HIV This Week

Ba O, O’Regan C, Nachega J, Cooper C, Anema A, Rachlis B, Mills EJ. HIV/AIDS in African militaries: an ecological analysis. Med Confl Surviv. 2008;24(2):88-100.

The HIV pandemic is considered a security threat. Policy-makers have warned of destabilization of militaries due to massive troop deaths. Estimates of the rate of HIV within African militaries have been as high as 90 per cent. Ba and colleagues aimed to determine if HIV prevalence within African militaries is higher than their host nation prevalence rates. Using systematic searching and access to United States Department of Defense data, the authors abstracted data on prevalence within militaries and their host communities. They conducted a random effects pooled analysis to determine differences in HIV prevalence rates in the military versus the host population, obtaining data on 21 African militaries. In general, HIV prevalence within the military was elevated compared to the general population. The differences were significant (odds ratio 1.97, 95% confidence interval: 1.58-2.45, P < 0.001). Further, inflated rates of HIV in militaries compared to non-military males of similar age were also significant (6.09, 4.47-8.30, P < or = 0.0001). States with recent conflicts and wars had elevated military rates, but these were also not significant (P = 0.4). Population levels predicted military prevalence rates (P < or = 0.001). HIV prevalence rates in most African militaries are significantly elevated compared to their host communities.

Editors’ note: The high HIV prevalence documented in the militaries of some countries in Africa is not surprising given that they are comprised predominantly of young, sexually active males. It does raise concerns about the potential for shortages in the numbers of qualified and experienced military personnel available for deployment, particularly when the armed forces play a key role in maintaining and promoting peace in the region. Intensified HIV prevention and antiretroviral treatment are key to maintaining a healthy military.

HIV prevalence is rising, especially among high risk females in Tijuana, Baja California, a Mexico-US border city situated on major migration and drug trafficking routes. Strathdee and colleagues compared factors associated with HIV infection among male and female injection drug users in Tijuana in an effort to inform HIV prevention and treatment programmes. Injection drug users aged > or = 18 years were recruited using respondent-driven sampling and underwent testing for HIV, syphilis and structured interviews. Logistic regression identified correlates of HIV infection, stratified by gender. Among 1056 injection drug users, most were Mexican-born but 67% were born outside Tijuana. Reasons for moving to Tijuana included deportation from the US (56% for males, 29% for females), and looking for work/better life (34% for females, 15% for males). HIV prevalence was higher in females versus males (10.2% vs. 3.5%, p = 0.001). Among females (N=158), factors independently associated with higher HIV prevalence included younger age, lifetime syphilis infection and living in Tijuana for longer durations. Among males (N=898), factors independently associated with higher HIV prevalence were syphilis titres consistent with active infection, being arrested for having 'track-marks', having larger numbers of recent injection partners and living in Tijuana for shorter durations. An interaction between gender and number of years lived in Tijuana regressed on HIV infection was significant (p = 0.03). Upon further analysis, deportation from the U.S. explained the association between shorter duration lived in Tijuana and HIV infection among males; odds of HIV infection were four-fold higher among male injectors deported from the US, compared to other males, adjusting for all other significant correlates (p = 0.002). Geographic mobility has a profound influence on Tijuana's evolving HIV epidemic, and its impact is significantly modified by gender. Future studies are needed to elucidate the context of mobility and HIV acquisition in this region, and whether US immigration policies adversely affect HIV risk.

Editors’ note: These findings suggest that geographic mobility may have had a differential effect on the risk of HIV infection among male and female injecting drug users in Tijuana, with a three-fold higher HIV prevalence documented among the women. However, its cross-sectional design means that a causal relationship cannot be confirmed. Nonetheless, supportive programmes for migrants, deportees, and other displaced persons on both sides of the U.S.-Mexico border could help mitigate the effects of social disruption and displacement.