Annotated Bib, post 8

Russak, Simcha M., Daniel J. Ortiz, Frank H. Galvan, and Eric G. Bing. “Protecting Our Militaries: A Systematic Literature Review of Military Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Prevention Programs Worldwide.” Military Medicine 170, no. 10 (October 2005): 886–97. https://doi.org/10.7205/MILMED.170.10.886.
Summary
Through the usage of eight electronic databases, dating from 1983 to February 2005, and manual searching, evaluative studies of HIV/AIDS prevention interventions for military service members.
Five hundred eighty-four abstracts were found, but only 8 met “formal acceptance criteria.” Qualifications included:
  1. published in English in peer reviewed journal
  2. included specific HIV/AIDS intervention applied to the military
  3. included outcomes

Five studies were done with U.S. soldiers and the remaining three were conducted with Thai Royal Military soldiers. They were assessed by one of four HIV prevention intervention methods: “clinic-based, educational, risk-reduction program, a cognitive-behavioral skills-building intervention known as the Sexually Transmitted Diseases/HIV Intervention Program (SHIP), a behavioral intervention targeting change at the individual, group, and institutional levels, and Thailand’s mass media campaign”  (100% Condom Program).

 

Single Approach/Single Session

One study was done at a U.S. military STI clinic. Soldiers were given a pre-evaluation and a post-evaluation to compare those with standard clinic care to those that received the same care and one of three intervention methods:

  1. Review of the patient’s HIV/STI risk assessment and problem-focused counseling
  2.  Viewing of an interactive video that intends to promote self-evaluation of risk behaviors
  3.  Targeted, situational, behavioral interventions where patients are put through an individual scenario with high-risk and encouraged to find alternatives

Interactive videos were significantly greater in creating sexual abstinence. Those that received a form of intervention were more likely to be willing to change to a “less risky sex partner” than those without any intervention. The groups did not, however, show much change in their conjunction of alcohol and sex.

Single Approach/Multiple Sessions

One study did a group-based, cognitive-behavioral intervention/prevention program called SHIP. It involved four 2-hour sessions that were interactive. These were given to U.S. Marines on ships before liberty visits. The control group was U.S. Marines over a span of three ships, assigned to be trained in cardiopulmonary resuscitation training.

This study assessed sexual activity and risk of HIV/STIs by a 3-point categorical index. Those with the intervention were less likely to be at a “low” or “high” sexual risk than the control group. The intervention group was also less likely to consider their partner a “stranger”, but there was no difference between the groups in whether their most recent partner was “regular” or “casual.” Additionally, the authors of this particular study saw no difference in the number of sexual partners and the length of time knowing their most recent sexual partner. There is, however, a reported difference in condom usage. The intervention group was more likely to use condoms, and to use it likely 100% of the time, compared to the control group.

In one of the studies, the intervention group was found more likely to be “non-drinkers” than not, but another study found no difference in consumption 1 year after. However, the latter study found that after a year, the intervention group was less likely to have sex after consuming alcohol. The length of the sessions did not seem to cause a significant difference, but those exposed to SHIP were more knowledgeable on HIV/STI.

Multiple Approaches/Multiple Sessions

One study, done on Thai conscripts, was a 15-month intervention with 3 approaches towards high-risk sexual behavior. The source states that they were nonrandomly assigned to one of 3 groups: intervention, diffusion (on the same base but without intervention), and control (different base, no intervention). Perhaps they are “nonrandomly” assigned because the study cannot have control on where soldiers are stationed, but the source doesn’t say. Mixed results were found in differences in sexual activity. The intervention group had notably fewer instances of commercial sex workers (CSWs) alone, but an increase in visits to CSWs. Alcohol use and condom use didn’t differ between the intervention group and the other groups. The authors concluded that, though HIV/STI indicators were lower in the intervention group, the reduction was not due to the intervention.

Mass Media

Mass media geared towards improving the sexual activity, condom use, illicit injected drug use, and STI indicators showed a significant reduction. There was a reduction in sex with CSWs, but there was an increase in the report of condom usage with CSWs. However, one study did not find the same reduction, regarding “less inconsistent condom use with girlfriends.” Both studies saw a reduction in incidences of STI/HIVs, but one study found an increase in drug use over the years.

 

Explanation for and Consequences of Few Published Studies

Only 8 studies were found that assessed the HIV/AIDS prevention for militaries in the world, but of the 62 responding countries, 98% had some HIV/AIDS prevention education. It’s possible that there’s a lack of studies because of financial constraints, or there are studies that are conducted but not published because they’re classified. Combined with the stigmas of homosexuality, other countries may deem militaries with homosexuals as weak.

“Regardless of the reason, the dearth of studies highlights the urgent need for governments to exercise a greater willingness to conduct, monitor, and share the efficacy of HIV/AIDS prevention programs. Otherwise, the large number of countries either coping with or soon to have an HIV/AIDS epidemic are left vulnerable because of needing to “reinvent the wheel” of prevention. Indeed, without such information, the socioeconomic, political, and global security of the entire world is being jeopardized.”

The source basically states that many countries are vulnerable and need to conduct and share the efficiency of their prevention programs and studies.

 

Final Thoughts

The source seems very detailed in the studies it discussed, however, it may have some ambiguity in some descriptions. Because the source is rewording studies done in the past, some things may be altered or misinterpreted. The source, did, however, acknowledge the significant variety in each study and noted the varying success in different topics. The variations included time, follow-up, session amount, and methods. The authors of the present source also recognize the English publications as an issue and admit to trying to minimize it, and the authors admit to publication bias: many authors self-reported the data, meaning they could alter it in any way they wanted the studies to have been portrayed.

This source gives me a perspective on the actual prevention methods that are occurring, as I was curious about what has been done to help the situation involving LGBT service members. Whether it be laws, prevention, or healthcare to the infected, I wanted to learn more about it. This source gave a more global spectrum of the case I was interested in, but it allows me to see the relations in militaries and see other perspectives. This source related to many others in acknowledging the lack of research in the field of military men that have sex with men.

 

 

 

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