Alcohol use and its association with sexual risk behaviors in the Armed Forces of the Republic of the Congo

Autoři: Bonnie Robin Tran aff001;  Nicole Glass aff001;  Osika Tripathi aff001;  Olivier Kalombo aff003;  Pascal Ibata aff004;  Romain Bagamboula Mpassi aff004
Působiště autorů: Department of Defense HIV/AIDS Prevention Program, San Diego, California, United States of America aff001;  Leidos Inc., Reston, Virginia, United States of America aff002;  US Embassy, Kinshasa, Democratic Republic of the Congo aff003;  Armed Forces of the Republic of the Congo, Brazzaville, Republic of the Congo aff004
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article



Previous research has shown alcohol misuse amplifies the risk of acquiring sexually transmitted infections [STIs], including HIV, by increasing high risk sexual behaviors. Military populations are particularly vulnerable to both alcohol misuse and STIs due to the unique conditions of military service. This study estimated the prevalence of probable hazardous and harmful alcohol use and examined associations with transactional sex, sex with a sex worker, and multiple sexual partners among military personnel in the Armed Forces of the Republic of the Congo (FAC).


A secondary analysis of data collected from a 2014 seroprevalence and behavioral epidemiology risk survey was performed. Participants included 703 active duty male service members 18 years of age or older who reported ever having sex. Patterns of harmful and hazardous drinking were measured with the Alcohol Use Disorders Identification Test (AUDIT). Participants with an AUDIT score ≥ 8 (indicative of probable hazardous and harmful alcohol use, and possible alcohol dependence) were compared to those with an AUDIT score ≤ 7.


A total of 15.8% received a score of 8 or higher on the AUDIT. These participants were more likely to be lower educated and of lower military rank. In separate multivariable models, an AUDIT score ≥ 8 was significantly associated with higher odds of sex with a commercial sex worker and having multiple sexual partners.


Study results emphasize the need to address patterns of harmful and hazardous alcohol use in the FAC and integrate alcohol misuse education into the HIV prevention program. The development of military-specific interventions to reduce alcohol-related risky sexual behaviors are also needed. Lastly, implementing policies such as restricting alcohol availability and sales on military bases, and adding warning labels to advertisements and containers may provide a more comprehensive response to reduce problematic alcohol use.

Klíčová slova:

Alcohol consumption – Alcoholism – Armed forces – HIV epidemiology – HIV infections – Human sexual behavior – Military personnel – Schools


1. World Health Organization, Volkov S. Alcohol: Key facts. 2018 Sep 21 [cited 13 December 2018]. In: WHO Health Organization/Home/Newsroom/Fact sheets/Detail/Alcohol [Internet]. Geneva: WHO 2018-. [about 5 screens]. Available from:

2. Cook RL, Clark DB. Is there an association between alcohol consumption and sexually transmitted diseases? A systematic review. Sex Transm Dis. 2005;32(3):156–64. doi: 10.1097/01.olq.0000151418.03899.97 15729152

3. Fisher JC, Bang H, Kapiga SH. The association between HIV infection and alcohol use: a systematic review and meta-analysis of African studies. Sex Transm Dis. 2007;34(11):856–63. doi: 10.1097/OLQ.0b013e318067b4fd 18049422

4. Baliunas D, Rehm J, Irving H, Shuper P. Alcohol consumption and risk of incident human immunodeficiency virus infection: a meta-analysis. Int J Public Health. 2010;55(3):159–66. doi: 10.1007/s00038-009-0095-x 19949966

5. Shuper PA, Neuman M, Kanteres F, Baliunas D, Joharchi N, Rehm J. Causal considerations on alcohol and HIV/AIDS—a systematic review. Alcohol Alcohol. 2010;45(2):159–66. doi: 10.1093/alcalc/agp091 20061510

6. Kalichman SC, Simbayi LC, Kaufman M, Cain D, Jooste S. Alcohol use and sexual risks for HIV/AIDS in sub-Saharan Africa: systematic review of empirical findings. Prev Sci. 2007;8(2):141–51. doi: 10.1007/s11121-006-0061-2 17265194

7. Woolf-King SE, Maisto SA. Alcohol use and high-risk sexual behavior in Sub-Saharan Africa: a narrative review. Arch Sex Behav. 2011;40(1):17–42. doi: 10.1007/s10508-009-9516-4 19705274

8. Steele CM, Josephs RA. Alcohol myopia. Its prized and dangerous effects. The American psychologist. 1990;45(8):921–33. doi: 10.1037//0003-066x.45.8.921 2221564

9. Crowe LC, George WH. Alcohol and human sexuality: review and integration. Psychol Bull. 1989;105(3):374–86. doi: 10.1037/0033-2909.105.3.374 2660179

10. Kalichman SC, Weinhardt L, DiFonzo K, Austin J, Luke W. Sensation seeking and alcohol use as markers of sexual transmission risk behavior in HIV-positive men. Ann Behav Med. 2002;24(3):229–35. doi: 10.1207/S15324796ABM2403_08 12173680

11. Toesland F. Alcohol consumption rising in Africa despite obstacles. African Business. 12 Jan 2016. Available from: Cited 20 December 2018.

12. Joint United Nations Programme on HIV/AIDS (UNAIDS). Global AIDS Update 2016. UNAIDS. 2016. Available from: Cited 14 December 2018.

13. Tran BR, Thomas AG, Ditsela M, Vaida F, Phetogo R, Kelapile D, et al. Condom use behaviours and correlates of use in the Botswana Defence Force. Int J STD AIDS. 2013;24(11):883–92. doi: 10.1177/0956462413486889 23970609

14. Tran BR, Davis A, Ito SI, Matchere F, Reader E, Nkhoma V, et al. Alcohol and Cannabis Use and Sexual Risk Behaviors in the Malawi Defence Force. AIDS Behav. 2018;22(9):2851–60. doi: 10.1007/s10461-018-2167-5 29869734

15. Jacobson IG, Ryan MA, Hooper TI, Smith TC, Amoroso PJ, Boyko EJ, et al. Alcohol use and alcohol-related problems before and after military combat deployment. Jama. 2008;300(6):663–75. doi: 10.1001/jama.300.6.663 18698065

16. Ames GM, Cunradi CB, Moore RS, Stern P. Military culture and drinking behavior among U.S. Navy careerists. J Stud Alcohol Drugs. 2007;68(3):336–44. doi: 10.15288/jsad.2007.68.336 17446972

17. Poehlman JA, Schwerin MJ, Pemberton MR, Isenberg K, Lane ME, Aspinwall K. Socio-cultural factors that foster use and abuse of alcohol among a sample of enlisted personnel at four Navy and Marine Corps installations. Mil Med. 2011;176(4):397–401. doi: 10.7205/milmed-d-10-00240 21539161

18. Djibo DA, Sahr F, Allen MJ, Jain S, Araneta MRG, Brodine SK, et al. Prevalence and Risk Factors for Human Immunodeficiency Virus (HIV) and Syphilis Infections Among Military Personnel in Sierra Leone. Current HIV Research. 2017;15:128–36. doi: 10.2174/1570162X15666170517101349 28521722

19. Rimoin AW, Hoff NA, Djoko CF, Kisalu NK, Kashamuka M, Tamoufe U, et al. HIV infection and risk factors among the armed forces personnel stationed in Kinshasa, Democratic Republic of Congo. Int J STD AIDS. 2015;26(3):187–95. doi: 10.1177/0956462414533672 24828556

20. Bing EG, Ortiz DJ, Ovalle-Bahamon RE, Cheng KG, Huang FH, Ernesto F, et al. HIV/AIDS behavioral surveillance among Angolan military men. AIDS Behav. 2008;12(4):578–84. doi: 10.1007/s10461-007-9280-1 17641966

21. Macera CA, Ito SI, Hale BR, Shaffer RA, Thomas AG, Dickieson J. Conducting HIV Seroprevalence and Behavioral Epidemiology Risk Surveys (SABERS) Among Partner Military Populations. Curr HIV Res. 2017;15(2):82–9. doi: 10.2174/1570162X15666170516164521 28521715

22. Prins A, Bovin MJ, Smolenski DJ, Marx BP, Kimerling R, Jenkins-Guarnieri MA, et al. The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Development and Evaluation Within a Veteran Primary Care Sample. J Gen Intern Med. 2016;31(10):1206–11. doi: 10.1007/s11606-016-3703-5 27170304

23. Peltzer K, Naidoo P, Matseke G, Louw J, McHunu G, Tutshana B. Prevalence of post-traumatic stress symptoms and associated factors in tuberculosis (TB), TB retreatment and/or TB-HIV co-infected primary public health-care patients in three districts in South Africa. Psychol Health Med. 2013;18(4):387–97. doi: 10.1080/13548506.2012.726364 23061988

24. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13. doi: 10.1046/j.1525-1497.2001.016009606.x 11556941

25. Monahan PO, Shacham E, Reece M, Kroenke K, Ong'or WO, Omollo O, et al. Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in western Kenya. J Gen Intern Med. 2009;24(2):189–97. doi: 10.1007/s11606-008-0846-z 19031037

26. Gelaye B, Williams MA, Lemma S, Deyessa N, Bahretibeb Y, Shibre T, et al. Validity of the Patient Health Questionnaire-9 for depression screening and diagnosis in East Africa. Psychiatry Res. 2013;210(2):653–61. doi: 10.1016/j.psychres.2013.07.015 23972787

27. Warner CM, Warner CH, Breitbach J, Rachal J, Matuszak T, Grieger TA. Depression in entry-level military personnel. Military medicine. 2007;172(8):795–9. doi: 10.7205/milmed.172.8.795 17803068

28. Russell DW, Cohen GH, Gifford R, Fullerton CS, Ursano RJ, Galea S. Mental health among a nationally representative sample of United States Military Reserve Component Personnel. Social psychiatry and psychiatric epidemiology. 2015;50(4):639–51. doi: 10.1007/s00127-014-0981-2 25421591

29. Babor T.F., Higgins-Biddle J.C., Saunders J.B., Monteiro M.G. The Alcohol Use Disorders Identification Test (AUDIT): Guidelines for Use in Primary Care. World Health Organization. 2001. Available from: Cited 13 December 2018.

30. Cheng KG, Ortiz DJ, Weiss RE, Shi L, Ovalle-Bahamon RE, Ernesto F, et al. Patterns of alcohol consumption and factors influencing problematic drinking among Angolan soldiers. J Subst Use. 2012;17(2):138–49.

31. Greenland S, Pearl J, Robins JM. Causal diagrams for epidemiologic research. Epidemiology. 1999;10(1):37–48. 9888278

32. World Health Organization (WHO). Global status report on alcohol and health 2018. WHO. 2018. Available from: Cited 14 December 2018.

33. Fox J, Pease B. Military deployment, masculinity and trauma: Reviewing the connections. The Journal of Men's Studies. 2012;20(1):16–31.

34. Anderson P, Chisholm D, Fuhr DC. Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. Lancet. 2009;373(9682):2234–46. doi: 10.1016/S0140-6736(09)60744-3 19560605

35. Giesen ES, Deimel H, Bloch W. Clinical exercise interventions in alcohol use disorders: a systematic review. J Subst Abuse Treat. 2015;52:1–9. doi: 10.1016/j.jsat.2014.12.001 25641736

36. Waller M, McGuire AC, Dobson AJ. Alcohol use in the military: associations with health and wellbeing. Subst Abuse Treat Prev Policy. 2015;10:27. doi: 10.1186/s13011-015-0023-4 26216215

37. Fear NT, Iversen A, Meltzer H, Workman L, Hull L, Greenberg N, et al. Patterns of drinking in the UK Armed Forces. Addiction. 2007;102(11):1749–59. doi: 10.1111/j.1360-0443.2007.01978.x 17935583

38. Heltemes KJ, Clouser MC, MacGregor AJ, Norman SB, Galarneau MR. Co-occurring mental health and alcohol misuse: dual disorder symptoms in combat injured veterans. Addict Behav. 2014;39(2):392–8. doi: 10.1016/j.addbeh.2013.06.001 23830527

39. Jakupcak M, Tull MT, McDermott MJ, Kaysen D, Hunt S, Simpson T. PTSD symptom clusters in relationship to alcohol misuse among Iraq and Afghanistan war veterans seeking post-deployment VA health care. Addict Behav. 2010;35(9):840–3. doi: 10.1016/j.addbeh.2010.03.023 20471180

40. Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. The Lancet Infectious diseases. 2012;12(7):538–49. doi: 10.1016/S1473-3099(12)70066-X 22424777

41. Grillo M, Tran BR, Tamoufe U, Djoko CF, Saylors K, Woodland K, et al. HIV and Syphilis Prevalence and Associated Risks in the Cameroonian Armed Forces. Curr HIV Res. 2017;15(2):137–45. doi: 10.2174/1570162X15666170517102327 28521725

42. Nwokoji UA, Ajuwon AJ. Knowledge of AIDS and HIV risk-related sexual behavior among Nigerian naval personnel. BMC Public Health. 2004;4:24. doi: 10.1186/1471-2458-4-24 15210055

43. Drumright LN, Gorbach PM, Holmes KK. Do people really know their sex partners? Concurrency, knowledge of partner behavior, and sexually transmitted infections within partnerships. Sex Transm Dis. 2004;31(7):437–42. doi: 10.1097/01.olq.0000129949.30114.37 15215701

44. Mah TL, Halperin DT. Concurrent sexual partnerships and the HIV epidemics in Africa: evidence to move forward. AIDS Behav. 2010;14(1):11–6; dicussion 34–7. doi: 10.1007/s10461-008-9433-x 18648926

45. Kiene SM, Subramanian SV. Event-level association between alcohol use and unprotected sex during last sex: evidence from population-based surveys in sub-Saharan Africa. BMC Public Health. 2013;13:583. doi: 10.1186/1471-2458-13-583 23767763

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