Abstract
Background:
Military personnel (MP) are exposed to situations such as loneliness and alcohol use that lead to sexual risk behaviours (SRBs) with serious implications for the spread of sexually transmitted infections (STIs). Compulsive sexual behaviour disorder (CSBD) is a psychosexual condition that is characterized by a consistent failure to control sexual behaviour and continuation of the behaviour despite the consequences. The prevalence of CSBD is underreported due to the sensitive nature of the behaviour. This study thereby assesses SRBs and CSBD and associated factors among MP.
Methods:
A cross-sectional study among 406 MP in Ibadan using a convenient sampling method to select the personnel serving in the two military barracks in Ibadan. MP available on the days of data collection were interviewed. A semi-structured, interviewer-administered questionnaire was used to obtain information on SRBs and CSBD. Descriptive and inferential statistics were done and the Chi-Square test was used to test for association between independent and outcome variables at p < 0.05.
Results:
The mean age of respondents was 30.1±10.1 years. Above half (52.7%) were aged 20 - 30 years, 70.7% were males, and 56.6% were not living with a partner. The prevalence of SRBs among respondents was 79.6% while the prevalence of CSBD was 6.4%. Gender and marital status were predictors of SRBs.
Conclusion:
The majority of MP engaged in SRBs while less than one-tenth had CSBD. Gender and marital status were predictors of SRBs. Risk reduction counseling was recommended for MP.
Keywords: Sexual risk behaviours, Compulsive sexual behaviour disorder, Military personnel
INTRODUCTION
The attainment and maintenance of sexual health require an optimistic and respectful approach to sexuality and sexual relationships, and the possibility of having pleasurable and safe sexual experiences that are free of coercion, discrimination, and violence.1 Sexual activity is the most intimate of human relationships while sexual behaviour is the most intimate of human interactions.2
Military personnel (MP) belong to the sexually active age group and also the high risk-taking group due to the nature of their job. Nigerian Military Personnel (NMP) are easily influenced by peer pressure rather than social convention.3 Sex with multiple partners is a tradition that has also persisted in the Nigerian Navy even in the era of Acquired Immunodeficiency Syndrome (AIDS).3 Other SRBs common among MP include multiple sexual partnering, concurrent sexual partnership, engaging in sexual activity under the influence of drugs or alcohol4, and extreme forms of sexual behaviour such as rape and compulsive sexual behaviour disorder (CSBD).
CSBD is characterized by a persistent pattern of failure to control intense sexual impulses or urges, failing to control repetitive sexual behaviour that is evident over an extended period (e.g., 12 months), and causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.5 It may involve a variety of commonly enjoyable sexual experiences.6 It engulfs various types of problematic sexual behaviours, including excessive masturbation, cybersex, excessive or problematic pornography use, telephone sex, strip club visitation, and other behaviours.7
Evaluation of the prevalence of CSBD is difficult due to the embarrassment and shame frequently reported by individuals with CSBD, as well as its lack of awareness and perceived prevalence in society. An estimated CSBD prevalence of 1% to 3% is present among the U.S. adult population8. A much higher prevalence of CSBD was found among a sample of US male military veterans9. According to Derbyshire10, many have argued that the prevalence of CSBD may be underreported in the general population due to the sensitive nature of sexual behaviour10. A prevalence of CSBD among a sample of US male veterans recently returning to civilian life at baseline was estimated as 16.7%.11
The stigma of not being able to control sexual impulses carries with it a connotation of depravity and moral selfishness. Stigmatization in the media and criminalization of “sexual offenders” create an atmosphere that does not promote treatment and prevention. As a result, access to care and seeking care, even when one recognizes that sexual behaviours are out of control, is a decision faced with barriers and limitations.12
Most research has focused on SRBs and their association with HIV and STIs7. Behaviours such as CSBD may be inadvertently overlooked by clinicians focusing on other more acute psychiatric problems and disorders such as Post Traumatic Stress Disorder (PTSD), and alcohol use disorder among others.13
While MPs engage in SRBs and experience frequent co-occurrence of CSBD with psychiatric disorders and traumatic experiences14, there is a huge gap in knowledge on SRBs and CSBD among MPs across different populations.
Across the African continent, there are only very few studies documenting the lifetime or current prevalence of CSBD. Most of what is known about the epidemiological nature of this disorder are from clinical treatment programmes focused on sexual addiction and a couple of studies conducted in the U.S. and Sweden13, 15. It is therefore imperative to assess the prevalence and factors associated with SRBs and CSBD in a developing country like Nigeria with the aim of addressing the knowledge gap and proffering solutions.
METHODOLOGY
Study Area
The study was carried out in Ibadan, the capital of Oyo state. Ibadan has a population of over 3 million residents and it is the most populous city in Oyo State, South-West Nigeria (National Population Commission [NPC], 2006). It is the third most populous metropolitan city in Nigeria. The geographical coordinate of Ibadan is latitude 7.3775 N and longitude 3.9470 E (7 23' 47" N 3 55'0" E).
The Nigerian Army has two bases located in Ibadan namely; Nigerian Army 81 Battalion Headquarters, Mokola, and Nigerian Army 2nd Division Headquarters, Odogbo cantonment. The total population of MP in Ibadan is at least two thousand (2000). Consent was obtained from the Commanding Officer and the General Officer Commanding (GOC), of both barracks, respectively, after multiple attempts and refusals.
Study Population
This study was carried out among men and women of the Nigerian army who were present at the cantonment during the course of the research.
Inclusion Criteria
In-service MP within the sexually active age group (18 years and above) that had been on active deployment and had been at least 6 months in service.
Exclusion Criteria
Other persons at the study site who were not MP.
Study Design
This study utilized a descriptive cross-sectional design.
Sample Size
A total number of 406 respondents were selected using Leslie Kish's (1965) formula while adopting a 50% previous prevalence due to a lack of local data. Convenience sampling was used to select respondents to achieve the required sample size. Any MP who was available and gave consent on the days of data collection was interviewed.
Data Collection Tool
A quantitative semi-structured inter vieweradministered questionnaire was used for this study. It comprised four sections namely:
Section A: Socio-demographic characteristics such as age, level of education, marital status, etc.
Section B: Job details such as number of years in services, international posting, etc.
Section C: SRBs such as sex under the influence of alcohol, sex with sex workers in the last 3 months, etc. Heavy alcohol intake was measured as more than four (4) bottles for men and more than three (3) for women in a day;
Section D: Sexual history such as sexual experience before and after joining the army, history of abuse, HIV status, etc.; and
Section E: Part I: CSBD such as any or cluster of hypersexual behaviours. There are seven core diagnostic criteria questions for CSBD (five A and two B criteria). Each criterion is rated on a 5-item severity index (0 - 4) so the total score can range from 0 to 28 points as a dimensional measure of the diagnostic criteria and associated adverse consequences. To screen positive for a probable diagnosis of a CSBD, a person must score 3 or 4 points on at least 4 of the five A criteria, and score 3 or 4 points on at least 1 of the two B criteria. Thus, the minimum total score to reach a probable diagnosis of CSBD would be 15 points gathered from at least four A and one B criteria. The maximum summed score would be 28 points.
Part II: Problematic Sexual-Orientation such as pornography, masturbation, cybersex, etc.
The instrument was developed based on general standards and existing literature. Pretesting of the questionnaire was conducted among a sample of 30 MP who were permanent staff from Tigers Officer Mess, Ikolaba, Ibadan. English and Pidgin were the widely spoken languages by MP, so the interviewer communicated with MP accordingly.
Data Collection Procedure
Data were collected daily till data collection was completed. Data were entered, cleaned, and analyzed using Statistical Package for Social Science (SPSS) version 24.
RESULTS
A total response of 406 was obtained from both military barracks, and Table 1 shows the sociodemographic characteristics of the respondents. The mean age was 30.1±10.1 years. Above half 214 (52.7%) were aged 20 - 30 years. More than two-thirds of 287 (70.7%) were males and 230 (56.6%) were not currently married or not living with a partner. Nearly two-thirds of 265 (65.3%) were Christians and more than 61.1% (248) of the respondents had obtained secondary education. The most represented ethnic group was Hausa (132), accounting for 32.5% of all respondents. More than half 219 (53.9%) of the respondents were the least earners.
Table 1:
Sociodemographic characteristics of respondents (N=406)
| Variables | Frequency | Percentage |
|---|---|---|
|
| ||
| Age group (years) | ||
| ≤20 | 60 | 14.8 |
| 21-30 | 214 | 52.7 |
| >30 | 132 | 32.5 |
| Mean±SD | 30.1±10.1 | |
| Gender | ||
| Male | 287 | 70.7 |
| Female | 119 | 29.3 |
| Marital status | ||
| Not currently married/Not living with a partner | 230 | 56.6 |
| Currently married | 176 | 43.4 |
| Religion | ||
| Islam | 141 | 34.7 |
| Christian | 265 | 65.3 |
| Level of education | ||
| Primary | 10 | 2.4 |
| Secondary | 248 | 61.1 |
| Tertiary | 148 | 36.5 |
| Ethnicity | ||
| Yoruba | 116 | 28.6 |
| Hausa | 132 | 32.5 |
| Igbo | 72 | 17.7 |
| Others* | 86 | 21.2 |
| Income (Naira) | ||
| ≤60,000 | 219 | 53.9 |
| >60,000 | 169 | 41.6 |
| No response | 18 | 4.5 |
Idoma, Urhobo, Fulani, Efik, etc.
Table 2 shows the distribution of respondents by their sexual history and abuse. The majority of 325 (80.0%) had ever had sexual experience. Slightly above twothirds 219 (67.4%) of sexually experienced respondents had sexual experience before joining the army while 288 (88.6%) sexually experienced respondents had sexual experience after joining the army. Only 77 (19.0%) of all the respondents had experienced at least one form of abuse during childhood. Nearly onefifth 76 (18.7%) of all the respondents had a history of physical abuse, and 41 (10.0%) reported experience of sexual abuse. A little above one-tenth 51 (12.6%) had ever coerced someone into having sex with them and about the same proportion of respondents (11.8%) had ever been coerced into having sex. Only 12 (3.0%) of all respondents reported they were HIV positive.
Table 2:
Distribution of respondents by sexual history and abuse (N=325)
| Variables | Frequency | Percentage |
|---|---|---|
|
| ||
| Ever had sexual experience (N=406) | ||
| Yes | 325 | 80.0 |
| No | 81 | 20.0 |
| Sexual experience before joining the army (N=325) | ||
| Yes | 219 | 67.4 |
| No | 106 | 32.6 |
| Sexual experience after joining the army (N=325) | ||
| Yes | 288 | 88.6 |
| No | 37 | 11.4 |
| Any form of abuse during childhood (N=406) | ||
| Yes | 77 | 19.0 |
| No | 329 | 81.9 |
| History of lifetime physical abuse (N=406) | ||
| Yes | 76 | 18.7 |
| No | 330 | 81.3 |
| History of lifetime sexual abuse (N=406) | ||
| Yes | 41 | 10.1 |
| No | 365 | 89.9 |
| Lifetime pattern of Abuse (N=406) | ||
| None | 313 | 77.1 |
| One | 69 | 17.0 |
| Both | 24 | 5.9 |
| Ever insisted that someone have sex with you (N=406) | ||
| Yes | 51 | 12.6 |
| No | 355 | 87.4 |
| Ever been coerced into having sex (N=406) | ||
| Yes | 48 | 11.8 |
| No | 358 | 88.2 |
| HIV Status (N=406) | ||
| Positive | 12 | 3.0 |
| Negative | 394 | 97.0 |
Table 3 shows the distribution of sexually experienced respondents by SRBs. Nearly two-third of 211 (64.9%) were sexually active in the preceding three months. Among the sexually active respondents in the preceding three months, 61 (28.9%) had a heavy intake of alcohol before sex, 46 (21.8%) engaged in sexual activity with sex workers, 81 (38.4%) had sex with casual friends, 92 (43.6%) had sex with someone other than their regular sexual partners more than once, 118 (55.9%) reported no usage of condom during sex, 16 (7.6%) had sex after using intravenous drugs and 39 (18.5%) had sex while drunk.
Table 3:
Distribution of sexually experienced respondents by SRBs
| Variables | Frequency | Percentage |
|---|---|---|
|
| ||
| Sexually active in the preceding 3 months (N=325) | ||
| Yes | 211 | 64.9 |
| No | 114 | 35.1 |
| Heavy intake of alcohol before sex in the preceding 3 months (N= 211) | ||
| Yes | 61 | 28.9 |
| No | 150 | 71.1 |
| Engaged in sexual activity with sex workers in the preceding 3 months (N= 211) | ||
| Yes | 46 | 21.8 |
| No | 165 | 78.2 |
| Sex with a casual friend in the preceding 3 months (N= 211) | ||
| Yes | 81 | 38.4 |
| No | 130 | 61.6 |
| Sex with someone other than a regular partner more than once in the preceding 3 months (N= 211) | ||
| Yes | 92 | 43.6 |
| No | 119 | 56.4 |
| No usage of condom during sex in the preceding 3 months (N= 211) | ||
| Yes | 118 | 55.9 |
| No | 93 | 44.1 |
| Sex after using Intravenous Drugs (ITV) drugs in the preceding 3 months (N= 211) | ||
| Yes | 16 | 7.6 |
| No | 195 | 92.4 |
| Had sex while drunk in the preceding 3 months (N= 211) | ||
| Yes | 39 | 18.5 |
| No | 172 | 81.5 |
Figure 1 shows the pattern of SRBs among sexually active respondents in the preceding three (3) months in ascending order. Non-usage of condoms was the highest occurring pattern, prevalent among 118 (55.9%) sexually active respondents, followed by sex with someone other than a regular sexual partner 92 (43.6%), sex with a casual friend 81 (38.4%), heavy intake of alcohol before sex 61 (28.9%), then sex with sex worker 46 (21.8%), sex while drunk 39 (18.5%) and preceding sex after intravenous drugs use 16 (7.6%).
Figure. 1:
Pattern of SRBs among respondents
Table 4 below shows the distribution of respondents by the experience of CSBD. The overall prevalence of CSBD among all respondents was 6.4%. Above one quarter 117 (28.8%) sometimes and 29 (7.1%) most times think, plan, or engage in a sexual act to cope with stress or other responsibilities in the preceding 12 months. Almost one-fifth 80 (19.7%) sometimes and 36 (8.8%) most often found it difficult to reduce or control how much they think about sex in the preceding 12 months. About eight percent 31 (7.6%) sometimes and 50 (12.3%) almost always had frequent and deep thoughts about sex to the extent of having significant problems with personal, social, or work life in the preceding 12 months.
Table 4:
Distribution of respondent by experience of CSBD (N=406)
| Variables | Never n (%) | Rarely n (%) | Sometimes n (%) | Often n (%) | Always n (%) |
|---|---|---|---|---|---|
|
| |||||
| Spent plenty of time thinking, planning or engaging in a sexual act in the preceding 12 months | 192 (47.3) | 58 (4.3) | 98 (24.1) | 36 (8.9) | 22 (5.4) |
| Thinking, planning or engaging in a sexual act to cope with difficult feelings in the preceding 12 months | 213 (52.5) | 72 (17.7) | 76 (18.7) | 36 (8.9) | 9 (2.2) |
| Thinking, planning or engaging in a sexual act to cope with stress or other responsibilities in the preceding 12 months | 199 (49.0) | 61 (15.0) | 117 (28.8) | 20 (4.9) | 9 (2.2) |
| Failed to reduce or control how much I think about sex in the preceding 12 months | 217 (53.4) | 73 (18.0) | 80 (19.7) | 22 (5.4) | 14 (3.4) |
| Engaging in sexual acts that could cause injuries or illness in the preceding 12 months | 292 (71.9) | 57 (14.0) | 32 (7.9) | 16 (3.9) | 9 (2.2) |
| Frequent and deep thoughts about sex made me very upset about myself in the preceding 12 months | 221 (54.4) | 61 (15.0) | 78 (19.2) | 20 (4.9) | 26 (6.4) |
| Frequent and deep thoughts about sex caused significant problems for me personally, socially or at work in the preceding 12 months | 278 (68.5) | 47 (11.6) | 31 (7.6) | 18 (4.4) | 32 (7.9) |
Table 5 shows the association between the sociodemographic characteristics of respondents and SRBs. SRBs were found to be statistically significant with gender and marital status at p  0.05. More males 143 (67.8 %) engaged in SRBs than 25 (11.9%) females. Of respondents who were not currently married or not living with a partner 85 (40.3%) engaged in SRBs compared to their counterparts who were currently married 83 (39.3%). There was no association between respondents' age group, level of education, income, years spent in service and ethnic group, and SRBs.
Table 5:
Association between sociodemographic characteristics and SRBs
| Variables | SRBs | |||
|---|---|---|---|---|
| No n (%) | Yes n (%) | χ2 | p-value | |
|
| ||||
| Age group | ||||
| ≤ 20 | 1 (9.1) | 10 (90.9) | 11.662 | 0.020 |
| 21-30 | 15 (13.6) | 95 (86.4) | ||
| >30 | 27 (30.0) | 63 (70.0) | ||
| Gender | ||||
| Male | 29 (16.9) | 143 (83.1) | 12.219 | 0.002* |
| Female | 14 (35.9) | 25 (64.1) | ||
| Marital status | ||||
| Currently Married | 33 (28.4) | 83 (71.6) | 12.428 | 0.002* |
| Not currently Married | 10 (10.5) | 85 (89.5) | ||
| Level of education | ||||
| Basic Education | 25 (18.5) | 110 (81.5) | 3.801 | 0.434 |
| Tertiary | 18 (23.7) | 58 (76.3) | ||
| Ethnicity | ||||
| Yoruba | 13 (20.3) | 51 (79.7) | 11.974 | 0.063 |
| Hausa | 16 (27.6) | 42 (72.4) | ||
| Igbo | 5 (15.2) | 28 (84.8) | ||
| Others | 9 (16.1) | 47 (83.9) | ||
| Income (Naira) | ||||
| ≤60,000 | 17 (18.5) | 75 (81.5) | 5.859 | 0.210 |
| >60,000 | 22 (20.6) | 85 (79.4) | ||
| Number of years spent in service (years) | ||||
| >5 | 20 (37.7) | 33 (62.2) | 7.218 | 0.125 |
| 5-15 | 69 (47.3) | 77 (52.7) | ||
| >15 | 68 (54.0) | 58 (46.0) | ||
Statistically significant at p<0.05
Table 6 shows the association between posting details and SRBs. There was no significant association between posting details and SRBs.
Table 6:
Association between posting experience and SRBs
| Variables | Frequencies | Percentages (%) | p-value |
|---|---|---|---|
|
| |||
| Local | |||
| Yes | 241 | 59.4 | 0.557 |
| No | 165 | 40.6 | |
| International | |||
| Yes | 161 | 39.7 | 0.832 |
| No | 245 | 60.3 | |
Statistically significant at p<0.05
Table 7 shows the association between sociodemographic characteristics and experience of CSBD. There was no association between respondents' age group, gender, marital status, level of education, ethnicity, income, number of years spent in service, and posting details and CSBD at p <0.05.
Table 7:
Association between sociodemographic characteristics and experience of CSBD
| Variables | CSBD | χ2 | p-value | |
|---|---|---|---|---|
|
| ||||
| Yes | No | |||
| n (%) | n (%) | |||
|
| ||||
| Age group | ||||
| ≤ 20 | 7 (11.7) | 53 (88.3) | 3.369 | 0.186 |
| 21-30 | 11 (5.1) | 203 (94.9) | ||
| >30 | 8 (6.1) | 124 (93.9) | ||
| Gender | ||||
| Male | 22 (7.7) | 265 (92.3) | 2.600 | 0.107 |
| Female | 4 (3.4) | 115 (96.6) | ||
| Marital status | ||||
| Currently Married | 7 (4.0) | 169 (96.0) | 3.052 | 0.081 |
| Not currently Married | 19 (8.3) | 211 (91.7) | ||
| Level of education | ||||
| Primary | 2 (20.0) | 8 (80.0) | 3.862 | 0.145 |
| Secondary | 17 (6.9) | 231 (93.1) | ||
| Tertiary | 7 (4.7) | 141 (95.3) | ||
| Ethnicity | ||||
| Yoruba | 7 (6.0) | 109 (94.0) | 0.149 | 0.985 |
| Hausa | 9 (6.8) | 123 (93.2) | ||
| Igbo | 5 (6.9) | 67 (93.1) | ||
| Others | 5 (5.8) | 81 (94.2) | ||
| Income (Naira) | ||||
| ≤60,000 | 14 (6.4) | 205 (93.6) | 0.732 | 0.693 |
| >60,000 | 10 (5.9) | 159 (94.1) | ||
| International posting | ||||
| Yes | 14 (5.7) | 231 (94.3) | 0.409 | 0.484 |
| No | 12 (7.5) | 149 (92.5) | ||
| Local posting | ||||
| Yes | 15 (9.1) | 150 (90.9) | 3.348 | 0.067 |
| No | 11 (4.6) | 230 (95.4) | ||
The factors that were identified to be significant at 10% and relevant based on the literature on bivariate analysis for SRBs were subjected to multivariate analysis; the result in Table 8 shows the contribution of each of the explanatory variables on the outcome variable (SRBs). Female respondents are 0.543 less likely (OR= 0.581; 95% CI: 0.448 - 0.753; p= 0.001) to engage in SRBs compared to male respondents. Respondents who are not currently married or not living with a partner are more likely (OR= 1.313; 95% CI: 1.032 - 1.672; p= 0.027) to engage in SRBs compared to respondents who are currently married. Age group and ethnicity were confounding variables.
Table 8:
Predictors of SRBs among respondents
| 95% CI | |||
|---|---|---|---|
|
| |||
| Variable | β-coefficient | Odd-ratio (LCL-UCL) | p-value |
|
| |||
| Age group (years) | |||
| ≤ 20 (ref) | 1 | 1.000 | |
| 21-30 | -0.029 | 0.972 (0.610-1.548) | 0.903 |
| >30 | -0.286 | 0.752 (0.451-1.251) | 0.272 |
| Gender | |||
| Male (ref) | 1 | 1.000 | |
| Female | -0.543 | 0.581 (0.448-0.753) | 0.001* |
| Marital status | |||
| Currently Married (ref) | 1 | 1.000 | |
| Not currently Married | 0.273 | 1.313 (1.032-1.672) | 0.027* |
| Ethnicity | |||
| Yoruba (ref) | 1 | 1.000 | |
| Hausa | -0.166 | 0.907 (0.696-1.181) | 0.469 |
| Igbo | 0.011 | 1.011 (0.734-1.392) | 0.947 |
| Others | 0.098 | 0.847 (0.651-1.102) | 0.216 |
DISCUSSION
Previous literature has shown there has been a gradual increase in the trend of SRBs amongst MP as it directly impacts the risk of contracting and spreading sexually transmitted infections (STIs)16, 25. This study equally found that SRBs was significantly high with a prevalence of 68% in men and 12% in women. However, compared to the most recent study that reported on the prevalence of SRBs amongst Immigration and correctional Officers25, the prevalence amongst military personnel as indicated by this study is almost five times more; and this can be due to certain factors such as: frequent postings away from home for extended periods of time, and the possibility of casual sex24.
CSBD, like SRBs, has been previously reported to be more common in men (12%) than in women (7%)21. Similarly, this study found that more males (7.7%) than females (3.4%) showed symptoms of CSBD. While sufficient evidence examining gender differences is lacking, a study reported that more men (13.8%) than women (4.3%) endorsed CSBD-related symptoms, although there was a limited proportion of women reporting CSBD13. The prevalence of CSBD among the respondents was reported at 6.4%. This is higher compared to estimates in previous studies which reported 1% to 3% among the U.S. adult population, although a survey among a sample of male U.S. veterans showed a much higher estimate of 16.7%8, 11. Reasons for this inconsistent prevalence may include underreporting of CSBD due to its sensitivity and problematic nature of sexual behaviour10.
A 60.0% prevalence of multiple sexual risk behaviours (MSRBs) was found among sexually active respondents. Almost all the respondents who engaged in MSRBs were male. More than half 54.3% of the respondents who engaged in MSRBs were not currently married or not living with a partner. A study also described MP as a young population perceiving themselves as invulnerable and seen by women of the local population as privileged thereby associating with them and causing them to engage in multiple partnering, and unprotected sex among others19. Sex with someone other than a regular partner more than once (43.6%) and sex with a casual friend (38.4%) were the second and third highest occurring, respectively, in the current study. Sex under the influence of alcohol and sex after drug use were among the patterns of SRBs reported in the current study, with the former occurring among 18.5% and the latter among 7.6% of respondents who were sexually active in the preceding three (3) months. SRBs were linked to alcohol abuse in a study20. Compulsive Sexual Behaviour Disorder showed no significant association with age group, gender, marital status, level of education, ethnicity, income, number of years spent in service, and posting experience on bivariate analysis at p<0.05 in the current study, although some studies reported some associations, and have linked addiction to sexual compulsive behaviour26, 27. Results from multivariate analysis on the factors associated with SRBs identified gender and marital status as predictors, including MSRBs. Female respondents were less likely to engage in SRBs compared to their male counterparts. A study in the U.S. showed that male veterans have a lifetime prevalence of paid sex compared to non-veterans22. Respondents who were not currently married or not living with a partner were also more likely to engage in SRBs compared to those who were currently married. Being single has been identified as a predisposing factor to SRBs17.
Results from the multivariate analysis also reported that gender and marital status were predictors of MSRBs. Female respondents were less likely to engage in MSRBs compared to male respondents. Male veterans have been reported to have a lifetime prevalence of extramarital sex23. Also, respondents who are not currently married or not living with a partner are more likely to engage in MSRBs compared to their currently married counterparts.
Although other factors like age, level of education, income, and posting experience were not significantly associated with SRBs in the current study, some previous studies reported their association. A similar study revealed one-third of MP within the age group 18-34 years engaged in premarital/extramarital sex; equally evident was also the fact that a significant proportion of the respondents had secondary education (one-third) and those who were involved in foreign operations (nearly half) also engaged in pre/extramarital sex18.
Limitations
Military personnel were generally cautious of entertaining questions to avoid exposing details that might be regarded as indiscipline if learned by enforcement authorities in the military. The nature of the questions was similar to the PTSD Psych Test which soldiers undergo and are required to pass, therefore they showed reluctance in responding to questions or participating in the study. These limitations were addressed by ensuring the confidentiality of information provided, explaining short-term and longterm beneficence, and providing material incentives.
This study also recorded low female participation due to the sensitive nature of the questions. Some highly religious personnel also felt the questions were intrusive. However, they were informed of their right to withdraw from participating at any point during data collection.
CONCLUSION AND RECOMMENDATIONS
The majority of the MP engaged in SRBs while less than one-tenth had CSBD. The common SRBs among respondents were non or inconsistent use of a condom, sex with someone other than a regular partner more than once, sex with a casual friend, heavy intake of alcohol before sex, sex with sex workers, sex while drunk, and sex after using intravenous drugs. Gender and marital status were predictors of SRBs.
Relevant stakeholders like health institutions should organize comprehensive, multilevel, multi-partner behavioural interventions that would take account of the social context in mounting individual-level programmes, modify social norms to support uptake and maintenance of behaviour change, tackle the structural factors that contribute to SRBs, and create an environment that promotes treatment and prevention for treatment-seeking individuals and society. The length of time MPs are required to spend during peace-keeping should be reviewed so that healthy sexual and marital relationships can be encouraged.
ACKNOWLEDGEMENT
Funding:
This study was self-funded.
Conflict of interest:
There was no conflict of interest regarding this study.
Ethical approval and consent to participate:
Written informed consent was obtained from all respondents and ethical approval was obtained from the Oyo State Research Ethical Review Committee, Ministry of Health Secretariat, Ibadan, Oyo state. Permission was sought from the Commanding Officer of the 81 Battalion, Mokola, Ibadan, and the General Officer Commanding of 2 Division, Nigeria Army, Odogbo cantonment, Ojoo, Ibadan.
Written Informed Consent:
Informed consent was obtained from study participants. They were all important information about the study, its risks, and benefits. Their participation in this study was voluntary. A signed written informed consent form was given before the commencement of the study.
Confidentiality:
Respondents were assured that all instruments used (i.e. questionnaires and database entries) were coded and would not bear their names, and also data collected was used for research purposes only and was kept on a password-protected computer. The name of the participants was not included in the questionnaire and also research assistant was trained to keep the information confidential. To improve the quality of data collected, anonymity and confidentiality of information obtained were ensured throughout the duration of the study.
Non-maleficence:
This study was conducted without any physical harm to the participants. Participants were free of any cost in this study. However, the research sought pardon for minimal harm due to the time spared by participants.
REFERENCES
- 1.World Health Organization. Sexual and Reproductive Health and Research (SRH). Available at https://www.who.int/teams/sexualand-reproductive-health-and-research/key-areasof-work/sexual-health/defining-sexual-health . 2006.
- 2.O'Reilly KR, Islam M, Sittirai W. In: Sexually Transmitted Diseases. 3rd Ed. Holmes KK, Mardh PA, Sparling FB, editors. McGraw Hill; 1999. pp. 1421–1429. [Google Scholar]
- 3.Igboanusi C. John-Camillus, Tukur Dahiru, Istifanus Anekoson Joshua. HIV/AIDS Knowledge and Attitude among Military Recruits at Depot Nigeria Army, Zaria, Nigeria. American Journal of Public Health Research. 2015;3(1):8–14. [Google Scholar]
- 4.Lehavot K, Hoerster K.D, Nelson K.M, et al. Health indicators for military, veteran, and civilian women. American Journal of Preventive Medicine. 2012;42:473–480. doi: 10.1016/j.amepre.2012.01.006. [DOI] [PubMed] [Google Scholar]
- 5.Gaebel et al, et al. Mental and behavioural disorders in the ICD-11: concepts, methodologies, and current status. Psychiatr. Pol. 2017;51(2):169–195. doi: 10.12740/PP/69660. PL ISSN 0033-2674 (PRINT), ISSN 2391-5854 (ONLINE) www.psychiatriapolska.pl . [DOI] [PubMed] [Google Scholar]
- 6.Sawchuk CN. Mayo Clinic, Rochester, Minn. 2017 Aug 22;
- 7.Karila L, Wéry A, Weinstein A, et al. Sexual Addiction or Hypersexual Disorder: Different Terms for the Same Problem? A Review of the Literature. 2014;20(25):4012–4020. doi: 10.2174/13816128113199990619. [DOI] [PubMed] [Google Scholar]
- 8.Klein V, Rettenberger M, Briken P. J Sex Med. 2014;11:1974–1981. doi: 10.1111/jsm.12602. [DOI] [PubMed] [Google Scholar]
- 9.Smith P.H, Potenza M.N, Mazure C.M, et al. Compulsive sexual behavior among male military veterans: Prevalence and associated clinical factors. Journal of Behavioral Addictions. 2014;3:214–222. doi: 10.1556/JBA.3.2014.4.2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Derbyshire KL, et al. Compulsive sexual behavior: A review of the literature. Journal of Behavioral Addictions. 2015;4:37. doi: 10.1556/2006.4.2015.003. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Kuzma JM, Black DW. Psychiatr Clin N Am. 2008;31:603–611. doi: 10.1016/j.psc.2008.06.005. [DOI] [PubMed] [Google Scholar]
- 12.Fong T.W. Understanding and Managing Compulsive Sexual Behaviours. November, Psychiatry. 2006 [PMC free article] [PubMed] [Google Scholar]
- 13.Kraus et al. The development and initial evaluation of the Pornography-Use Avoidance Self Efficacy Scale. Journal of Behavioral Addictions. 2017;6(3):354–363. doi: 10.1556/2006.6.2017.057. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Mark W. Evans, MSPH1, Borrero Sonya, MD MS2,3,4, Yabes Jonathan, PhD2,5, Rosenfeld Elian A., PhD3,4. Sexual Behaviors and Sexually Transmitted Infections Among Male Veterans and Nonveterans. American Journal of Men's Health. 2017;11(4):791–800. doi: 10.1177/1557988317698615. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Ross M.W, Mansson S.A, Daneback K. Prevalence, severity, and correlates of problematic sexual Internet use in Swedish men and women. Archives of Sexual Behavior. 2012;41(2):459–466. doi: 10.1007/s10508-011-9762-0. [DOI] [PubMed] [Google Scholar]
- 16.Nwokoji U. Adaji, Ademola J Ajuwon. Knowledge of AIDS and HIV risk-related sexual behavior among Nigerian naval personnel. BMC Public Health. 2004;4:24. doi: 10.1186/1471-2458-4-24. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Adebajo S, Egbewunmi OO, Jerome M, et al. Knowledge, Attitude and Sexual Behavior Among the Military Concerning HIV/AIDS/STIs. Technical Report by the Armed Forces Programme on AIDS Control (AFPAC) 2001 Aug
- 18.Hussain NAA, Akande TM. African Journal of Clinical and Experimental Microbiology. 2. Vol. 10. 2009. Sexual behaviour and condom use among Nigerian soldiers in Ilorin, Kwara State, Nigeria; pp. 128–135. [Google Scholar]
- 19.Joint United Nations Program on AIDS . 1998. AIDS and the Military. Best practice collection . [Google Scholar]
- 20.Anastario MP, Tavarez MI, Chun H. Sexual risk behavior among military personnel stationed at border-crossing zones in the Dominican Republic. Rev Panam Salud Publica. 2010;28(5):361–367. [PubMed] [Google Scholar]
- 21.Langstrom N, Hanson RK. High rates of sexual behaviour in the general population: correlates and predictors. Arch Sex Behave. 2006;35:37–52. doi: 10.1007/s10508-006-8993-y. [DOI] [PubMed] [Google Scholar]
- 22.London AS, Wilmoth JM. Veteran status and paid sex among American men: Results from three national surveys. Archives of Sexual Behavior. 2015;44:997–1009. doi: 10.1007/s10508-014-0446-4. [DOI] [PubMed] [Google Scholar]
- 23.London AS, Allen E, Wilmoth JM. Veteran status, extramarital sex, and divorce: Findings from the 1992 National Health and Social Life Survey. Journal of Family Issues. 2013;34:1452–1473. [Google Scholar]
- 24.Essien EJ, Monjok E, Chen H, et al. Correlates of HIV knowledge and sexual risk behaviors among female military personnel. AIDS Behav. 2010 Dec;14(6):1401–1414. doi: 10.1007/s10461-010-9701-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Nureni Azeez, Aishat Bukola Usman, Adebowale Ayo Stephen, et al. Risky Sexual Behaviour among Male Immigration and Correctional Personnel in Kano State, Nigeria, 2018, 29 April 2020, PREPRINT (Version 1) available at Research Square. 2020
- 26.Brem M.J, Shorey R.C, Anderson S, Stuart G.L. Depression, anxiety, and compulsive sexual behaviour among men in residential treatment for substance use disorders: The role of experiential avoidance. Clinical Psychology & Psychotherapy. 2017;24(6):1246–1253. doi: 10.1002/cpp.2085. [DOI] [PubMed] [Google Scholar]
- 27.Mechelmans D.J, Irvine M, Banca P, et al. Enhanced Attentional Bias towards Sexually Explicit Cues in Individuals with and without Compulsive Sexual Behaviours. PLOS ONE. 2014;9(8):e105476. doi: 10.1371/journal.pone.0105476. [DOI] [PMC free article] [PubMed] [Google Scholar]