HIV/AIDS in the Military

HIV/AIDS in the Military

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May 31, 2019
HIV/AIDS in the Military
Chapters 31 and 33 of Title 10, U.S. Code, provide broad
Armed Forces Health Surveillance Center estimates that
authority to the Department of Defense (DOD) to establish
there are approximately 350 servicemembers diagnosed
certain accession and retention standards for
with HIV annually. The rate of newly diagnosed HIV
servicemembers. These standards set minimum thresholds
infections among servicemembers tested (also called the
in areas such as educational aptitude, physical fitness, and
seroprevalence rate) in 2017 was 23 per 100,000. This rate
medical fitness that must be met for an individual to enter
is lower when compared to the general U.S. population,
military service.
ages 20-34. Figure 1 illustrates trends in HIV incidence
rates in the military since 1990.
DOD policies establish the medical fitness standards
required to enter, or be retained, in the Armed Forces. In
Across the active components, the seroprevalence rate (per
certain instances, applicants or current servicemembers may
100,000 servicemembers) in 2017 was highest in the Navy
develop, present with, or have a history of a medical
(30), followed by the Army and Air Force (17), and the
condition or physical defect that would be disqualifying for
Marine Corps (15). Among the reserve components, the
entry into or continued military service.
seroprevalence rate was highest in the Army Reserve (38),
followed by the Army National Guard and Marine Corps
There are approximately 434 disqualifying medical
Reserve (32), Navy Reserve (23), Air Force Reserve (17),
conditions, including a human immunodeficiency virus
and Air National Guard (10).
(HIV) infection. While DOD policy prohibits the accession
of any applicant who tests positive for HIV, current
Entry into Military Service
servicemembers who become infected may continue to
In general, DOD policies prohibit applicants with
serve.
laboratory evidence of HIV infection (i.e., HIV+) from
HIV/AIDS in the Military
entering military service. All applicants typically undergo a
comprehensive medical examination, including HIV
The U.S. Centers for Disease Control and Prevention
screening, at a military entrance processing station or
(CDC) describes HIV as a chronic viral infection that
attacks an individual’s immune system.
military treatment facility (MTF). For applicants to the U.S.
HIV can be
Service Academies, the Uniformed Services University of
transmitted when certain of one’s bodily fluids (e.g., semen,
the Health Sciences, or other officer candidate programs,
blood, breast milk) are injected into the blood stream or
HIV screenings are conducted within 72 hours of arrival at
come into contact with mucus membrane or damaged tissue
the training site. Reserve Officer Training Corps (ROTC)
of another. Untreated HIV infections can lead to Acquired
cadets and midshipmen must be tested prior to the
Immunodeficiency Disease Syndrome (AIDS). DOD’s
program’s commencement.
Figure 1. Rates of New HIV Diagnoses Among Servicemembers, 1990-2017

Source: Department Health Agency, Medical Surveil ance Monthly Report, “Review of the U.S. Military’s Human Immunodeficiency Virus
Program: a Legacy of Progress and Future of Promise,” Vol. 25, No. 9, September 2018, https://go.usa.gov/xmQ6z.
Notes: *Data is through June 30, 2017. Includes active and reserve component members.
https://crsreports.congress.gov

HIV/AIDS in the Military
Retention in Military Service
individuals from entering military service, (2) retain HIV+
DOD policy requires all servicemembers to be tested for
servicemembers if they are fit for duty, and (3) apply the
HIV “every 2 years unless more frequent screenings are
accession, rather than retention, standards to previously
clinically indicated.” Routine HIV screenings are typically
separated and returning (prior service) applicants. DOD
conducted during the periodic health assessment, an annual
argues that servicemembers should be free of medical
evaluation of a servicemember’s medical readiness status.
conditions that may require excessive time lost from duty
Servicemembers testing positive for HIV are referred to
and of contagious diseases that may endanger the health of
appropriate treatment and are required to undergo a medical
other personnel. Others argue that HIV+ individuals who
evaluation of fitness conducted by a medical evaluation
adhere to prescribed treatment can (already) perform the
board (MEB). A MEB reviews the servicemember’s
duties involved with military service without becoming sick
medical condition and ability to perform his/her job, then
or posing a danger to themselves or others.
issues findings and a recommendation on continued
Retention Policy for Non-Deployable Service Members.
military service, such as:
Under DOD’s policy, each military department makes its
 Fit for Duty – member returns to work with no
own determination on servicemember deployability. This
limitations.
creates potential retention disparities among the military
 Limited Duty (LIMDU) – member is placed on a
departments. For instance, certain HIV+ servicemembers
temporary or permanent LIMDU status requiring
have been considered deployable with limitations, while
modifications or restrictions on the scope of work he/she
others have been categorized as non-deployable and
is able to perform.
subsequently separated from military service.
 Not Fit for Duty – member is referred to the physical
Cost/Benefit to Retain HIV+ Servicemembers. There are
evaluation board for further review and determination
certain tangible and intangible costs to recruit, retain,
on continued military service.
separate, and replace servicemembers. Balancing the
Generally, DOD prohibits involuntary separations solely for
cost/benefit of retaining or separating HIV+
being HIV+ and may retain servicemembers if they are able
servicemembers may require DOD to consider additional
to fully perform the duties of their specific occupational
costs for health care, loss of military occupational skills and
specialty. Retained servicemembers are placed in a
experience, personnel replacement, or impacts to military
permanent LIMDU status and may be restricted to certain
capabilities.
duty locations (including overseas) that can medically
support their condition.
Relevant Policies
HIV+ servicemembers remain eligible for certain non-
DOD Instruction 6130.03, “Medical Standards for
combat or non-contingency deployments and must meet the
Appointment, Enlistment, or Induction into the Military
DOD’s retention policy for non-deployable service
Services,” May 6, 2018
members. Implemented in October 2018, the policy
DOD Instruction 6485.01, “Human Immunodeficiency Virus
requires servicemembers who are in a non-deployable
(HIV) in Military Service Members,” June 7, 2013
status for more than 12 consecutive months to be evaluated
DOD Instruction 1332.45, “Retention Determinations for
for retention or be administratively separated from the
Non-Deployable Service Members,” July 30, 2018
military.
HIV/AIDS Prevention and Health Care Services
CRS Products
DOD offers clinically appropriate counseling and treatment
CRS Report R45399, Military Medical Care: Frequently Asked
for HIV/AIDS at certain MTFs or through civilian health
Questions, by Bryce H. P. Mendez
care providers participating in TRICARE. TRICARE
covers only medically necessary and evidence-based
Other Resources
treatments (e.g., antiretroviral therapies approved by the
DOD, “Department of Defense Personnel Policies Regarding
U.S. Food and Drug Administration). Certain
Members of the Armed Forces Infected with Human
contraceptives, pre-exposure prophylaxis (PrEP), and post-
Immunodeficiency Virus: Report to the Committees on the
exposure prophylaxis (PEP) aimed at reducing the risk of
Armed Services of the Senate and House of Representatives,”
contracting HIV, are also available to servicemembers and
August 2018, https://go.usa.gov/xmQMX
other eligible beneficiaries (i.e., family members, retirees).
Defense Health Agency, Medical Surveillance Monthly Report,
Active duty servicemembers incur no out-of-pocket costs
“Review of the U.S. military’s human immunodeficiency virus
for DOD health care services, including HIV treatment.
program: a legacy of progress and a future of promise,” Vol. 24,
Other beneficiaries may be subject to cost-sharing based on
No. 9, p. 2-14, https://go.usa.gov/xmQ6z
their TRICARE health plan, beneficiary category, and type
of medical service received. If a beneficiary receives HIV

treatment that is not directly provided, referred by a DOD
or TRICARE provider, or otherwise covered by DOD, then
Bryce H. P. Mendez, Analyst in Defense Health Care
he/she may be required to pay for those services.
Policy
Considerations for Congress
IF11238
Differences in Accession vs. Retention Standards. DOD
has recently affirmed its policies that (1) prohibit HIV+
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HIV/AIDS in the Military

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