Sexually Transmitted Infections - Prevalence, Knowledge and Behaviours among Professional Defence Forces in Estonia: A Pilot Study

INTRODUCTIONPrevious research on military personnel has concluded with various results, identifying sexually transmitted infections (STIs) and high risk behaviours as both higher and lower than in the general population (1, 2). Knowing the prevalence of blood borne pathogens, including STIs and viral hepatitis, is important for a military to ensure its members receive proper education, care and training (3-7). At one time, the primary concern in testing military forces was to prevent infections in combat situations when there was a potential for blood exposure. Chronic, long term viral infections, including human immunodeficiency virus (HIV) and hepatitis C virus (HCV) may now be effectively managed once diagnosed. The increased life expectancy of infected persons can equal that of uninfected persons (8). Persons with chronic viral infections are growing in numbers and due to advancing treatment are now able to serve in military forces compared to the recent past. Defence forces need to be deployment ready at all times, whether on assignments that are domestic, humanitarian, security, defensive, or peace keeping (9). Part of this readiness is ensuring appropriate training, prophylaxis, vaccinations, and other preventive safeguards for personnel deployed to regions with vector borne infectious diseases, such as yellow fever and most recently ebola. Depending on health status, some personnel may have different deployment availability given the status of chronic infections.One component of understanding an approach to testing in a military population is through identifying risk behaviours; alcohol and other drug use as well as high sexual risk behaviours help identify persons at increased risk of disease acquisition (10-13). As drug use and high risk sexual behaviour are driving forces for these infections, targeted education and prevention programmes that include testing can be provided to personnel when risk behaviours are known to be prevalent. Globally, alcohol prevention programmes are emerging in militaries, indicating the readiness of defence ministries to provide necessary education and training to improve the health of its personnel (14).In many countries, including nations with high prevalence rates, there are no formal studies on STIs, blood borne pathogens, or risk behaviours in militaries. In these same nations, while prevalence data are collected from persons known to engage in high risk behaviours, such as injecting drug users, commercial sex workers or men who have sex with men, but less frequently, military personnel. In Estonia, a nation in Eastern Europe with a high prevalence of HIV and HCV as well as persons who inject drugs, military data are limited, while data on knowledge and risk behaviours among Estonian youth aged 10-29 have been collected in studies conducted by the National Institute for Health Development (NIHD). The NIHD has also collected data on HIV knowledge and testing in the general population aged 16-64. (15)The primary objective of this study is to fill a gap in knowledge and to inform the national government of the prevalence of HIV, hepatitis b virus (HBV), HCV, and STIs among professional defence forces when there is no routine STI or HIV testing programme (Government Order No 282). These findings will provide input to government and defence forces for planning testing programmes in the future. Another goal of the study was to estimate the risk-behaviours, attitudes and knowledge related to STIs to create additional input for planning education and prevention strategies for military forces in the region.MATERIALS AND METHODSA cross sectional study used convenience sampling among professional defence forces. Participation was both voluntary and anonymous. Persons must have been at least 18 years old and able to provide consent. A sample size of 385 participants was planned with proportional recruitment from multiple sites to represent the total military. …