Seroprevalence and risk factors for human immunodeficiency virus in the Rwanda Defense Forces

Background: HIV is considered a threat to national security, particularly in African nations where rates are high. Studies show that HIV rates differ between civilian and military populations. While rates of HIV are lower in Rwanda than other African countries, the prevalence among the Rwanda Defense Forces (RDF) is unknown.;Methods: Male military personnel, ≥21 years old, were asked to complete a self-administered risk survey and HIV rapid test. The survey included questions on demographics, sexual behaviors, circumcision, and assessments for post-traumatic stress disorder (PTSD-checklist), depression (CESD) and alcohol use (AUDIT).;Results: Mean age was 31.7 years old (range: 21-47). Most were married/living together (73%), lower rank (77%) and never foreign deployed (61%). HIV prevalence was 4.2% (n = 26/616). Overall, levels of knowledge were high and stigma low. Some participants reported an occasional (26%) or commercial sex worker (15%) partner. Eighty-nine percent had previously tested for HIV and 70% correctly reported their HIV positive status prior to testing. More HIV positive soldiers reported always using a condom, and no sexual partner in the past 3 months, showing safer sex behaviors among infected soldiers. Forty-seven percent reported being circumcised, and 15% reported recent sexually transmitted infection (STI) symptoms. Almost 30% of participants had symptoms of depression, problem alcohol use (10%) and PTSD (7%). Increasing age was significantly associated (on the log scale) with HIV infection and odds of infection were lower among those circumcised (OR 0.4, 95% CI 0.2-1.0). Soldiers with PTSD or depressive symptoms were significantly different by age, rank, foreign deployment history, high risk partner history or STI symptoms, and level of alcohol use than those without.;Conclusions: Although HIV prevalence is lower in Rwanda than in some other African militaries, and HIV positive soldiers exhibit safer sex behaviors, behaviors among HIV negative soldiers such as sex with higher risk partners, and low rates of condom use needs to be addressed. Screening for PTSD, depression or alcohol use could provide an opportunity for targeted HIV prevention education and support services for those at higher risk of engaging in HIV risk behavior.