Posttraumatic stress, depression, alcohol use and HIVAIDS risk among Angolan soldiers

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Post-traumatic stress, depression, alcohol use
and HIV/AIDS risk among Angolan soldiers
Charles R. Drew University of Medicine and
Science the Angolan Armed Forces
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• Collaborators
• United States Eric G Bing Karen G Cheng,
  Daniel J Ortiz, Ricardo Ovalle-Bahamón
• Charles R. Drew University of Medicine and
  Science, Los Angeles
• Angola Col. Francisco Ernesto, Col. Francisco
  João de Deus
• Angolan Armed Forces, Luanda
• Funding National Institute of Mental Health
  (R01-MH64883-01), US Department of Defense
  (GC-3482-132-01-009)

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Background

• Poor mental health and alcohol use are associated
  with poor sexual decision-making (e.g., Kelly, et
  al., 1995 Strathdee, et al., 1998 Thompson, Kao
  , Thomas, 2005)
• Post-conflict militaries have unique HIV
  prevention needs
• Impact of war on mental health
• Role of alcohol
• Coping mechanism
• Increased strength in fighting

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Angola

• 27-year civil war ended in 2002
• Emphasizing HIV prevention now while the
  infection rate still low (3.7 UNAIDS, 2006)

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Goals of study

• Assess frequency of post-traumatic stress,
  depression and alcohol use among soldiers
• Assess HIV-related risk
• Assess relationship between mental health and
  alcohol use and HIV risk

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Procedure

• Randomly selected soldiers from 12 military
  bases in the capital and in the northern and
  southern regions
• Interviewed by trained civilian interviewers
• Conducted Feb 2005 May 2005

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Procedure

• Dimensions assessed were
• Mental Health
• War-related traumatic events
• Post-traumatic stress (Impact of Event
  Scale-Rev)
• Depression (MHI-5)
• Alcohol
• AUDIT Problem drinking
• Alcohol use before sex (past month)
• HIV/AIDS risk
• Number of partners (past 3 months)
• Sex with occasional or commercial partners (past
  3 months)
• STI symptoms (past year)

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Characteristics of sample

• 568 men (total sample)
• Average age 28.9 years
• Rank
• Privates 33.5
• Sergeants 59.5
• Officers 7.0
• Average number of years in military 10.6
• 97 were enlisted during civil war

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Characteristics of sample

• Average years of education 6.0
• Cultural groups
• Ovimbundo 37.5
• Kimbundo 30.9
• Bakongo 8.0
• Other 23.6
• Married 27.6
• Have children 81.3

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Mental health
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Mental health

• Both measures were used continuously in
  multivariate analyses

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Alcohol use
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Indicators of HIV/AIDS risk
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Analyses

• Hierarchical mixed linear/logistic models
• Outcomes
• number of partners (log) past 3 mo.
• sex with occasional or commercial partner past 3
  mo.
• STI symptoms past year
• Predictors
• Sample characteristics
• Mental health (traumatic events, post-traumatic
  stress, depression)
• Alcohol use (alcohol before sex)

To account for nesting of participants in bases
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Predictors of number of sexual partners (log) in
past 3 months
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Predictors of sex with occasional or commercial
partner (past 3 months)
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Predictors of STI symptoms (past year)
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Summary

• Problematic alcohol use consistently predicted
  increase in HIV/AIDS risk among soldiers
• Other predictors were poor mental health, higher
  rank, and being married

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Implications

• Post-conflict militaries in resource-limited
  countries face unique challenges
• Very few providers trained in mental health or
  substance abuse
• Need creative solutions
• Structural interventions policy changes
• E.g., reduce accessibility to alcohol near base
• HIV prevention designed for higher ranks and
  married people
• Mental health?

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Contact us

• Karen Cheng kacheng_at_cdrewu.edu
• Eric Bing eric.g.bing_at_gmail.com