Epidemiology of HIV among US Air Force Military Personnel, 1996-2011

OBJECTIVE:

The objectives of this study were to describe the epidemiology of HIV in the United States Air Force (USAF) from 1996 through 2011 and to assess whether socio-demographic characteristics and service-related mobility, including military deployments, were associated with HIV infection.

METHODS:

We conducted a retrospective cohort analysis of USAF personnel who were HIV-infected during the study period January 1, 1996 through December 31, 2011 and a matched case-control study. Cases were USAF personnel newly-diagnosed with HIV during the study period. Five randomly-selected HIV-uninfected controls were matched to each case by age, length of service, sex, race, service, component, and HIV test collection date. Socio-demographic and service-related mobility factors and HIV diagnosis were assessed using conditional logistic regression.

RESULTS:

During the study period, the USAF had 541 newly diagnosed HIV-infected cases. HIV incidence rate (per 100,000 person-years) among 473 active duty members was highest in 2007 (16.78), among black/ African-American USAF members (26.60) and those aged 25 to 29 years (10.84). In unadjusted analysis restricted to personnel on active duty, 10 characteristics were identified and considered for final multivariate analysis. Of these single (adjusted odds ratio [aOR], 8.15, 95% confidence interval [CI] 5.71-11.6) or other marital status (aOR 4.60, 95% CI 2.72-7.75), communications/ intelligence (aOR 2.57, 95% CI 1.84-3.60) or healthcare (aOR 2.07, 95% CI 1.28-3.35) occupations, and having no deployment in the past 2 years before diagnosis (aOR 2.02, 95% CI 1.47-2.78) conferred higher odds of HIV infection in adjusted analysis.

CONCLUSION:

The highest risk of HIV infection in the USAF was among young unmarried deployment-naïve males, especially those in higher risk occupation groups. In an era when worldwide military operations have increased, these analyses identified potential areas where targeted HIV prevention efforts may be beneficial in reducing HIV incidence in the USAF military population.

Below:  Incidence rates of new HIV diagnoses (and 95% confidence intervals) among active duty Air Force personnel, 1996–2011

Socio-demographic factors of HIV-infected and matched HIV-uninfected United States Air Force active duty personnel, 1996–2011.

Characteristic	Cases(n = 473)	Controls(n = 2315)	Unadjusted Odds Ratio	95% Confidence Interval	P-Value
Marital status*
Married	94	1297	Referent	-	-
Other	46	142	4.21	(2.78–6.38)	<0.0001
Single, never married	333	873	9.76	(7.20–13.2)	<0.0001
Missing	0	3	-	-	-
Highest education attained					0.0074
Bachelors or higher	59	401	Referent	-	-
Some college or less	412	1890	1.71	(1.23–2.38)	0.0013
Missing	2	24	-	-	-
Occupation* *
Communications/ Intelligence	170	494	2.84	(2.14–3.76)	<0.0001
Engineer/ Mechanic/ Repair	94	757	Referent	-	-
Healthcare	48	170	2.20	(1.47–3.29)	0.0001
Other	146	742	1.57	(1.16–2.14)	0.0036
Pilot/ aircrew	15	152	0.73	(0.41–1.31)	0.2875
Rank
Enlisted	430	1982	1.95	(1.36,2.80)	0.0003
Officer	43	333	Referent	-	-
Home of Record^
Continental US	304	1405	Referent	-	-
Other/ unknown	76	318	0.87	(0.59,1.30)	0.5055
Missing	93	592	-	-	-

*Other marital status included individuals who reported that they were neither married nor single on their personnel records.

**The occupation category, engineer, included non-combat engineer; ‘Other’ occupations included infantry/ combat engineer/ Special Forces/ artillery/ armor/ motor transport/ administration and other categories.^A service member’s residence at the time of entrance to the US military.

Full article at:   http://goo.gl/fdcmcx

By:  Hakre S1, Mydlarz DG2, Dawson P3, Danaher PJ4, Gould PL5, Witkop CT5, Michael NL6, Peel SA7, Scott PT6, Okulicz JF4.

• 1United States Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America.
• 2Preventive and Occupational Medicine Branch, National Guard Bureau, Arlington, Virginia, United States of America.
• 3Biostatistics, The EMMES Corporation, Rockville, Maryland, United States of America.
• 4Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas, United States of America.
• 5Air Force Medical Support Agency, Defense Health Headquarters, Falls Church, Virginia, United States of America.
• 6United States Military HIV Research Program, Walter Reed Army Institute of Research, Bethesda, Maryland, United States of America.
• 7HIV Diagnostics and Reference Laboratory, United States Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America. 

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