Should the Army and Air Force change their policies regarding HIV+ personnel?

SGM Erik Marquez Since I'm going to Afghanistan, I recalled personal experiences when I was in Hawai'i, the ROK recently and Kosovo before they changed the mission. All three had heavy civilian contractor presence and just as much, if not more so in Afghanistan. Would the prospect of an attack whereas HIV+ civilians, Sailors and Marines be considered a nothing burger? While I'm fascinated by this recent science on undetectable means untransmittable but unaware of the current info of Afghanistan or other OCONUS locations with highly probable attacks against us.

SSG Duke Allen That's the one thing I was confused about on the website. May have overlooked it, but never mentioned anything like a blood transfusion or exposure to blood loss.

SFC (Join to see) - a little further research will lend the knowledge that if undetectable in blood, undetectable in semin/other body fluids. When someone is tested for their viral load it's a blood sample that's done, not semin (not being crass, I wasn't sure if you or others had any knowledge of how testing is conducted.)

I haven't looked about blood transfusions. I might see what I can find but research tells us that undetectable is Untransmissable. The CDC reluctantly released this late last year or earlier this year. I say reluctantly because the stigma is still there due to the campaign of the 80's/90's. Not saying the way they went about it was right or wrong, it served its purpose but it's a tad bit antiquated.

The PARTNER study had zero transmission between heterosexual and homosexual serodiscordant couples engaging in unprotected sex. Logging sexual encounters in the tens of thousands the cut off at the time for the viral load test was 200 copies per ml of blood.

So, there are a few points to bear in mind:

(1) There's a faulty assumption here -- that by introducing undetectable servicemembers onto the battlefield, you're introducing a new risk. That's not the case. In fact, undetectable servicemembers are probably the safest people to be next to on the battlefield....

The HIV test that is administered doesn't tell you that you don't have HIV. It only tells you that your body isn't producing HIV antibodies yet. HIV is transmitted during the "window" between someone being infected and diagnosed -- because that's when it's most contagious, the virus rapidly multiplies at an exponential rate immediately after infection before the body begins responding. The military only tests people every two years. And, you're talking about a highly sexually active 18-25 year old population -- often more likely to engage in high risk behavior before and after being deployed.... So, the comparison is people who are known to not have a detectable level of their virus in their blood vs. people who have not been identified as producing the HIV antibody during their last test up to two years ago.

You should also note that we're not considering enemy combatants or local nationals either -- neither of which probably have regular access to testing or care. You're much more likely to become infected from someone you encounter in the countries we're deployed to.

(2) The idea that soldiers have to be regarded just as bags of blood for transfusions is a bit faulty. Yeah, HIV+ servicemembers can't donate blood. But, you can't just hook up an IV to anyone either. AB+ is only 3% of the population and they can only donate to each other. So, they're generally useless as far as transfusions go too. But, we don't exclude them.

(3) The PARTNERS study was focused on the risks of sexual transmission. But, if you look at some of the literature in the UK and Canada, they're much broader in their statements -- often saying it is untransmittable through all bodily fluids. That's because there are higher levels of HIV in semen than in blood or saliva. You should also consider the levels of contact.

While I wouldn't suggest blood transfusions.... You should consider the type of contact that we're comparing and the concentrations of the virus in semen vs. blood. MSG Herrington is absolutely right about HIV dying when exposed to air. So, you're talking about a higher risk with sexual intercourse. Ejaculating semen into someone is going to be a higher risk than surface contact with blood (even with open wounds). And, again, with undetectable servicemembers, we're talking about people with no detectable levels of the virus in their blood.

(4) The other thing I want to point out is that people have "known" that HIV wasn't transmittable via sexual intercourse for a while. It's just that the multi-year longitudinal studies are finally catching up.... But, we also know the risks of transmission by blood contact -- even if that's difficult to quantify with a study. That's why you don't see restrictions in healthcare or food service, federal law enforcement or foreign service.

Soldiers aren't the only ones who are potentially exposed to blood. There's nothing inherently unique about that. If there were documented cases of undetectable transmission by people in those professions, those restrictions would be imposed pretty quickly.

....I will discuss the food service, vehicle maintenance, and dentist lower in the thread.

The current policy is that HIV+ servicemembers are permitted to continue serving so long as their condition is stable. There's no bar on reenlistment. That was the policy developed during the 1990s. It was considered enlightened at the time that it was adopted, but it hasn't kept pace with medical advancements.

Some of the problems....

(1) It doesn't really talk about those who are "undetectable".
(2) If you have someone who is in a combat arms branch, that person can't switch to a specialty branch -- even if people think the risk might be less. So, the idea of being uncomfortable with an HIV+ infantryman on the battlefield vs. letting him become a JAG officer, a Chaplain, or a Dentist isn't an option under the current policy.
(3) The best practices of prevention aren't addressed. It's not condoms and latex barriers anymore. The most effective practices are things like HIV treatment and PrEP.
(4) HIV+ servicemembers aren't allowed to donate to other HIV+ people -- a big issue when you consider some of the organ transplant studies like HOPE at John Hopkins.
(5) You involve untrained unit-level commanders reading a script in prescribing medical decisions for servicemembers. That's a problem when you start interposing them between the servicemember and the doctor.
(6) There is also a lengthy exception to policy process. Every deviation from the policy has to go all the way up to the Undersecretary and the Deputy Chief of Staff. Besides the obvious HIPPA problems of routing a packet all the way up there, you have issues of why someone at that level is making routine personnel and health care decisions for individual servicemembers when they should be focused on army-wide things.

Those are a few other reasons you're seeing the Navy and Marine Corps revising their policies.... They're eliminating a lot of these issues. The Army and the Air Force haven't started that process yet.