Self-Reported Sexually Transmitted Infections & Sexual Risk Behaviors in the U.S. Military: How Sex Influences Risk

BACKGROUND:

Sexually transmitted infections (STIs) are prevalent in the U.S. military. However, there are limited data on risk-factor differences between sexes.

METHODS:

We used data from the 2008 Department of Defense Survey of Health Related Behaviors among active duty military personnel to identify risk factors for self-reported STIs within the past 12 months and multiple sexual partners among sexually active unmarried service members.

RESULTS:

There were 10,250 active duty personnel, mostly white (59.3%) aged 21 to 25 years (42.6%). The prevalence of any reported STI in the past 12 months was 4.2% for men and 6.9% for women. One-fourth of men and 9.3% of women reported 5 or more sexual partners in the past 12 months. Binge drinking, illicit substance use, and unwanted sexual contact were associated with increased report of sexual partners among both sexes. Family/personal-life stress and psychological distress influenced number of partnerships more strongly for women than for men (Adjusted Odds Ratio [AOR]=1.58, 95% Confidence Interval [CI]=1.18-2.12 and AOR=1.41, 95% CI=1.14-1.76, respectively). After adjusting for potential confounders, we found that the report of multiple sexual partners was significantly associated with the report of an STI among men (AOR, 5.87 [95% CI, 3.70-9.31], for ≥5 partners; AOR, 2.35 [95% CI, 1.59-3.49], for 2-4 partners) and women (AOR, 4.78 [95% CI, 2.12-10.80], for ≥5 partners; AOR, 2.35 [95% CI, 1.30-4.25], for 2-4 partners).

CONCLUSIONS:

Factors associated with the report of increasing sexual partnerships and report of an STI differed by sex. Sex-specific intervention strategies may be most effective in mitigating the factors that influence risky sexual behaviors among military personnel.

Difference in behaviors of sexually active unmarried service members by gender, 2008 HRBS dataset (n=10,250)

Characteristics	Men (n=6,822)			Women (n=3,428)			p-value
	n	%	95% CI	n	%	95% CI
Alcohol and Drug Use
Binge drinking	4101	61.1	(57.1, 65.2)^	1290	38.1	(35.1, 41.2)	<.001***
Any illicit substance use, past 12 mo.	588	10.3	(8.5, 12.1)	215	6.6	(4.2, 9.1)	<.001***
Marijuana	466	8.3	(6.4, 10.1)	178	5.5	(3.1, 7.9)	0.007**
Cocaine	210	3.6	(2.6, 4.6)	66	2.0	(1.0, 3.0)	0.014*
Ecstasy	178	3.2	(2.5, 3.9)	66	2.3	(1.3, 3.3)	0.055
Methamphetamine	102	1.7	(1.2, 2.2)	30	0.9	(0.5, 1.2)	<.001***
Heroin	89	1.4	(1.0, 1.8)^	20	0.5	(0.1, 0.9)	0.004**
Other illicit substance	297	5.1	(4.3, 5.8)^	70	2.3	(1.3, 3.3)	<.001***
Any prescription drug use for non-medical purpose, past 12 mo.	1291	20.4	(18.7, 22.1)	771	23.8	(21.2, 26.3)	0.006**
Stimulants	188	3.3	(2.7, 3.9)	108	3.3	(2.4, 4.1)	0.993
Tranquilizers	416	6.8	(6.0, 7.7)	275	8.4	(6.9, 10.0)	0.032*
Sedatives	219	3.7	(3.0, 4.4)	142	4.4	(3.1, 5.7)	0.346
Painkillers	1199	18.9	(17.2, 20.5)	717	22.2	(19.6, 24.9)	0.009**
Steroids	156	2.6	(2.1, 3.0)	55	2.0	(1.3, 2.8)	0.248
Sexual Risks
Condom use at last sex	2685	43.0	(40.9, 45.1)^	1005	32.1	(28.8, 35.4)	<.001***
Main partner at last sex	4404	62.9	(61.1, 64.6)	2839	82.5	(80.2, 84.8)^	<.001***
No. of sex partners, past 12 mo.							<.001***
5+	1654	25.2	(23.5, 26.8)^	339	9.3	(7.8, 10.8)
2-4	2705	39.8	(38.4, 41.2)	1278	38.4	(35.2, 41.6)
1	2463	35.0	(34.0, 36.1)	1811	52.3	(48.5, 56.0)^
No. of NEW sex partners, past 12 mo.							<.001***
2+	3403	51.3	(50.2, 52.3)^	1069	30.7	(27.3, 34.1)
1	1574	23.4	(22.5, 24.3)	965	31.3	(29.4, 33.3)^
None	1799	25.3	(24.3, 26.4)	1383	37.9	(35.2, 40.7)^
Unwanted sexual contact	196	2.9	(2.3, 3.6)	515	14.2	(12.0, 16.4)^	<.001***
STI, past 12 mo.	273	4.2	(3.5, 4.8)	217	6.9	(5.7, 8.1)^	<.001***
Mental Health Indicators
Depression	1567	24.8	(23.2, 26.4)	977	28.4	(26.6, 30.2)^	0.002**
Anxiety	871	13.9	(12.2, 15.5)	678	20.3	(17.6, 22.9)^	<.001***
PTSD	762	12.2	(10.7, 13.7)	467	13.9	(12.4, 15.4)	0.097
Overall stress							<.001***
Low	3370	48.9	(46.1, 51.6)^	1421	40.9	(37.7, 44.1)
Moderate	1821	27.0	(25.6, 28.4)	1079	31.6	(29.5, 33.7)^
High	1571	24.1	(21.7, 26.5)	904	27.5	(25.1, 29.8)
High military-related stress	1765	27.1	(25.1, 29.1)	1068	31.4	(28.6, 34.2)	<.001***
High family or personal-life stress	1256	19.2	(17.7, 20.6)	815	22.9	(20.9, 25.0)^	<.001***
Any gender-Related stress	--	--	--	2887	86.0	(83.9, 88.1)	--
Psychological distress	1053	16.6	(15.1, 18.1)	782	22.2	(19.3, 25.1)^	<.001***
Suicide ideation	341	5.7	(4.9, 6.4)	193	5.4	(3.9, 7.0)	0.797
Suicide attempt	85	1.4	(1.0, 1.8)	79	2.2	(1.4, 3.0)	0.048*

^95% confidence intervals of the prevalence estimate do not overlap

*p<0.05;

**p<0.01;

***p<0.001; P-values derived by Rao-Scott Chi-Square Test Percentages shown are weighted; n’s are unweighted

Full article at:  http://goo.gl/O7oZ0n

By:  Stahlman S1, Javanbakht M, Cochran S, Hamilton AB, Shoptaw S, Gorbach PM.

• 1From the *Department of Epidemiology, Fielding School of Public Health, †Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, and ‡Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA. 
• Sex Transm Dis. 2014 Jun;41(6):359-64. doi: 10.1097/OLQ.0000000000000133.

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