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In a new analysis of military health surveillance data during 1990 through 2013, service members diagnosed with HIV-1 in more recent years have tended to remain on active duty longer than those who became infected in the earlier years of that time period.
The analysis characterized the duration of military service after service members’ initial diagnoses of HIV-1 infection and compared the lengths of service for those who were diagnosed during successive five-year intervals beginning in 1990, 1995, 2000, and 2005, and the four-year interval of 2010–2013. By several measures, the durations of service after initial diagnoses of HIV-1 infection were clearly longer in the later-infected cohorts compared to the earliest cohort (1990–1994), said the report published in the August issue of the Medical Surveillance Monthly Report by the Armed Forces Health Surveillance Center.
The median length of service after diagnosis increased by approximately 1.4 years from the earliest cohort (2.29 years) to the 2005–2009 cohort (3.65 years). For the earliest cohort (1990–1994), 4.39 years passed before 75 percent of those infected had left service, but for the next two cohorts, the corresponding time periods were 8.48 years (1995–1999) and 9.13 years (2000–2004). The findings are most consistent with the growing availability and effectiveness of treatments for HIV-1 infection and disease since the early 1990s. Among the factors that may have contributed to service members staying longer in the military during the surveillance period were the growing availability and effectiveness of treatments for the disease; the decline in stigmas associated with the diagnosis of HIV-1 infection and its link to homosexuality; and the most recent changes in U.S. military policy that allows gay to serve in its ranks, the report said.
“Until fairly recently, there were significant institutionalized stigma associated with homosexuals in the military,” the report said. “However, as the management of HIV-associated disease continues to improve and as the U.S. military adapts to the inclusion of homosexuals within its ranks, stigmas associated with HIV-1 infection and homosexuality will decrease. Thus, in the future, relatively more service members who are diagnosed with HIV-1 infections, regardless of their sexual orientations, may elect to continue their military service careers.”
Estimated median durations of service after initial HIV-1 diagnoses ranged from 2.29 years in Cohort 1 to 3.65 years in Cohort 4. Thus, in the 15 years between 1990–1994 and 2005–2009, the median durations of service after HIV-1 diagnoses increased by 1.4 years. (Because more than 60 percent of Cohort 5 were still in service at the end of the surveillance period, the estimate of the median duration of service after diagnoses of Cohort 5 members was unstable and is not included here.)
The estimated duration of service from HIV-1 diagnoses until 75 percent of cohort members had left service was much longer among Cohort 2 (8.48 years), and more than twice as long among Cohort 3 (9.13 years), than Cohort 1 (4.39 years) members. Thus, in the 10 years between 1990–1994 and 2000–2004, the durations of service of the 25 percent who stayed in service the longest after diagnoses increased by 4.7 years (Figures 1, 2). (Because more than one-third of Cohorts 4 and 5 were still in service at the end of the surveillance period, estimates of the 75th percentiles of durations of service after diagnoses of those cohorts were unstable and are not included here.)
During the overall surveillance period, median durations of service after HIV-1 diagnoses steadily increased with age from greater than 20 years through 30–39 years at times of diagnoses. Also, compared to their respective counterparts, median durations of service after diagnoses were longer among females, officers and senior enlisted members, Navy members, and those still in service at the end of the surveillance period.
During the 24-year surveillance period, a total of 5,227 military members were newly diagnosed with HIV-1 infections. The mean number of HIV-1 infection diagnoses per year was 218 with a range of new cases from 86 in 1995 to 817 in 1990.
Source: Armed Forces Health Surveillance Center (AFHSC)