AIDS

AIDS. Shortly after the first cases of acquired immunodeficiency syndrome (AIDS) were recognized among civilians in 1981, early forms of the disease (AIDS‐related complex and lymphadenopathy syndrome) were detected among active duty personnel. The causative virus (now called the human immunodeficiency virus, HIV) was first isolated from ill soldiers and their asymptomatic but nonetheless infected wives in 1984. These military studies provided the first proof that HIV could be transmitted through heterosexual intercourse. Nationwide blood bank testing for HIV began in June 1985. Shortly thereafter, in October 1985, the Department of Defense (DoD) began screening all civilian applicants for military service; those who tested positive for the virus were medically disqualified from service. Overall, 1 in 650 applicants was found to be infected, but prevalence rates in various geographic and demographic subpopulations varied from as low as 1 in 20,000 in the upper Midwest to 1 in 50 in northeastern urban centers. The HIV screening program was the first population‐based screening program in the United States, and provided the first hard data that the epidemic had already spread silently throughout the country by the mid‐1980s.

HIV screening of active duty military personnel began in 1986. Based largely on the recommendations of the Armed Forces Epidemiological Board, policies for HIV infection were established to be comparable to those for any other chronic medical condition. Infected military personnel were to remain on active duty, to lodge in military quarters, and to continue work in their duty assignment. Implemented at a time when fear of HIV contagion was widespread in the United States, these policies were farsighted and courageous. All DoD HIV‐positive personnel were to be medically evaluated periodically, and those with advanced disease were honorably discharged with medical disability and benefits. HIV‐infected personnel were restricted from overseas deployment, from health care jobs where potentially risky procedures were performed, and from sensitive Personal Reliability Program (e.g., nuclear missile) positions. In an effort to decrease HIV transmission, HIV‐infected active duty personnel were counseled by their commanders that if they knowingly put others at risk of infection through sexual intercourse, they could be prosecuted through the military justice system. Overall, DoD policies were designed to reflect fair and rational public health principles.

Screening was originally undertaken annually for all active duty personnel, but this interval has gradually lengthened with a number of new service‐specific regulations. For example, testing takes place every five years for all air force personnel, or for the following clinically indicated reasons: during pregnancy; on entry into a drug/alcohol rehabilitation program; on presenting at a STD (sexually‐transmitted disease) clinic; on deployment overseas; on PCS (Permanent Change of Station) overseas. However, all personnel must be proven negative within six months of any overseas deployment.

The U.S. military HIV research program began in 1986, when Congress provided $40 million for this purpose. The U.S. Army Medical Research and Development Command, as the lead agency for infectious disease research, managed the tri‐service program. Major accomplishments include the following firsts: definition of antibody test criteria for a diagnosis of HIV (criteria used worldwide today); evidence that HIV was becoming a serious problem among minorities; detection of transmission of drug‐resistant HIV strains; tracking the global spread of genetic variants; vaccine therapy trials; and international preventive vaccine trials.

At the heart of the controversy over HIV/AIDS research is the question of its relevance to the military. HIV/AIDS has little or no direct impact on readiness or combat operations for U.S. forces. However, recent studies have shown very high HIV prevalences among some African (one in four) and Asian (one in ten) military populations. From a broader national security point of view, the global pandemic is a threat requiring maximal efforts by all capable U.S. agencies.

Rates for new infections have decreased; in 1995, the DoD's total of infections among active duty personnel was approximately 300. In 1996, an amendment to the department's authorization bill ruled that all HIV‐infected personnel on active duty must be involuntarily separated, regardless of their fitness for duty or years of service; however, as of 1999, the policy was not to separate HIV‐infected personnel who were physically fit. The impact of this legislation on the effectiveness of public health control of HIV within the military remains to be determined.
[See also Diseases, Sexually Transmitted; Medical Practice in the Military.]

Donald S. Burke