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Military Medicine’s Contribution to an AIDS-free Generation

As we look forward to World AIDS Day this year, I’m amazed at how far we’ve come in the battle against HIV and how effectively U.S. government agencies continue to work collaboratively towards an AIDS-free generation.

At the U.S. Department of Defense (DoD) HIV/AIDS Prevention Program (DHAPP) we support HIV prevention programs around the world— in 70 countries—providing and expanding HIV prevention, care, and treatment support for active-duty military personnel, dependent family members and surrounding civilian communities. To see how far we’ve come, we have to look back 30 years to where we began.

DoD Battles Infectious Diseases
The U.S. military medical community has been a consistent leader in solving international health problems, particularly in the area of infectious diseases, and HIV/AIDS is no exception. Diseases such as yellow fever, malaria, and dengue fever have had a major negative impact on the readiness of our U.S. Armed Forces going back to before World War I. The lessons we have learned fighting these diseases in military populations have made a significant contribution to the worldwide knowledge and management of these infections. When we look back at the last 30 years of HIV/AIDS, we quickly realize that the U.S. military has made equally important contributions to fighting the epidemic.

The DoD initiated HIV screening of all applicants for military service beginning in August of 1985, only months after the first screening test for the newly identified virus was developed. We began “force wide” HIV screening for active duty members two months later. DoD leadership knew they had to aggressively protect the health of the force, but also that the traditional military medicine needed to be engaged in the fight against this disease for the benefit of the entire nation and the world. In those early years, rates of HIV infection in military recruits and active duty members were some of the few “large population” numbers that existed to inform the nationwide medical community and the public about the early nature of the epidemic.

Leading HIV Vaccine Research
In 1986 Congress authorized the U.S Military HIV Research Program (MHRP) — centered at Walter Reed Army Institute of Research (WRAIR) — which seeks to protect the warfighter and serve the global community by reducing the risk of HIV infection worldwide. Research efforts encompass threat assessment and epidemiology, HIV diagnostics, vaccine development and testing, and therapeutics research.

Early on, MHRP developed the first disease staging system, which was adopted by the U.S. Army in 1986. The Walter Reed Staging Classification system, the first of its kind, provided uniformity for routine clinical evaluation of military personnel, which led to a better understanding of the natural history of these infections, and helped evaluate the clinical response to antiviral treatment regimens. Around the same time, MHRP published evidence of the then-controversial notion that HIV could be transmitted heterosexually. In 1987, MHRP scientists developed the criteria for Western blot positivity—the fist supplemental confirmatory test for HIV. Fast forward to 2009, MHRP announced the results of the first HIV vaccine study to show protection against HIV.

Educating Troops to Change Behavior
Military research provided a firm foundation to wage war against HIV/AIDS, however, we knew to stop the spread of HIV in troops now we needed a “tool box” of interventions that could be implemented force-wide quickly, and more importantly were effective. Within the military, the U.S. Navy led the way in developing and implementing successful HIV/AIDS behavior change communication activities and comprehensive prevention. Modules incited behavior change and educated troops about the risk of HIV at home and on deployments. The Navy also created the first HIV prevention training specifically targeted toward those that already had HIV – Prevention with Positives. This strategy educates HIV positive troops and their families so that they know how to reduce the risk of transmitting HIV.

Reducing HIV in Foreign Militaries
Today, international efforts are led by the DoD HIV/AIDS Prevention Program (DHAPP) – with the U.S. Navy designated as the Executive Agent for the program – centered at the Naval Health Research Center in San Diego, CA.

Pursuing HIV/AIDS activities with foreign militaries is clearly tied to security interests, regional stability, humanitarian concerns, counterterrorism, and peacekeeping efforts due to the impact of HIV/AIDS as a major destabilizing factor in developing countries. In fact, the Secretary of Defense identified HIV/AIDS in foreign militaries as a national security issue in the Security Cooperation Guidance.

Since 2003, DHAPP has played a key role in preventing HIV in foreign militaries through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) as the DoD implementing agency for the initiative. Foreign militaries frequently have HIV infections rates similar to the surrounding civilian populations, yet they remain a population with increased HIV risk factors, including high mobility and separation from partners. Due to security issues and the stigma surrounding HIV/AIDS, foreign militaries are typically more amenable to working with U.S. counterpart defense representatives. Therefore, the DoD plays a critical role in galvanizing foreign militaries to take preventative action against the spread of this disease.

DHAPP continues its efforts today to combat HIV/AIDS among respective military services implementing bilateral and regional strategies in coordination with respective Combatant Commands and PEPFAR Country Teams. Funding through PEPFAR and the Defense Health Program ensure that militaries around the world are not hindered by morbidity and mortality affecting deployment cycles and troop levels.

The military has been committed to fighting this battle since the beginning and won’t stop until it’s over – until we see an AIDS free generation!

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