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Lifetime Sexual Assault, High-Risk Behavior, and Sexually Transmitted Infections Among Women Veterans

Goyal V, Mengeling M, Booth B, Torner J, Syrop C, Sadler AG. Lifetime Sexual Assault, High-Risk Behavior, and Sexually Transmitted Infections Among Women Veterans. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 9; San Diego, CA.

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Research Objective. Data on reproductive health outcomes among the growing population of women Veterans are lacking. Active duty Servicewomen report elevated rates of high-risk sexual behaviors including absent or inconsistent condom use and having a new or concurrent sexual partners, which may explain the high prevalence of sexual transmitted infections (STI) in this group. This study aimed to examine high-risk sexual behaviors, STI, and lifetime sexual assault (LSA) among women Veterans. Study Design. Data were from a retrospective cohort study to determine lifetime prevalence of STI from self-reports gathered via computer-assisted telephone interview. Also collected were data on sexual behavior and LSA before, during, and after military service. Bivariate analysis was used to evaluate the association between LSA and STI history, reported as an unadjusted odds ratio with 95% confidence interval. Population Studied. 1004 women Veterans < 51 years of age enrolled at two Midwestern VA Medical Centers or outlying clinics between 2000-2008. Principal Findings. Participants had mean age of 38.3 years, were predominantly white (89%), and the majority had college or technical training (56%). Lifetime prevalence of gonorrhea was 5%, chlamydia was 15%, genital herpes was 8%, and < 1% reported syphilis. Women reported a mean of 5.1 years of unprotected intercourse, 19% had unintended sex after alcohol/drug use, and 31% had at least one non-monogamous sexual partner after military service. Women reporting an STI were significantly more likely than those who did not to receive treatment for drug or alcohol abuse (26% vs. 12%, p < 0.05), have depression (61% vs. 50%, p < 0.05), a younger age at first intercourse (mean age 16.9 vs. 17.5 years, p < 0.05), a greater number of lifetime sexual partners (mean 11.5 vs. 9.9, p < 0.05), report no condom use before military service (29% vs. 23%, p < 0.05), report unintended sex after alcohol/drug use before (37% vs. 29%, p < 0.05), during (51% vs. 30%, p < 0.05), and after (25% vs. 17%, p < 0.05) military service, and non-monogamous sexual partners before (48% vs. 36%, p < 0.05), during (61% vs. 40%, p < 0.05), and after (40% vs. 28%, p < 0.05) military service. Women reporting LSA (62%) were significantly more likely to report a history of STI compared to those never assaulted (OR 1.89, 95% CI, 1.37-2.60). Women who reported LSA were also more likely to report depression, alcohol/drug abuse, and multiple high-risk sexual behaviors before, during, and after military service compared to their non-abused counterparts. Conclusions. High-risk sexual behaviors are prevalent among women Veterans which may explain the high rates of gonorrhea and chlamydia infection in this population. Women who have experienced LSA are a sub-group at significant risk for STI, as well as depression and alcohol/drug use that can contribute to the cycle of high-risk behaviors. Implications for Policy or Practice. Reproductive health services for Servicewomen and Veterans should emphasize assessment of high-risk sexual behaviors and screening and treatment for STI and associated mental health conditions. These findings have important implications for needed resources and interventions to address high-risk behaviors and adverse outcomes of untreated STI that can impair Servicewomen's lifelong health and fertility.

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