Correlates of HIV Knowledge and Sexual Risk Behaviors Among Female Military Personnel

Correlates of HIV knowledge and Sexual risk behaviors amongFemale Military Personnel

E. James Essien, MD, DrPH*,***, Emmanuel Monjok, MD, MPH*, Hua Chen, MD, PhD*, SusanAbughosh, Ph.D*, Ernest Ekong, MD, MPH**, Ronald J. Peters, DrPH***, Laurens Holmes Jr,MD, DrPH****, Marcia M. Holstad, DSN*****, and Osaro Mgbere, PhD, MPH*******Institute of Community Health. University of Houston, Texas Medical Center, 1441 MoursundStreet, Houston. Texas 77030, USA**Institute for Health Research and Development, Yaba, Lagos, Nigeria***The University of Texas School of Public Health, 7000 Fannin Street, Houston, Texas 77030, USA****Nemours Center for Childhood Cancer Research, 1700 Rockland Road, Wilmington, DE 19803,USA*****Nell Hodgson School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA******Houston Department of Health and Human Services, 8000 N. Stadium Dr. Houston, TX 77054,USA

AbstractObjective—Uniformed services personnel are at an increased risk of HIV infection. We examinedthe HIV/AIDS knowledge and sexual risk behaviors among female military personnel to determinethe correlates of HIV risk behaviors in this population.

Method—The study used a cross-sectional design to examine HIV/AIDS knowledge and sexualrisk behaviors in a sample of 346 females drawn from two military cantonments in SouthwesternNigeria. Data was collected between 2006 and 2008. Using bivariate analysis and multivariatelogistic regression, HIV/AIDS knowledge and sexual behaviors were described in relation to socio-demographic characteristics of the participants.

Results—Multivariate logistic regression analysis revealed that level of education and knowingsomeone with HIV/AIDS were significant (p<0.05) predictors of HIV knowledge in this sample.HIV prevention self-efficacy was significantly (P<0.05) predicted by annual income and race/ethnicity. Condom use attitudes were also significantly (P<0.05) associated with number of children,annual income, and number of sexual partners.

Conclusion—Data indicates the importance of incorporating these predictor variables intointervention designs.

KeywordsHIV/AIDS; Risk behaviors; Military personnel; Nigeria

Correspondence: Dr. E. James Essien. Institute of Community Health, University of Houston, Texas Medical Center, 1441 MoursundStreet, Houston, Texas 77030, USA. Tel.: 713-795-8393; Fax: 713-795-8383; [email protected].

NIH Public AccessAuthor ManuscriptAIDS Behav. Author manuscript; available in PMC 2010 December 1.

Published in final edited form as:AIDS Behav. 2010 December ; 14(6): 1401–1414. doi:10.1007/s10461-010-9701-4.

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IntroductionHuman Immunodeficiency Virus infection is a major public health challenge in the FederalRepublic of Nigeria. Nigeria is the second most affected country in sub-Saharan Africa (SSA)with HIV disease, representing 14% of HIV/AIDS cases in the region1. While official reportshave suggested that the HIV epidemic has been slower to impact Nigeria than other countriesin Africa, research evidence in Nigeria suggests that HIV prevalence is high, as well asgeographically and socially widely distributed. For example, Esu-Williams et al.2 report thatin a sample of 2,300 persons from five states in Nigeria, HIV-1 appears in over 60% ofcommercial sex workers (CSW), 8% of blood donors in some states, with male clients of CSWs,truck drivers, and STD patients having respectively 8%, 9%, and 21%. More recently, a UnitedStates Naval Health Research Center funded study found a 15% Seroprevalence rate amongNigerian military personnel.3 As the most populous country in Africa (Population > 130million) and one of the most populous countries in the world, even a small increase in the HIV/AIDS prevalence rate in Nigeria would represent a significant share of the global HIV/AIDSburden4.

In 2007 women accounted for 58 percent of all adults aged 15 and above living with HIV. 5Some of the factors responsible for the growing epidemic among women in Nigeria includevarious cultural practices like polygamy and a culture of silence over sexuality, the risingpopularity of multi-partner mating among urban-based women in the 15-29 years' age group,women's inability to negotiate safe sex with their partners, lack of sexual education both athome and in schools, religious leaders' teaching which has led to stigma and which has notbeen empowering to women and an unwillingness of most men to use condoms. Research hasalso shown that because of cultural and economic reasons, many women feel unable to refusethe sexual advances of partners even when they know they risk infection. 6, 7 Poverty haspushed some young women between the ages of 15 and 25 into sex work 6 or to be involvedin transactional sex with older men (sugar daddies) who give them monies, school fees or giftsin exchange for sex. In exploring the reasons for extramarital sexual relationships amongmarried women in South-western Nigeria, Oruboloye and others 7 noted that 60% of marriedurban women and 33% of rural married women have extramarital sex for enjoyment, while34% of married rural women and 14% of married urban women had sex as a means of securingeconomic benefits. This is particularly important since unprotected sex among married couplesis the norm, yet many married men and women engage in unprotected extramarital sexualrelations, and thus risk infecting their spouses. Thus, the level of high-risk sexual networkingwithin or outside marriage in Nigeria tends to expose large sections of the population to therisk of HIV and other sexually transmissible diseases.

Epidemiologic evidence has consistently shown that military personnel are a high risksubpopulation with social norms that place them at an elevated risk of HIV infection.8, 9Nwokoji and Ajuwon 10 explored the HIV related risk behaviors among military personnel inNigeria by asking 480 enlisted men to complete a 70-item questionnaire that assessed HIV/AIDS knowledge, sexual behavior and risk-perception. The study revealed that 41% of therespondents did not use a condom during their last sexual encounter with a commercial sexworker and posting on international assignments was a positive predictor of lack of condomuse. Similarly, Essien et al 11, 12 examined the determinants of HIV risk behaviors amongNigerian military personnel and found a direct correlation between alcohol and marijuana useand HIV risk perception. Their study also showed that knowledge of how to correctly wear acondom and male gender were positive predictors of intent to wear a condom. From a broaderperspective, other investigators 10, 13 have shown a positive relationship between alcohol andmarijuana use and inconsistent condom use among Nigerian military personnel.

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A few reports in the literature have addressed the issue of HIV transmission among Nigerianmilitary personnel. Most soldiers are young and sexually active with a sense of invulnerabilitythat may lead to risky sexual behaviors and reduced condom use.13 Soldiers are often deployedfrom home for extended periods of time, have a regular income and the opportunity for casualsex.14 For instance, it has been reported that almost half of the military personnel thatparticipated in the various peacekeeping operations admitted having sexual partners duringtheir time away from home and with these sexual partners, only half of the respondents usedcondoms.8 In addition, societal norms that do not support condom use have been known toalso contribute to the efficiency of HIV transmission among Nigerian military personnel.15

Like their male counterparts, the high mobility of women in the armed forces also places themat risk of HIV infection for the same reasons they share. Also, female military personnel sexualinteractions with local partners while on peacekeeping missions, and with officers returningfrom peacekeeping missions to the barracks may also put them at risk of HIV infection sincethe lifestyles of militaries on such missions are often characterized by high levels of multiplesexual partners, including sex with commercial sex workers; low condom use, and exposureto blood transfusions in the line of duty. In addition, they are subject to sex under duress,transactional sex for favors from superior officers; and sometimes are at risk of outright rape.Therefore, the complexity of sexual networking within or outside the militaries suggest thatsome female military personnel may serve as a significant vector in a concentrated HIVepidemic in the barracks, as well as being a potential bridge to the general population throughsexual relationship with civilians. While there is a growing body of literature examining HIVrisk behaviors among Nigerian military personnel, these studies have been basedpredominantly on male samples and provide only limited information about risk behaviorsamong female military personnel. The current research sought to address this void in theliterature by examining the correlates of HIV knowledge and risk behaviors among Nigerianfemale military personnel.

MethodsParticipants

Study participants were female military personnel drawn from two cantonments inSouthwestern Nigeria. The study population was comprised of 346 females, ages 18 and above,who were recruited to participate in an HIV intervention study. Female military personnel wereeligible to participate in the study if they were: (1) sexually active and had a history ofunprotected vaginal intercourse in the past twelve months; (2) had a history of multiple sexualpartners; (3) did not plan to retire from the military in the next twelve months; (4) had a historyof alcohol and drug use; (5) and had the ability to communicate in English. Participants wereexcluded from the study if they were unable to sign an informed consent form or had anemotional disorder that could interfere with the study.

Study DesignThe study used the baseline data that was collected for a videotape-based HIV preventionintervention to examine the correlates of HIV knowledge and risk behaviors in the studypopulation. Baseline data were collected in 2006 and 2008 using a cross-sectional design. Thestudy used an adapted version of a previously validated instrument, 16 which was designed toassess HIV/AIDS knowledge, HIV risk behaviors, alcohol and drug use, condom use practices,HIV prevention self-efficacy and peer norms. Also, captured were the socio-demographiccharacteristics of the participants. The instrument was cross-validated with the present studypopulation.



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MeasuresThe investigative team administered the assessments using a group format. The facilitator usedoverhead projection transparencies of the instrument to walk the participants through themeasures. This procedure has been found to be particularly effective in eliciting accurateresponses to HIV risk assessments among populations with a low level of literacy.17 Measuresincluded demographic characteristics, HIV/AIDS knowledge, HIV prevention self-efficacy,condom use attitudes and barriers, substance use and sexual behaviors and peer norms.

Socio-demographic characteristics—The participants reported their age, marital status,race/ethnicity, religion, level of education, and employment status. Information was alsoobtained on socio-economic characteristics such as annual income, sexual relationships, andpersonally knowing someone with HIV/AIDS.

AIDS-related knowledge—We used a 10-item test to assess HIV/AIDS risk preventionknowledge. The items elicited information on HIV transmission knowledge, condom useknowledge, and AIDS-related knowledge. A categorical scale with three levels of responses(Yes, No, Don't know) was used. Example items included “Can a woman give the AIDS virusto a man?” (yes), “Can you get AIDS by touching a person with AIDS?” (no). Each correctanswer was scored 1 point, and a total score of 10 points was attainable based on the numberof questions. Participants that scored 5 points or less were classified as having ‘poor’knowledge and those that scored above 5 points were classified as having ‘good’ knowledge.The internal consistency of the HIV/AIDS knowledge scale in our sample was, alpha= 0.74.

HIV Prevention Self-efficacy—We assessed HIV prevention self-efficacy using a 6-itemscale that examined the participants' self-efficacy for condom use, HIV testing and substanceuse prior to sexual intercourse. Examples of items are: “Talked with sex partner about usingmale condoms or safer sex in the past three months”, “Did not have sex because you did nothave a condom”, “drank less or used drugs less before having sex”. The questions wereanchored on a three-month timeframe. The responses were categorized, with the highest scoreindicating a more favorable HIV prevention self-efficacy. Participant taking a positive actionon any of the items for 5 times or less in the past 3 months was classified as having ‘low’ HIVprevention self-efficacy and those taking positive action for more than 5 times as having ‘High’HIV prevention self-efficacy. The internal consistency of the HIV prevention self-efficacyscale in our sample was Cronbach alpha = 0.78

Condom use attitudes and barriers—Attitudes toward male and female condoms wereassessed using items that measured intent and utilization of condoms. A binary scale (yes orno) was used to score the item for actual condom use: I have used latex condoms. Condomattitude and barriers were assessed using a four-item test. The participants responded on a four-point scale ranging from 1 (strongly disagree) to 4 (strongly agree). The items included:“Female condoms take away pleasure” (reverse score), “male condoms reduce the fun of sex(reverse score)”. “I would be embarrassed to buy condoms” (reverse score), and male“condoms are a hassle to use”. Overall, a positive attitude towards condom use was determinedby the lowest score. Participants with a total score less than or equal to 55 were regarded ashaving positive attitudes towards condom use, and those scoring above 55, as having negativeattitudes. The internal consistency of the condom use scale in our sample was Cronbach alpha= 0.66.

Substance use and sexual behaviors—We classified drug use into major substanceswith which ingestion could result in behavioral impairment and altered mentation. These agentsincluded alcohol, marijuana, cocaine, amphetamines, and ecstasy. The agents were assessedin relation to sexual encounters. First, we asked the participants to provide a Yes or No response



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to questions that elicited information on the use of substances prior to sexual encounters duringthe past three months. Secondly, the participants were also asked to indicate the frequency ofsubstance use during the past three months. These responses were later categorized into fourgroups and used in the scale development. The internal consistency of the substance use andsexual risk behavior scale in our sample was Cronbach alpha = 0.62.

Human Subjects and Ethical ConsiderationsThe research protocol was reviewed and approved by the relevant Institutional Review Boardsat University of Houston in the United States and Institute for Health Research andDevelopment in Nigeria.

Statistical analysisFirst, descriptive analysis using frequency runs was carried out to determine the distributionof socio-demographic characteristics of the study participants. Chi-square statistic, (withFisher's exact test applied where applicable to correct for small cells count), was used to assessthe association of the Socio-demographic characteristics of study participants with HIV/AIDSknowledge, condom use attitudes, HIV prevention self-efficacy, and substance use and sexualbehaviors, respectively. Based on the outcome of this analysis, the predictor variables for usein multivariable logistic regressions were selected a priori, if they were epidemiologicallyimportant or if they were significant at the 0.10 level in a bivariate analysis. Multivariablelogistic regression was used to model HIV/AIDS knowledge, condom use attitudes and HIVprevention self-efficacy, and substance use. Adjusted Prevalence Odds Ratio (APOR) with95% confidence interval was computed for each association. All tests were two-tailed, withprobability value of 0.05 used as the statistical significance level. Data management andstatistical analyses were performed using SPSS software version 14.0 (SPSS Inc, Chicago, IL).

ResultsSociodemographic Characteristics

The Sociodemographic characteristics of the study population are presented in Table 1. Therewere a total of 346 participants from two military cantonments with majority of them of agerange 30-39 years (56.4%). Most of these participants had high school diploma and above (303,87.8%), with 42 (12.2%) having less than high school education. The marital status of the studypopulation indicates that 64.4% of participants were singles, with only 4.1% living as partners.Only 9.9% of them were married, with 40.8% of the participants claiming to have one or morechildren. Among the female military personnel, there were more Christians (77.7%) thanMuslims (21.1%). Also, there were more participants of Yoruba tribe (33.8%), compared toHausa and Ibo tribes. However, other minor tribes together represented about 33.2% of thestudy population (Table1). Approximately 30% of the respondents reported knowing one ormore people that have been infected with HIV/AIDS. Ninety six percent of the participantswere still in active service, with majority of them (51%) in the lower income brackets of₦241, 000- ₦360,000 per annum (Table 1).

Knowledge of HIV/AIDSTable 2 shows the bivariate and multivariate correlates of HIV/AIDS knowledge among femalemilitary personnel in Nigeria. The knowledge scores ranged from 2 to 10 with a mean of 7.6(SD=2.18). The results indicate that overall, 76.1% of the participants have good knowledgeof HIV/AIDS compared to 23.9% with poor knowledge of the disease. Knowledge of HIV/AIDS among the group was independently associated with educational attainment (P=0.005),religion (P=0.021), number of sexual partners (P=0.050) and knowing someone with the HIV/AIDS disease (P=0.001). Of the participants with good knowledge of HIV/AIDS, 34.9% of



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them compared to 13.8% with poor knowledge of HIV/AIDS agreed that they knew peopleinfected with the disease (table 2). However, multivariate logistic regression analysis showedthat HIV/AIDS knowledge among the female military personnel was significantly predicted(R2=0.06; P<0.01) by level of education (P=0.050) and knowing someone with the HIV/AIDSdisease (P=0.003). Those with high school diploma and above were twice more likely thanthose below high school, to have good knowledge of HIV/AIDS (APOR=2.08; 95%CI:0.97-4.46).

HIV Prevention Self-EfficacyThe confidence among the participants in performing a specific behavior was determined inrelation to their socio-demographic characteristics (Table 3). On the average, more than 70%of the participants reported low HIV prevention self-efficacy, having taken a positive actionfor only 2.64 times (SD: 1.73) on the average in the last 3 months (result not presented).Univariate analysis indicated that significant independent associations were only notedbetween HIV prevention self-efficacy and the following variables: race/ethnicity (χ2 = 7.56;P=0.053), religion (χ2 = 5.71; P=0.017), and annual income (χ2 = 3.99; P=0.046), respectively.However, multivariate analysis indicated that HIV prevention self-efficacy among the femalemilitary personnel was significantly predicted (P≤0.05) by their annual income and race/ethnicity (Table 3). The Yoruba race recorded a significant average protective APOR of 0.44,95% CI 0.22–0.92. Female military personnel with high income earnings were 3.48 times(APOR=3.48; 95%CI: 1.09-11.08), more likely to have high HIV prevention self-efficacy andto engage in safe sex behaviors than those with low income earnings.

Condom use attitudes and barriersTable 4 presents the bivariate and multivariate association of condom use attitude and barrierscale in the study population. An overall ratio of 1:1 was noted for participants with positiveand negative condom use attitude and barrier with a mean scores of 59.2 (SD: 2.99) and 51.2(SD: 3.98), respectively. Among the covariates considered, only participants' annual income(P= 0.054) and number of sexual partners (P=0.025) were significantly associated with condomuse attitude and behavior. Majority of the participants (61.8%) indicated that they had sex withmultiple partners in the past three months, with 34.3% and 27.5% of them having positive andnegative condom use attitudes. Multivariate analysis of the association, however, indicates thatpositive condom use attitudes and behavior among female military personnel was significantlypredicted by the number of children (P=0.003), annual income (P=0.036) and the number ofsexual partners (P=0.001). Participants with high annual income were 71% more likely(APOR=1.71; 95%CI: 1.04-2.83) to have positive attitudes towards condom use and to engagein safe sexual behaviors than the low annual income earners. With respect to sexual activity,during the previous three months period, study participants on the average had 3 sexualencounters without condoms and 4 sexual encounters with condoms (Table 5). This impliesthat condoms were used about 57% of the time. There was a significant difference between thenumber of times they had ‘sex without a condom’ with a single partner (Mean = 4.0; 95%CI:3.62-4.39) compared to ‘sex with multiple partners’ (Mean = 2.79; 95%CI: 2.27-3.32).However, no significant differences (P>0.05) were observed by type of partners (casual vs.non-casual).

Substance use and sexual behaviorsThe overall proportional distribution indicates that about 31% of the study population reportedbeing involved in sexual behaviors associated with substance use. However, of the correlatesconsidered, the following were significantly associated with substance use and sexualbehaviors of participants: educational attainment (P=0.012), race/ethnicity (P=0.039),employment status (P=0.05), number of sexual partners (P=0.000) and knowing someone with



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HIV/AIDS disease (P=0.000) (Table 6). Multivariable logistic regression analysis showed thatsubstance use and risky sexual behavior among the female military personnel was significantlypredicted by their educational level, number of sexual partners and knowing someone withHIV/AIDS disease. Participants with high school certificate and above, having sex withmultiple partners, and knowing someone impacted by the HIV/AIDS disease had a significantlyhigher likelihood of substance use with adjusted prevalence odds ratios of 3.92, 3.08 and 2.58,respectively (Table 6).

DiscussionMilitary populations, in general, have increased vulnerability to HIV infection, compared tothe general civilian populations. Risk factors among the military include high rates of sexualpartner change, elevated rates of STIs, low rates of condom use with commercial sex workersand other casual partners, and significant mixing between groups having high and low riskbehavior patterns.25 The study attempted to ascertain participants' level of knowledge withrespect to HIV/AIDS through a number of questions. Although more than three quarters of theparticipants had good knowledge of HIV/AIDS including mode of transmission, few of themlacked adequate knowledge to make responsible decisions about HIV/AIDS risk behavior andpossessed beliefs about HIV exposure that may increase their risk. Similar findings of armedforces personnel having a high degree of knowledge and engaging in risk-taking behaviorshave been reported in other studies.19, 20, 21 However, an appreciable level of knowledge ofthe modes of transmission of HIV and how to prevent it are important prerequisites for behaviorchange.21 The significant association noted in the bivariate analysis between religiousaffiliation and HIV/AIDS knowledge suggests that religious organizations may constitute astrong cultural force for preventive education in the military. More than three quarter of thepersonnel in our study were Christians, even though Muslims represent nearly 45 percent ofthe general population in Nigeria.18

In our study population we found that knowledge of HIV/AIDS was significantly associatedwith level of education and the personnel's knowing of someone infected with HIV/AIDSdisease. Majority of the respondents were literate, with only 12.2 percent having less than highschool education. Unlike in the past, new entrants into the Nigerian armed forces are nowrequired to have some level of education either from within the military system through theNigerian Defense Academy or from outside the system. Thus, the Nigerian military populationis quite well educated compared with the general population.18 Educational level might protectagainst HIV infection through information and knowledge that may affect long-term behavioralchange, particularly for women by “reducing the social and economic vulnerability thatexposes [them] to a higher risk of HIV/AIDS than men”, including prostitution and other formsof economic dependence on men.23 We noted that knowing someone impacted by the HIVdisease tends to encourage the females' quest for HIV/AIDS knowledge. Proximity to thedisease (e.g., knowing someone with HIV/AIDS) has similarly been shown to be useful ineducating others about the disease.24 This finding confirms the wisdom of many communityprograms that utilize persons with HIV to reach and motivate the community. However, thelow level of variance explained by the correlates in our study is an indication that several otherfactors not captured here may be responsible for determining the female military personnel'sknowledge of HIV/AIDS.

In our study, we found that more than 70% of the respondents had lower HIV prevention self-efficacy; with race, religious affiliations and annual income being significant correlates.Although this finding differs from previous reports where women were said to have greatercondom use self-efficacy, 26, 27 it does support the gender difference in perceived controlduring a sexual encounter.28, 29 Specifically, the lack of perceived control over a sexualencounter by women may explain the lower HIV prevention self-efficacy and the higher



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perceived condom use barriers reported by the females in our sample. Also, the series ofmisconceptions about the nonexistence of AIDS and/or the myths about the availability of cure,10 may encourage some females to practice risky behaviors. Culturally, women carryingcondoms in Nigeria are stigmatized as being sexually permissive. Therefore, as reported bymany researchers, condom use self-efficacy in women may generally reflect their ability toapply condoms, negotiate condom use, exert self-control during sexually arousing encounters,and develop acceptance of sexuality. 28, 30 In our study, the low HIV prevention self-efficacymay have contributed to the less than optimal use of condoms. The variable odds of lower HIVprevention self-efficacy by ethnicity in the study population may help account for the role ofethnicity in predicting sexual risk behaviors. It is also possible that the ability to tease apartcultural and social bias from personal choice may dramatically impact HIV prevention self-efficacy. In Nigeria there are three major ethnic groups namely Yoruba, Ibo and Hausa. TheHausas who occupy the northern part of the country are mainly Muslims, while the Yorubasfound in the southwestern region are a blend of Christians and Muslims. The Ibos inhabit thesoutheastern part of the country and are mainly Christians of Catholic faith. It is a generallyheld view among these major ethnic groups that decisions on safe sex are left with men. Womenare rarely in a position to insist on the use of a condom if their partners do not want it. Nor canthey protect themselves by using a female condom without their partners' permission or theymay be accused of infidelity. With females constituting approximately 6-10% of the militaryin Nigeria, 13 and being exposed to the same - and sometimes even greater - pressure as mento enter into casual sexual relationships, there is need to promote ingenious ways of femaleself-protection from the highly dominant males. Therefore being safe in the circumstancewould require the female military personnel to change their individual behaviors and to developstrategies to change the social context of their lives in the barracks.

On a fundamental level, Christians and Muslims in Nigeria have similar views on why HIVcontinues to spread: both groups see promiscuous behavior as the root cause of the HIV crisisand promiscuity is frowned upon heavily because of religious teachings and because ofunderlying cultural traditions within the Nigerian society. Although Christians do not believepeople should engage in sexual behavior before marriage, a social stigma is the harshestpunishment a person would receive from society if their extra-marital sex is discovered.Muslims, on the other hand, could be punished for their decisions about extra marital sexthrough the system of Sharia law. While morals and ethics in Islamic laws generally tend toshape women lives through antagonism toward sex and sexual relations and explain the verylow level of access to the women, there is however, no strong evidence that this may have adirect impact on risky sexual behavior among Muslims. Ethnic comparison associates theYoruba with the greatest incidence of extramarital sexual activity when compared to the Ibosand Hausas. 31 This is because the Yorubas tend to be more permissive of both male and femaleinfidelity. 32, 33 The protective odds of HIV prevention self-efficacy noted among participantsof Yoruba ethnicity may be related to high exposure to western education, which tend toempower them with control over their sexuality including ability to negotiate condom use.

Consistent condom use is the most effective way to reduce exposure to HIV and other sexuallytransmitted diseases among sexually-active individuals. Approximately, 50% of therespondents in our sample had positive condom use attitudes and behaviors, possibly becausethis measure composed of beliefs with opposing valences that condoms are both effective andalso reduce pleasure.34 Negative attitudes toward condoms were generally associated withirregular or non-use of condoms by some participants. Despite their negative attitudes, thoseparticipants claimed to use condoms when they perceived their partner to be of high-risk. Someparticipants reported that they dislike condoms because its use reduces sexual pleasure, a reasonthat has commonly been cited by other researchers for none use of condoms during sexualencounters. 28, 35, 36



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In line with prior qualitative and quantitative research, 36, 37 respondents were unwilling touse condoms with their steady partners, because they believed condom use connotes distrustand a lack of intimacy, because they did not feel that their partner was at risk, or because theyfelt that condom use with long-term partners was unnecessary. In contrast, participants withmultiple partners had more positive attitudes, and were more likely to protect themselves duringsexual encounters. However, consistent users tended to use condoms with both steady andcasual partners, while less frequent condom users preferred to use them with people whomthey considered to pose comparatively higher risk such as new partners, and casual partners.But despite the relative good knowledge of this group about sexual transmission of HIV, ouranalysis indicates that 46% of the participants had sex with casual partners without usingcondoms. Unprotected sex with a casual partner is a risk factor for HIV infection among mobilepopulations like the military.19

A third of the participants reported substance use during sexual encounters, with 18% of thosehaving multiple sexual partners. Our current study also showed that female military personnelwho use substances were three times more likely to have multiple partners. Previous studiessimilarly associated substance use with multiple sex partners.38 The assumptions that alcoholand/or drug use will enhance a person's sexual attraction, behavior, or performance can alsohave an impact. For example, it has been noted that adolescents who expect alcohol to leadthem to be less inhibited sexually are more likely to participate in risky sexual behavior whenthey drink.39 It is very common to have restaurants and bars around military barracks, wherealcohol, and sometime illicit drugs are sold. Such social environments also support the meetingof new sexual partners and may help to explain the relationship between substance use and thelikelihood of having multiple partners. We noted in our study, that participants with multiplepartners were three times more likely to use alcohol and drugs during sexual encounters thanthose who had a single partner. Similarly, widespread alcohol use and sexual relationships inthe context of alcohol were noted among Nigerian soldiers with no significant differencebetween the genders. 13 If substance use leads to unsafe sexual activity, understanding thedynamics of this relationship can contribute to research and preventive and educational effortsto contain the spread of HIV.

If sexual risk taking is caused by lessened inhibitions due to substance use, then educationmight warn about the impact of alcohol and drugs on one's judgment and the potentialconsequences of such situations, such as the increased risk of STD and HIV transmission.Unfortunately, our study found that although participants with high school education and abovehad higher levels of HIV knowledge, they were approximately four times more likely to usealcohol and drugs than those who had less than high school education. It's been also reportedthat not all types of risky sexual behavior were avoided with increased levels of education.23 Therefore, it is important to distinguish the differential impact that education has on differentsexual behaviors, including condom use and multiple sexual partnership.

Implications for Interventions—Our findings from this investigation have implicationsfor the design of HIV/AIDS prevention interventions for Nigerian women in the militaryservice. The Nigerian military authority should conduct regular and sustained STD and HIVprevention education programs among military personnel and their families in the barracks andschools to reinforce health promoting behaviors. Such programs should include HIVprevention self-efficacy, and also the addition of an HIV positive peer educator should beconsidered. Female military personnel have already been identified as desirable peer educatorsthan their male counterparts based on their educational attainments. 13 Efforts should befocused on those segments of the military population shown to have lower knowledge levels,lower levels of preventive actions, low self-efficacy for condom use, and higher exposure torisk.



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Self-efficacy has been identified as an important component of condom use 40, 41 and thus,the low levels of HIV prevention self-efficacy reported in this group is a concern. Since thedemands of sexual communication may vary across sexual encounters based on the partner,the intimacy level, and a host of other situational factors, there is need to gear risk reductionself-efficacy interventions (sexual communication training) toward specific contexts.Specifically, the differing cultural and religious backgrounds of the female military personnelcould be examined within the context of an intervention to articulate and discuss cross-culturalsex role norms, reduction in number of sexual partners and consistent use of condoms. Thismay inform individuals and their partners of underlying social influences that impact how eachperson approaches sexuality. Understanding these factors is critical for the design of a culturallyand contextually tailored intervention for the reduction of sex-related health risks amongNigerian military personnel and their families.

Limitations—The data have the usual limitations of sexual behavior research, being self-reported information it is subject to reporting errors and biases, which could not be practicallyor ethically validated. They are also cross-sectional in nature, with current measures ofpsychosocial variables being used to predict reports of past behavior. Thus, while the studyprovides useful information about the associations between variables, conclusions should notbe drawn about causation or prediction. Also, since the study used military cantonments fromone of the six regions in Nigeria, the findings may not be generalizable or representative of thefemale military personnel in Nigeria. Future studies are needed to assess the effectiveness ofHIV prevention interventions among this venerable subpopulation.

ConclusionDespite the relatively good knowledge about sexual transmission of HIV, there was a low levelof confidence in HIV prevention self-efficacy and many in this subpopulation engaged inbehaviors that elevate their risk of exposure to HIV infection. Since these female servicepersonnel live and interact freely with civilian population they represent a potential bridginggroup for disseminating HIV into the larger population. Although there were no consistentassociations of the correlates to a number of the outcome variables considered in our study,targeted intervention programs for this group, taking the variables associated with the outcomemeasures into account could help to minimize the consequences of the epidemic. Since femalemilitary personnel are more vulnerable to HIV transmission through sex with infected partners,efforts are needed to ensure that their needs are met through gender-sensitive HIV interventionprograms. The Nigeria military service, like many others, has an organized structure that couldprovide an excellent opportunity for the implementation of such intervention programs, whichcould help reduce military personnel chances of exposure to HIV. It is recommended thatfurther studies of sexual behaviors in this group be carried out using a larger sample size andconsidering other correlates in addition to those identified in the current study.

AcknowledgmentsResearch was funded by a grant from the United States National Institute of Mental Health (Grant number RO1MH073361-02)

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4. Kaiser Family Foundation. The HIV/AIDS Epidemic in Nigeria. HIV/AIDS Policy Fact Sheet.October;2005

5. UNAIDS. Epidemiological fact sheet on HIV and AIDS. 2008 [December 10, 2009]. Available at:http://www.unaids.org/en/CountryResponses/Countries/nigeria.asp

6. Caldwell JC. Understanding the AIDS epidemic and reacting sensibly to it. Soc Sci Med 1995;41:299–302. [PubMed: 7481924]

7. Oruboloye, IO.; Caldwell, JC.; Caldwell, P.; Santow, G., editors. Health Transitions Series. HealthTransition Centre, The Australian National University; 1994. Sexual networking and AIDS in Sub-Saharan Africa.

8. Ekong, E. HIV/AIDS and the Military. In: Adeyi, Olusoji; Kanki, Phyllis; Odutolu, Oluwole; Idoko,John, editors. AIDS in Nigeria. Harvard University Press; 2006.

9. UNAIDS. Best Practice Collection. Geneva: UNAIDS; 1998. AIDS and the Military.10. Nwokoji UA, Ajuwon AJ. Knowledge of AIDS and HIV risk-related Sexual Behavior among Nigerian

Naval Personnel. BMC Public Health 2004;4:24. [PubMed: 15210055]11. Essien EJ, Ogungbade OO, Ward D, Ekong E, Ross MW, Meshack A, Holmes L. Influence of

educational status and other variables on HIV risk perception among military personnel: A largecohort finding. Mil Med 2007;72(11):1177–1181. [PubMed: 18062392]

12. Essien EJ, Ogungbade OO, Kamiru HN, Ekong E, Ward D, Holmes L. Emerging socio-demographicand lifestyle predictors of intention to use a condom in Human Immunodeficiency Virus (HIV)intervention among Uniformed Services personnel. Mil Med 2006;171(10):1027–1034. [PubMed:17076460]

13. Okulate GT, Jones OB, Olorunda MB. Condom use and other HIV risk issues among Nigeria soldiers:challenges for identifying peer educators. AIDS Care 2008;20(8):911–6. [PubMed: 18777219]

14. Yeager R, Hendrix C, Kingma S. International military HIV/AIDS policies and programs: strengthsand limitations in current practice. Mil Med 2000;165:87–92. [PubMed: 10709366]

15. Aniekwu NI. Gender and Human Rights Dimensions of HIV/AIDS in Nigeria. Afr J Reprod Health2002;6(3):30–7. [PubMed: 12685406]

16. Kalichman SC, Cherry C, Browne-Sperling F. Effectiveness of a Video-Based Motivational Skills-Building HIV Risk Reduction Intervention for Inner-City African American Men. J Consult ClinPsychol 1999;67(6):959–966. [PubMed: 10596517]

17. Carey MP, Maisto SA, Kalichman SC, Forsyth A, Wright I, Johnson BT. Enhancing motivation toreduce risk for HIV infection for economically disadvantaged urban women. J Consult Clin Psychol1997;65:531–541. [PubMed: 9256553]

18. National Population Commission [Nigeria]. Nigeria Demographic and Health Survey. Calverton,Maryland: National Population Commission and ORC/Macro; 2000.

19. Adebayo SB, Mafeni J, Moreland S, Murray N. Knowledge, Attitude and Sexual Behavior amongthe Nigerian Military Concerning HIV/AIDS and STDs. Armed Forces Programme on AIDS Control(AFPAC). Final Technical Report September;2002 :95.

20. Jenkins, et al. Correlates of human immunodeficiency virus infection risk behavior in male attendeesof a clinic for sexually transmitted diseases. Clin Infect Dis 2000;30(40):723–729. [PubMed:10770735]

21. Bing EG, Ortiz DJ, Ovalle-Bahamon RE, Cheng KG, Huang FH, Enesto F, Duan N. HIV/AIDSBehavioral Surveillance among Angolan Military Men. AIDS and Behav 2008;12(4):578–84.

22. UNAIDS. AIDS Care, and STD Control Program. 2000. National AIDS Programs: A Guide toMonitoring and Evaluating National HIV Prevention. UNAIDS/00.17E

23. World Bank. Education and HIV/AIDS: A Window of Hope. Washington, D.C., USA: 2002.24. Zimet GD, Hillier SA, Anglin TM, Ellick EM, Krowchuk DP, Williams P. Knowing someone with

AIDS: The impact on adolescents. J Pediatr Psychol 1991;16:287–294. [PubMed: 1890555]25. Temoshok, LR.; Kingma, SJ. HIV Exposure Risk in Military Populations: An Uncharted Prevention

Frontier. International Conference on AIDS; July 7-12, 1996; p. 48Abstract No. Mo.D.35426. Fisher JL. Gender issues with condom use self-efficacy beliefs (Immune deficiency). Diss Abstr Int

1996;56(10):5754.



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27. Ransom JE. Factors related to safer sex behaviors in young college students. Diss Abstr Int 1998;59(5):2126.

28. Bryan AD, Aiken LS, West SG. Young women's condom use: The influence of acceptance ofsexuality, control over the sexual encounter, and perceived susceptibility to common STIs. HealthPsychol 1997;6:468–479. [PubMed: 9302544]

29. Gerteisen GM. HIV/AIDS risk perceptions, health beliefs, perceived self-efficacy and sexual issuesrelated to young women's condom use behavior. Diss Abstr Int 1998;58(11B):5913.

30. O'Leary A, Goodhart F, Jemmott S, Boccher-Lattimore D. Predictors of safer sex on the collegecampus: A social cognitive theory analysis. J Am Coll Health 1992;40:254–263. [PubMed: 1602092]

31. Adegbola, O.; Babatola, O. The Cont Afr HIV/AIDS Epidemic. 1999. Premarital and extramaritalsex in Lagos, Nigeria; p. 19-44.

32. Ladebo OJ, Tanimowo AG. Extension Personnel's Sexual Behaviour and Attitudes toward HIV/AIDSin South-Western Nigeria. Afri J Reprod Hlth 2002;6(2):51–59.

33. Orubuloye IO, Caldwell JC, Caldwell P. Perceived male sexual needs and male sexual behavior inSouthwest Nigeria. Soc Sci Med 1997;44(8):1195–1207. [PubMed: 9131743]

34. Bogart LM, Kral AH, Scott A, Anderson R, Flynn N, Gilbert ML, Bluthenthal RN. Condom Attitudesand Behaviors among Injection Drug Users Participating in California Syringe Exchange Programs.AIDS and Behav 2005;9(4):423–432.

35. Geringer WM, Marks S, Allen WJ, Armstrong KA. Knowledge, attitudes, and behavior related tocondom use and STDs in a high risk population. J Sex Res 1993;30:75–83.

36. Carballo-Dieguez A, Dolezal C. HIV risk behaviors and obstacles to condom use among Puerto Ricanmen in New York City who have sex with men. Am J Public Health 1996;86:1619–1622. [PubMed:8916531]

37. Farmer MA, Meston CM. Predictors of Condom Use Self-Efficacy in an Ethnically Diverse UniversitySample. Arch Sex Behav 2006;35(3):313–326. [PubMed: 16804746]

38. Kegeles S, Hays RB, Coates TJ. The Mpowerment Project: A community-level HIV preventionintervention for young gay men. Am J Public Health 1996;86(8):1129–36. [PubMed: 8712273]

39. Dermen KH, et al. Sex-related alcohol expectancies as moderators of the relationship between alcoholuse and risky sex in adolescents. J Stud Alcohol 1998;59(1):71–77. [PubMed: 9498318]

40. Fisher J, Fisher W. Changing AIDS-risk behavior. Psychol Bull 1992;111(3):455–474. [PubMed:1594721]

41. Mize SJS, Robinson BE, Bockting WO, Scheltema KE. Meta-analysis of the effectiveness of HIVprevention interventions for women. AIDS Care 2002;14(2):163–180. [PubMed: 11940276]



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Table 1

Socio-demographic characteristics of participants

Variable N %a

Total 346 100

Age (yrs)

18-29 82 23.7

30-39 195 56.4

40+ 69 19.9

Education Level

Less than High School 42 12.2

High School and above 303 87.8

Marital Status

Single 221 64.4

Married 34 9.9

Separated/divorced/widowed 74 21.6

Living as partner 14 4.1

Number of Children

No child 205 59.2

One or more child(ren) 141 40.8

Race/Ethnicity

Hausa 64 18.5

Ibo 50 14.5

Yoruba 117 33.8

Other 115 33.2

Religion

Christian 269 77.7

Muslim 73 21.1

Other 4 1.2

Employment Status

Active Service 331 96.2

Trainee b 13 3.8

Annual Income (× 1000)

₦120-240 63 18.3

₦241-360 176 51.0

₦361-500 93 27.0

₦500+ 13 3.8

Sexual Relationship


NIH


NIH


NIH



Variable N %a

Sex with one partner 218 63.0

Sex with multiple partners 128 37.0

Personally known someone with HIV

Yes 105 30.3

No 241 69.7

Number of people known with HIV

None 241 69.7

1-2 85 24.6

> 2 20 5.8

aWeighted % of those who responded; Some percentages may not add up exactly to 100% due to rounding.

bRefers to military personnel undergoing some form of training.


NIH


NIH


NIH



Tabl

e 2

Biv

aria

te a

nd m

ultiv

aria

te a

ssoc

iatio

n be

twee

n so

cio-

dem

ogra

phic

cha

ract

eris

tics a

nd H

IV/A

IDS

know

ledg

e am

ong

fem

ale

mili

tary

per

sonn

el

HIV

/AID

S K

now

ledg

e

Cor

rela

tes

Goo

dPo

orM

ultiv

aria

te d

n%

en

% e

χ2C

P-va

lue

Wal

dA

POR

(95%

CI)

aP-

valu

e

Age

(yrs

)

< 30

yrs

6123

.917

21.3

>= 3

0 yr

s19

476

.163

78.7

0.24

0.62

2N

/A--

Edu

catio

n L

evel

Less

than

Hig

h Sc

hool

(Ref

)b24

9.4

1721

.33.

532.

08 (0

.969

-4.4

61)

0.05

0*

Hig

h Sc

hool

and

abo

ve23

090

.663

78.7

7.87

0.00

5**

Mar

ital S

tatu

s

Sing

le19

878

.360

75.9

Mar

ried

5521

.719

24.1

0.19

0.66

7N

/A--

--

Num

ber

of C

hild

ren

No

child

155

60.8

4961

.3

One

or m

ore

child

(ren

)10

039

.231

38.7

0.01

0.94

1N

/A--

Rac

e/E

thni

city

Hau

sa41

16.1

2126

.3

Ibo

3814

.910

12.5

Yor

uba

8633

.728

35.0

5.18

0.15

9N

/A--

--

Oth

er90

35.3

2126

.3

Rel

igio

n

Chr

istia

n (R

ef)b

206

82.1

5670

.01.

150.

698

(0.3

61-1

.348

)0.

284

Mus

lim45

17.9

2430

.05.

360.

021*

Em

ploy

men

t Sta

tus


NIH


NIH


NIH



HIV

/AID

S K

now

ledg

e

Cor

rela

tes

Goo

dPo

orM

ultiv

aria

te d

n%

en

% e

χ2C

P-va

lue

Wal

dA

POR

(95%

CI)

aP-

valu

e

Trai

nee

(Ref

)b4

1.6

45.

10.

094

(f)

2.54

3.34

(0.7

57-1

4.73

2)0.

111

Act

ive

Serv

ice

250

98.4

7594

.9

Ann

ual I

ncom

e

Low

175

68.6

6075

.9

Hig

h80

31.4

1924

.11.

550.

213

N/A

--

Sexu

al R

elat

ions

hip

Sex

with

one

par

tner

(Ref

)b16

564

.742

52.5

0.64

1.25

(0.7

25-2

.147

)0.

425

Sex

with

mul

tiple

par

tner

s90

35.3

3847

.53.

840.

050*

Pers

onal

ly k

now

n so

meo

ne w

ith H

IV

No

(Ref

)b16

665

.169

86.3

13.0

10.

001*

**8.

840.

34 (0

.166

-.691

)0.

003*

*

Yes

8934

.911

13.8

a APO

R (9

5%C

I): A

djus

ted

Prev

alen

ce O

dds R

atio

; 95%

Con

fiden

ce In

terv

al.

b Ref

: Ref

eren

ce c

ateg

ory.

c Exce

pt fo

r rac

e/et

hnic

ity w

ith d

f=3,

all

othe

r cor

rela

tes h

ave

df =

1.

d Onl

y co

rrel

ates

that

met

the

entry

crit

eria

of P

≤ 0

.10

in th

e bi

varia

te a

naly

sis w

ere

incl

uded

in th

e m

ultiv

aria

te lo

gist

ic re

gres

sion

mod

el.

e Som

e pe

rcen

tage

s may

not

add

up

exac

tly to

100

% d

ue to

roun

ding

.

f: Fi

sher

's Ex

act T

est.

N/A

: Not

App

licab

le

* Sign

ifica

nce

leve

l: P<

0.05

;

**Si

gnifi

canc

e le

vel:

P<0.

01;

*** Si

gnifi

canc

e le

vel:

P<0.

001.


NIH


NIH


NIH



Tabl

e 3

Biv

aria

te a

nd M

ultiv

aria

te a

ssoc

iatio

n be

twee

n so

cio-

dem

ogra

phic

cha

ract

eris

tics a

nd H

IV P

reve

ntio

n Se

lf-Ef

ficac

y am

ong

fem

ale

mili

tary

per

sonn

el

Cor

rela

tes

HIV

Pre

vent

ion

Self-

Effi

cacy

Hig

hL

owM

ultiv

aria

te d

n%

en

% e

χ2c

P-va

lue

Wal

dA

POR

(95%

CI)

aP-

valu

e

Age

(yrs

)

< 30

yrs

2627

.152

21.8

>= 3

0 yr

s70

72.9

187

78.2

1.09

0.29

7N

/A--

--

Edu

catio

n L

evel

Less

than

Hig

h Sc

hool

(Ref

)b7

7.3

3414

.30.

61 (0

.246

-1.5

10)

0.28

5

Hig

h Sc

hool

and

abo

ve89

92.7

204

85.7

3.11

0.07

81.

14

Mar

ital S

tatu

s

Sing

le78

82.1

180

75.9

Mar

ried

1717

.957

24.1

1.48

0.22

3N

/A--

--

Num

ber

of C

hild

ren

No

child

6365

.614

159

.0

One

or m

ore

child

(ren

)33

24.4

9841

.01.

260.

261

N/A

----

Rac

e/E

thni

city

Hau

sa (R

ef)b

1414

.648

20.1

Ibo

2121

.927

11.3

7.56

0.05

3*3.

260.

33 (0

.099

-1.0

99)

0.07

1

Yor

uba

3435

.480

33.5

4.82

0.44

(0.2

15-0

.917

)0.

028*

Oth

er27

28.1

8435

.11.

360.

70 (0

.381

-1.2

78)

0.24

4

Rel

igio

n

Chr

istia

n (R

ef)b

8487

.517

875

.71.

004.

85 (0

.220

-10.

654)

0.31

7

Mus

lim12

12.5

5724

.35.

710.

017*

Em

ploy

men

t Sta

tus


NIH


NIH


NIH



Cor

rela

tes

HIV

Pre

vent

ion

Self-

Effi

cacy

Hig

hL

owM

ultiv

aria

te d

n%

en

% e

χ2c

P-va

lue

Wal

dA

POR

(95%

CI)

aP-

valu

e

Act

ive

Serv

ice

9610

0.0

229

96.6

Trai

nee

00.

08

3.4

0.11

1 (f

)N

/A--

--

Ann

ual I

ncom

e

Low

(Ref

)b60

62.5

175

73.5

4.44

3.48

(1.0

91-1

1.07

5)0.

035*

Hig

h36

37.5

6326

.53.

990.

046*

Sexu

al R

elat

ions

hip

Sex

with

one

par

tner

6264

.614

560

.7

Sex

with

mul

tiple

par

tner

s34

35.4

9439

.30.

440.

505

N/A

----

Pers

onal

ly k

now

n so

meo

ne w

ith H

IV

No

7072

.916

569

.00.

490.

483

N/A

----

Yes

2627

.174

31.0

a APO

R (9

5%C

I): A

djus

ted

Prev

alen

ce O

dds R

atio

; 95%

Con

fiden

ce In

terv

al.

b Ref

: Ref

eren

ce c

ateg

ory

c Exce

pt fo

r rac

e/et

hnic

ity w

ith d

f=3,

all

othe

r cor

rela

tes h

ave

df =

1

d Onl

y co

rrel

ates

that

met

the

entry

crit

eria

of P

≤ 0

.10

in th

e bi

varia

te a

naly

sis w

ere

incl

uded

in th

e m

ultiv

aria

te lo

gist

ic re

gres

sion

mod

el.

e Perc

enta

ges m

ay n

ot a

dd u

p ex

actly

to 1

00%

due

to ro

undi

ng.

f: Fi

sher

's Ex

act T

est.

N/A

: Not

App

licab

le

* Sign

ifica

nce

leve

l: P<

0.05

.


NIH


NIH


NIH



Tabl

e 4

Biv

aria

te a

nd M

ultiv

aria

te a

ssoc

iatio

n be

twee

n so

cio-

dem

ogra

phic

cha

ract

eris

tics a

nd C

ondo

m u

se A

ttitu

de a

nd B

ehav

ior a

mon

g fe

mal

e m

ilita

ry p

erso

nnel

Cor

rela

tes

Con

dom

use

Atti

tude

and

Beh

avio

r

Posi

tive

Neg

ativ

eM

ultiv

aria

te d

n%

en

% e

χ2c

P-va

lue

Wal

dA

POR

(95%

CI)

aP-

valu

e

Age

(yrs

)

< 30

yrs

4627

.132

19.4

2.61

0.63

(0.3

7-1.

10)

0.10

6

>= 3

0 yr

s12

472

.913

380

.62.

750.

097

Edu

catio

n L

evel

Less

than

Hig

h Sc

hool

(Ref

)b21

12.4

2012

.1

Hig

h Sc

hool

and

abo

ve14

887

.614

587

.90.

010.

932

N/A

----

Mar

ital S

tatu

s

Sing

le13

379

.212

576

.2

Mar

ried

3520

.839

23.8

0.42

0.51

9N

/A--

--

Num

ber

of C

hild

ren

No

child

(Ref

)b11

165

.393

56.4

9.06

0.44

(0.2

5-0.

75)

0.00

3**

One

or m

ore

child

(ren

)59

34.7

7243

.62.

800.

094

Rac

e/E

thni

city

Hau

sa (R

ef)b

3319

.429

17.6

Ibo

2313

.525

15.2

1.92

0.58

9N

/A--

--

Yor

uba

5331

.261

37.0

Oth

er61

35.9

5030

.3

Rel

igio

n

Chr

istia

n (R

ef)b

135

80.4

127

77.9

Mus

lim33

19.6

3622

.10.

300.

584

N/A

----

Em

ploy

men

t Sta

tus


NIH


NIH


NIH



Cor

rela

tes

Con

dom

use

Atti

tude

and

Beh

avio

r

Posi

tive

Neg

ativ

eM

ultiv

aria

te d

n%

en

% e

χ2c

P-va

lue

Wal

dA

POR

(95%

CI)

aP-

valu

e

Act

ive

Serv

ice

163

97.0

162

98.2

Trai

nee

53.

03

1.8

0.72

3 (f

)N

/A--

--

Ann

ual I

ncom

e

Low

(Ref

)b11

165

.712

475

.24.

391.

71 (1

.04-

2.83

)0.

036*

Hig

h58

34.3

4124

.83.

590.

054*

Sexu

al R

elat

ions

hip

Sex

with

one

par

tner

(Ref

)b55

32.4

7344

.211

.64

0.40

(0.2

3-0.

67)

0.00

1***

Sex

with

mul

tiple

par

tner

s11

567

.792

55.8

5.01

0.02

5*

Pers

onal

ly k

now

n so

meo

ne w

ith H

IV

No

118

69.4

117

70.9

0.90

0.76

5N

/A--

--

Yes

5230

.648

29.1

a APO

R (9

5%C

I): A

djus

ted

Prev

alen

ce O

dds R

atio

; 95%

Con

fiden

ce In

terv

al.

b Ref

: Ref

eren

ce c

ateg

ory

c Exce

pt fo

r rac

e/et

hnic

ity w

ith d

f=3,

all

othe

r cor

rela

tes h

ave

df =

1

d Onl

y co

rrel

ates

that

met

the

entry

crit

eria

of P

≤ 0

.10

in th

e bi

varia

te a

naly

sis w

ere

incl

uded

in th

e m

ultiv

aria

te lo

gist

ic re

gres

sion

mod

el.

e Perc

enta

ges m

ay n

ot a

dd u

p ex

actly

to 1

00%

due

to ro

undi

ng.

f: Fi

sher

's Ex

act T

est.

N/A

: Not

App

licab

le

* Sign

ifica

nce

leve

l: P<

0.05

;

**Si

gnifi

canc

e le

vel:

P<0.

01;

*** Si

gnifi

canc

e le

vel:

P<0.

001.


NIH


NIH


NIH



Tabl

e 5

Con

dom

Use

for

Vag

inal

Sex

in th

e pa

st th

ree

mon

ths a

mon

g Se

xual

ly-A

ctiv

e Fe

mal

e M

ilita

ry P

erso

nnel

in N

iger

ia+

Var

iabl

en

(%)

With

out C

ondo

mM

ean

(95%

CI)

+P-

valu

en

(%)

with

con

dom

Mea

n (9

5% C

I) +

P-va

lue

Ove

rall

278

(100

)3.

40 (3

.07-

3.72

)--

-31

8 (1

00)

4.18

(3.9

1-4.

47)

---

Sexu

al R

elat

ions

hip

Sing

le p

artn

er17

8 (6

4)4.

00 (3

.62-

4.39

)19

6 (6

2)4.

15 (3

.81-

4.50

)

Mul

tiple

par

tner

s10

0 (3

6)2.

79 (2

.27-

3.32

)0.

000*

**12

2 (3

8)4.

22 (3

.78-

4.66

)0.

825n

s

Type

of p

artn

er

Cas

ual

128

(46)

3.23

(2.8

0-3.

66)

148

(47)

4.21

(3.8

4-4.

59)

Non

-cas

ual

150

(54)

3.56

(3.0

7-4.

05)

0.31

7ns

170

(53)

4.16

(3.7

5-4.

57)

0.85

3ns

+M

ean

(95%

CI)

num

ber o

f tim

es p

artic

ipan

ts h

ad v

agin

al se

x w

ith o

r with

out c

ondo

m in

the

past

thre

e m

onth

s

*** Si

gnifi

canc

e le

vel:

P<0.

001;

nsno

t sig

nific

ant (

P>0.

05).


NIH


NIH


NIH



Tabl

e 6

Biv

aria

te an

d M

ultiv

aria

te as

soci

atio

n be

twee

n so

cio-

dem

ogra

phic

char

acte

ristic

s and

Sub

stan

ce u

se an

d se

xual

beh

avio

rs am

ong

fem

ale m

ilita

ry p

erso

nnel

Cor

rela

tes

Subs

tanc

e us

e an

d se

xual

beh

avio

rs

Yes

No

Mul

tivar

iate

d

n%

en

%χ2

cP-

valu

eW

ald

APO

R (9

5%C

I)a

P-va

lue

Age

(yrs

)

< 30

yrs

2523

.653

23.1

>= 3

0 yr

s81

76.4

176

76.9

0.08

0.92

9N

/A--

--

Edu

catio

n L

evel

Less

than

Hig

h Sc

hool

(Ref

)b6

5.7

3515

.33.

92 (1

.47-

10.4

8)0.

006*

*

Hig

h Sc

hool

and

abo

ve99

94.3

194

84.7

0.01

2** (

f)7.

41

Mar

ital S

tatu

s

Sing

le83

78.3

175

77.4

Mar

ried

2321

.751

22.6

0.03

0.85

9N

/A--

--

Num

ber

of C

hild

ren

No

child

6963

.913

759

.8

One

or m

ore

child

(ren

)39

36.1

9240

.20.

350.

555

N/A

----

Rac

e/E

thni

city

Hau

sa (R

ef)b

1917

.943

18.8

2.15

0.51

(0.2

1-1.

25)

0.14

3

Ibo

2119

.827

11.8

8.39

0.03

9*2.

181.

79 (0

.83-

3.85

)0.

140

Yor

uba

2624

.588

38.4

0.05

1.09

(0.5

2-2.

30)

0.82

4

Oth

er40

37.7

7131

.0

Rel

igio

n

Chr

istia

n88

83.8

174

77.0

Mus

lim17

16.2

5223

.02.

020.

155

N/A

----

Em

ploy

men

t Sta

tus


NIH


NIH


NIH



Cor

rela

tes

Subs

tanc

e us

e an

d se

xual

beh

avio

rs

Yes

No

Mul

tivar

iate

d

n%

en

%χ2

cP-

valu

eW

ald

APO

R (9

5%C

I)a

P-va

lue

Trai

nee

(Ref

)b0

0.0

83.

5

Act

ive

Serv

ice

106

100

219

96.5

0.05

* (f

)0.

000.

000.

99

Ann

ual I

ncom

e

Low

7873

.615

768

.9

Hig

h28

26.4

7131

.10.

780.

379

N/A

----

Sexu

al R

elat

ions

hip

Sex

with

one

par

tner

(Ref

)b46

43.4

161

70.3

Sex

with

mul

tiple

par

tner

s60

56.6

6829

.722

.22

0.00

0***

17.5

03.

08 (1

.82-

5.22

)0.

000*

**

Pers

onal

ly k

now

n so

meo

ne w

ith H

IV

No

(Ref

)b88

83.0

147

64.2

12.2

70.

000*

**8.

392.

58 (1

.36-

4.89

)0.

004*

*

Yes

1817

.082

35.8

a APO

R (9

5%C

I): A

djus

ted

Prev

alen

ce O

dds R

atio

; 95%

Con

fiden

ce In

terv

al.

b Ref

: Ref

eren

ce c

ateg

ory

c Exce

pt fo

r rac

e/et

hnic

ity w

ith d

f=3,

all

othe

r cor

rela

tes h

ave

df =

1

d Onl

y co

rrel

ates

that

met

the

entry

crit

eria

of P

≤ 0

.10

in th

e bi

varia

te a

naly

sis w

ere

incl

uded

in th

e m

ultiv

aria

te lo

gist

ic re

gres

sion

mod

el.

e Perc

enta

ges m

ay n

ot a

dd u

p ex

actly

to 1

00%

due

to ro

undi

ng.

f: Fi

sher

's Ex

act T

est.

N/A

: Not

App

licab

le.

* Sign

ifica

nce

leve

l: P<

0.05

;

**Si

gnifi

canc

e le

vel:

P<0.

01;

*** Si

gnifi

canc

e le

vel:

P<0.

001.


Correlates of HIV Knowledge and Sexual Risk Behaviors Among Female Military Personnel

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