use does not vary with the level of perceived risk.

Steps taken by respondents to reduce risky behaviours were few. Only 40 percent of the respondents had been tested for HIV, out of which 35 percent voluntarily took the test.However, 89 percent will take the HIV screening test if it were to be provided free of charge.

The facts emerging from this survey have revealed that the Nigerian military personnel indulge in high-risk sexual behaviours, which puts them at high risk of contracting STDs, including HIV. The implications of this are two-fold. Firstly, the risk of contracting HIV may threaten the preparedness of the military to carry out its functions. Secondly, since military personnel live amongst the civilian population, they can serve as a potential core transmission group of these infections to the larger civilian population.

These findings highlight an urgent need for proper planning and execution of targeted prevention strategies in order to prevent undesirable consequences. There is also a need for biological sentinel surveillance in the military in order to track HIV and STDs so that resources can be re-directed to areas where they are most needed. Military personnel living with HIV/AIDS should be assured of the confidentiality of their HIV test results and protection of job security, employment, and the possibility of advancement in rank at least until medical discharge from the service.

It is also recommended that the Nigerian military formulate policies addressing whether or not condoms should be distributed freely and how regular the supply should be. Further studies are needed to determine the ideal duration of time military personnel can spend away from their base and avoid unhealthy sexual relationships.

Introduction

...As HIV continues to spread through the world, it has become increasingly obvious that the epidemic does not follow a set course in all societies. Rather, it affects different geographical areas and population sub-groups in different ways and at different times. This variation further complicates the task of monitoring the course of the HIV epidemic and hence, in providing appropriate interventions. Therefore, the benefits to be derived from a better understanding of the trends over time and of the behaviours of persons in the country during the epidemic cannot be over-emphasised. Such an understanding can only be achieved through surveillance, which provides much needed information about who is most at risk and which behaviours put them at risk.

The purpose of biological sentinel surveillance is to track HIV infection levels in populations that are of particular interest in the epidemic or representative of a larger population. However, one of the biggest difficulties encountered in tracking the spread of HIV is determining the extent to which the population tested is representative of any larger population. Behavioural surveys of HIV-related behaviour help to identify sub-populations at risk, which will help focus scarce resources on areas where more useful information and benefits can be derived.

It is generally recognised that certain sub-groups in the general population are more at risk of contracting and transmitting HIV infection than others. Military personnel have been reported to be among the most susceptible populations to HIV...It is commonly understood that military personnel are generally young, sexually active people imbued with feelings of invincibility and a greater inclination toward high-risk behaviour compared with the general public. By virtue of the nature of their work, which involves a large degree of mobility and long periods of staying away from their families, they engage in high-risk sexual behaviours that expose them to STDs and HIV/AIDS. Furthermore, aside from having new recruits, who are usually in the 15–24 year-old age group and therefore most at risk of contracting HIV, military camps and barracks often attract commercial sex workers (CSWs), thus increasing vulnerability.

When this health risk is high enough, it can be seen as a significant threat to the preparedness of the military to carry out its functions. The proper planning and formulation of policies by the military to address this threat must be based on accurate and timely information.

This behavioural survey attempts to elicit behavioural information that would contribute to a better understanding of the dynamics and underlying factors of the spread STDs and HIV/AIDS in the military. It will also serve as baseline information that can be linked with future follow-up studies or interventions.

Footnote numbers were omitted from this excerpt.