Qualitative research permits a better understanding of patient’s perception of HIV and TB in specific populations. The case of the military population in Eastern Democratic Republic of Congo

The military population of the South-Kivu Province in the Democratic Republic of Congo (DRC) has been identified as a group at high risk for Tuberculosis (TB) and HIV. This population lives in camps, with a very intense promiscuity and financial vulnerability. Between 2009 and 2011, the positivity rate among those tested for HIV was 27% (558/2050), compared to 18% in the control group (361/2052). The sociologist E. Goffman defines “total institutions” as places where people are all treated alike and behavior is regulated. In these closed environments, individuals develop secondary adjustments, or “abnormal” behaviors as a way to express their remaining capacity of auto-determination. These concepts can be transposed to soldiers living in military camps. Our hypothesis is that they develop “un-responsible” sexual and social behaviors exposing them to dangerous diseases as HIV and TB. Material and methods In our study, in order to allow soldiers to share their own perception on the diseases and their behaviors, we performed semi-structured interviews among 14 individuals belonging to this specific community and 2 interviews among the medical staff. This method is well validated in the domain of social sciences and consists of having a list of prepared themes to be explored, without constraining the discussion to rigid forms. In our study, we questioned soldiers about their knowledge, perception and behaviors regarding HIV and TB. Results We observed that, in spite of the fact that information was available, 13/14 (93%) reported unprotected sexual intercourses with multiple partners. Despite free availability of condoms in the military camps, their use is discouraged by various “mystic“ beliefs, doubts about their efficiency or their negative impact on pleasure sensations. 5/14 reported to use condoms to light the fire or clean their shoes. 10/14 did not consider getting tested for HIV in the future. 3/14 believed that HIV testing has a negative impact on health. Regarding TB, 9/14 reported to know someone who had the disease, and 6/14 knew that TB was a curable disease. 7/14 considered prolonged cough a sign of TB and 2 considered that TB was present only in presence of hemoptysis. Discussion This qualitative study shows that the military population in Eastern DRC is at very high risk of HIV and TB, but that beliefs and perceptions of these contagious diseases are a major obstacle to early detection, effective treatment and disease control.