Rate of STD from sex workers drops dramatically for 2ID
December 14, 2003
CAMP RED CLOUD, South Korea — An Area I prostitution crackdown begun more than a year ago has resulted in fewer U.S. soldiers contracting sexually transmitted diseases from nightclub workers, military health officials say.
But the STD rate from soldier-to-soldier contact remains the No. 1 means of transmission.
The campaign followed late 2002 media reports blaming Army policies for human trafficking in South Korea.
A 2003 inspector general’s report on human trafficking in South Korea found the military has “aggressively educated” soldiers, but that some military police patrols were too friendly with club owners where prostitution was taking place. Prostitution is rampant outside U.S. bases, including the 2nd Infantry Division’s Camp Casey, officials said. Crackdowns help stem such activity; it involves standardizing courtesy patrols in nightclub districts, strict enforcement of standards for premises frequented by soldiers and educating troops about rules relating to off-base conduct. Area I Community Health Nurse Capt. Keith Palm of the 702nd Main Support Battalion said the measures are paying off with reduced STD numbers involving soldiers who have sex with club workers.
In fact, the STD rate for 2ID soldiers who contracted diseases from sex workers fell from 18 percent in 2002 to 8.5 percent this year.
“Last year, the second most- named source of STDs was club workers, who are generally prostitutes,” Palm said. “This year, with the Army putting an emphasis on not going to prostitutes, they went to the fifth most-named source.”
Lt. Col. Chris Bailey is a member of the Armed Forces Disciplinary Control Board that communicates with nightclubs operating in Area I. According to Bailey, the Army has become pro-active in informing soldiers about the penalties for using prostitutes.
Procedures for courtesy patrols have been standardized and there is increased engagement with the Korean Special Tourist Association, including nightclubs catering to U.S. soldiers.
Members essentially trade tax benefits and list privileges in return for keeping non-U.S. citizens out of their clubs before curfew or risk being declared off-limits.
Three clubs in Area I have been declared off-limits in the past three months, Bailey said.
A message is being sent to troops by “increasing the disciplinary response” — punishing soldiers who fraternize with sex workers. “Once you tell them it is a bad thing you have to prove it is a bad thing,” Bailey said.
Meanwhile, Palm said most STD cases in Area I involve soldier-to-soldier contact, which accounts for 46 percent of 2ID cases.
Soldier-to-soldier contact also was the No. 1 cause last year, he said, noting the rate has decreased slightly.
“That might be because people … assume another soldier will be safe because they receive regular HIV tests,”Palm said. “When it is someone they know from their unit they think: “What is the worst I could get, gonorrhea or chlamydia?’” Palm said STDs can impair field performance and if left untreated can cause infertility.
The 2ID STD rate has fallen during the past three years and is now 17.9 cases per 1,000 soldiers, slightly below the U.S. rate for people ages 20-24, which Palm used as a basis for comparison.
According to the Centers for Disease Control and Prevention, the stateside STD rate for adolescents and young adults is between 18 percent and 20 percent each year.
Chlamydia makes up 71 percent of cases in Area I, gonorrhea 17 percent and all other STDs including herpes and syphilis account for another 12 percent, Palm said.
Only one HIV case was detected in South Korea this year, in a soldier who acquired it in the United States, officials said. Any soldier or SOFA-status person who is HIV-positive is sent back to the United States under provisions of the Status of Forces Agreement, officials said.
Women — who make up 10 percent of 2ID — comprise 41 percent of STD cases. The male STD rate is only 10.8 cases per 1,000 compared to 69.8 cases per 1,000 female soldiers.
Maj. John Maza, 2ID preventative medicine officer, said the higher detection rates for female soldiers are likely because they are screened more often than males for STDs — during pap smears and mandatory annual chlamydia tests — and also because females are more susceptible. Maza said STDs are more likely to be asymptomatic in females but will cause symptoms such as dripping genitals in males.
Forty-three percent of chlamydia cases and 33 percent of gonorrhea cases detected within 2ID have no symptoms.
Support units have higher STD rates than combat units, probably because support units have more females so there are more opportunities for contact, Palm said.
The unit with the highest STD rate within the 2ID is a support unit that has a rate of 40 cases per 1,000 soldiers compared to the division average of 17.9 per 1,000.
Officials declined to name that unit.
The unit with the lowest STD rate is the 506th Infantry Battalion at Camp Greaves with three cases per 1,000 soldiers.
Palm said the units closest to the demilitarized zone have the lowest STD rates.
“They are in the field all the time, and there are no women,” he said.
No soldier can be punished for having an STD or seeking treatment, Palm said.
“They found in Vietnam that if you punished people they would avoid treatment to the point where they were really sick,” he said. STD case information is only available to medical officers; commanders have access to data but cannot obtain the names of people treated.
“There is no negative effect from coming to see me,” Palm said. “They might tell me they were unfaithful to their wife but I don’t report that to their commander.”
Soldiers are required to tell medical officials who they think they got an STD from.
Palm interviews soldiers and said he tracks 90 percent of the contacts. “There are people who use prostitutes. One guy I saw had sex with 14 women in a month … but 90 percent only name one person.
“I will contact the person but I don’t use the original person’s name at all,” Palm said. “I just say, “I have been told you are a sexual contact to chlamydia or gonorrhea. You need to get tested or get treatment.’” But some contacts are nearly impossible to find.
“If they say ‘I was with a Korean woman named Song,’ and that’s all I know, then I’m not going to be able to find her,” he said.
There are a number of programs to help combat STDs.
Maza teaches a monthly course for line commanders emphasizing STD prevention, screening, and treatment.
There is a 2ID health educator who educates soldiers about STDs.
Information about how to avoid STDs is contained in the Warrior Standard Book.
STD avoidance also is dealt with during field sanitation training classes.
All of the educational efforts have the same message — the only sure way of avoiding STDs is abstinence.
“When I give my classes, I say masturbation is a safe option unless they are getting really crazy,” Palm said.
The medical staff gets information on STDs through lab test results and from unit health care providers.
“We want to know if soldiers got the disease in a club, from a foreign national or from a spouse,” Palm said.
Few soldiers diagnosed with an STD get upset at the person from whom they contracted the disease, Palm said.
“Generally, a lot of people are accepting because they know they took the risk,” Palm said. “They want to make sure the other person gets taken care of and that they don’t have long-term health effects from the infection.”
“The 2nd Infantry Division is committed to ensuring the safety and well being of its soldiers. The Division has a policy that prohibits soldiers from entering any establishment that promotes prostitution, allows sex for money, or permits any form of human trafficking. If a soldier violates this policy, punitive action may be taken against the soldier under the Uniform Code of Military Justice.
“Training the division’s leaders and soldiers on the awareness, identification and reduction of prostitution and human trafficking outside U.S. Army installations is a top priority. One entity that addresses these issues is the Armed Forces Disciplinary Control Board. It is comprised of senior leadership within the division and Area I and meets frequently to discuss issues that affect the safety of our soldiers including the safety of off-post clubs.
“Clubs that are suspected of allowing or condoning prostitution may be placed off limits to servicemembers. In addition to frequent courtesy patrols that report to the board, members review statistics concerning soldiers who contract STDs and inform the clinic that it was contracted from an employee of a certain club.
“We will not allow our soldiers to visit a club that engages in prostitution or human trafficking if we can prove that those illegal activities are taking place. It is of the utmost importance to the AFDCB and the command that soldiers have a safe environment to enjoy their leisure time.”
— Maj. Tamara Parker, 2ID public affairs officer