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Current Trends Trends in Human Immunodeficiency Virus Infection HIV among Civilian Applicants for Military Service -- United States, October 1985-March 1988

Since October 1985, the U.S. Department of Defense has routinely tested civilian applicants for military service for serologic evidence of infection with human immunodeficiency virus type 1 (HIV-1).

From October 1985 through March 1988, 1,525,869 recruit applicants were tested; presence of HIV-1 antibody was confirmed by enzyme immunoassay and Western blot in 2152 (1.4 per 1000). During this period, seroprevalence rates based on 6-month intervals decreased from 1.5 to 1.2 per 1000 applicants (Table 1).

Between the first and last intervals, seroprevalence rates showed a statistically significant decrease among male recruit applicants. During the same time period, prevalence of HIV-1 antibody remained unchanged among female applicants (Table 1). Overall, the number of applicants for military service decreased by approximately 12%. Reported by: MR Peterson, LT COL, USAF (BSC), J Bircher, PhD, Office of the Assistant Secretary of Defense (Health Affairs), Washington, DC. AIDS Program, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Applicants for U.S. military service constitute a geographically diverse group of young, apparently healthy persons who are systematically tested for evidence of HIV-1 infection. The interpretation of seroprevalence trends in this group is complicated by two important considerations. First, social and demographic characteristics of military applicants differ from those of the U.S. civilian population in the same age groups. Males and racial and ethnic minorities are overrepresented among applicants, while certain groups at high risk for HIV-1 infection, including homosexual men and intravenous (IV)-drug users, are subject to exclusion from military service. Second, characteristics of the applicant population have probably changed over time because of increased self-deferral of persons who suspect that they have been exposed to HIV-1.

Seroprevalence among military applicants was reported to be stable after the first 6, 15, and 24 months of testing (1-4). However, these data are derived from a series of cross-sectional surveys. Direct measurement of incidence of HIV-1 infection is possible only in cohort studies, which detect new infections in a specified population over time. For example, among several cohorts of homosexual and bisexual men, incidence of HIV-1 infection has decreased (4). For other groups, such as IV-drug users and heterosexually active persons, comparable data are not available.

The apparent decrease in seroprevalence among military recruit applicants is limited to males. This trend probably reflects increasing self-deferral among high-risk males, as well as other factors. The stable seroprevalence rate among female applicants is consistent with the possibility that women may be less aware of their risk for HIV-1 infection and thus less likely to self-defer. Risk factor information for seropositive recruit applicants will assist in interpreting these observations.

The 50% decline in seroprevalence among white males, who constitute nearly two thirds of recruit applicants, dominates the observed trend for all applicants. Because the dynamics of the HIV-1 epidemic differ among demographic subgroups, it is important to monitor subgroup-specific trends in seroprevalence among military applicants (5,6). These data will permit comparisons with those from other screened volunteer populations (e.g., blood donors and Job Corps entrants), as well as from surveys of populations less subject to self-selection biases (e.g., hospital patients and childbearing women) (7,8).

References

  1. CDC. Human T-lymphotropic virus type III/lymphadenopathy-associated virus antibody prevalence in U.S. military recruit applicants. MMWR 1986;35:421-4.

  2. Burke DS, Brundage JF, Herbold JR, et al. Human immunodeficiency virus infections among civilian applicants for United States military service, October 1985 to March 1986: demographic factors associated with seropositivity. N Engl J Med 1987;317:131-6.

  3. CDC. Trends in human immunodeficiency virus infection among civilian applicants for military service--United States, October 1985-December 1986. MMWR 1987;36:273-6.

  4. CDC. Human immunodeficiency virus infection in the United States: a review of current knowledge. MMWR 1987;36(suppl S-6).

  5. Brundage JF, Burke DS, Gardner LI, Visintine R, Peterson M, Redfield RR. HIV infection among young adults in the New York City area: prevalence and incidence estimates based on antibody screening among civilian applicants for military service. NY State J Med 1988; 88:232-5.

  6. Gardner LI, Brundage J, McNeil J, Burke D, Miller R. Race specific trend analyses of HIV antibody prevalence in the United States (Abstract). IV International Conference on AIDS. Book 2. Stockholm, June 12-16, 1988:221.

  7. CDC. Quarterly report to the Domestic Policy Council on the prevalence and rate of spread of HIV and AIDS in the United States. MMWR 1988;37:223-6.

  8. Hoff R, Berardi VP, Weiblen BJ, Mahoney-Trout L, Mitchell ML, Grady GF. Seroprevalence of human immunodeficiency virus among childbearing women: estimation by testing samples of blood from newborns. N Engl J Med 1988;318:525-30.



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