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
CDC. Human T-lymphotropic virus type
III/lymphadenopathy-associated
virus antibody prevalence in U.S. military recruit applicants. MMWR
1986;35:421-4.
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.
CDC. Trends in human immunodeficiency virus infection among
civilian
applicants for military service--United States, October
1985-December
1986. MMWR 1987;36:273-6.
CDC. Human immunodeficiency virus infection in the United
States: a
review of current knowledge. MMWR 1987;36(suppl S-6).
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.
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.
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.
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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