By Matthew M. Burke
Stars and Stripes
Published: May 22, 2013
SASEBO NAVAL BASE, Japan — More than nine months have passed since the Navy decided to open up overseas and large-ship platform assignments to HIV-positive sailors and Marines, but not a single sailor has gotten such a posting.
The Navy’s Personnel Command is grappling with how to implement the instruction, which also covers blood-borne pathogens like hepatitis B and C.
Secretary of the Navy Ray Mabus handed down the policy in August 2012.
Personnel Command officials declined to comment on when the policy would actually take effect. Instructions can take time to implement, Personnel Command spokesman Lt. Cmdr. Rob Lyon told Stars and Stripes in an email.
“Navy Personnel Command recently completed a review of SECNAVINST 5300.30E, dealing with blood-borne pathogens, to ensure sailors affected will have the greatest opportunity to be successful, and any concerns by their receiving commands will be addressed,” Lyon said. “We will more than likely have more to discuss once the Milpersman article (implementation guidance) has been chopped by all parties.”
The policy effectively opened the assignments to HIV-positive sailors and Marines who are stable and have undetectable viral loads, which translates into minimal medical complications, Bureau of Medicine and Surgery spokeswoman Shoshona Pilip-Florea told Stars and Stripes in December.
The change was made possible because of medical advances that allow someone who contracts the Human Immunodeficiency Virus to live 20-30 years without adverse health effects with as little as one pill per day.
The implementation guidance gives medical personnel, detailers and receiving commanders a veto power for each request “based on the medical risks and needs of the Navy,” depending on whether the command in question could “support care,” Pilip-Florea said.Prospective recruits are still precluded from joining the services if they have the virus.
“The policy change better aligns the treatment of HIV with how other chronic illnesses are managed by Navy Medicine,” Pilip-Florea said. “In the case of HIV-positive servicemembers, these personnel and the services have put a lot of time and effort into their careers, and there is no medical reason for them not to be able to continue serving with pride.”
Pilip-Florea said the biggest change from the previous policy for HIV-positive sailors and Marines comes in added flexibility to case management. Those servicemembers would no longer be bound to stateside medical facilities and rules that dictated the frequency of clinical evaluations.
“The frequency of clinical evaluations for HIV-infected military personnel shall be determined by the member’s health status and by nationally accepted guidelines,” the instruction reads. “On a case-by-case basis, follow-up HIV evaluations may be performed at smaller naval medical treatment facilities with the results of those appointments being reported for tracking purposes.”
Pilip-Florea said Navy Medicine does not track cost data for specific conditions or long-term chronic illnesses so treatment costs — stateside versus overseas — are not known.
The Navy policy is unique, officials from the other service branches said.
The Army prohibits HIV-positive soldiers from being deployed or assigned overseas, according to Col. Andrew Wiesen, Western Region Medical Center’s chief of preventive medicine and the Army Surgeon General’s preventive medicine consultant. Any soldier found to be HIV positive while overseas will be reassigned stateside.
There are numerous reasons for the Army’s policy, including host-nation restrictions, the incompatibility of medical treatment and supply of medications with deployment, and protection of the blood supply, Wiesen said. Soldiers are often asked to donate blood in emergencies, and testing is not always reliable or complete in a deployed setting.
The Air Force also limits HIV-positive airmen to stateside assignments, according to spokeswoman Donna Tinsley. However, active-duty airmen can apply for a waiver if the receiving unit can provide the needed care.
“Essentially if the OCONUS (outside the continental United States) base is in need of the position and willing to take on the member and can provide adequate care, then it’s more likely to get accepted,” she said.
However, waivers are frowned upon, Air Force officials said. HIV-positive airmen are prohibited from donating blood.
“A major concern regarding deployment would be blood donation,” Air Force Capt. Candice Ismirle said. “Refusal to do so in cases of mass casualties, etc., will cause other members to question why and may make it difficult for the patient to keep their diagnosis confidential. Also, if there was pressure to donate blood and the patient did so, there could be HIV transmission in the deployed setting.”
Ismirle said all deploying airmen must be free of medical conditions that require special appliances, frequent treatment or follow-up by medical specialists or sub-specialists. The virus is disqualifying and requires a waiver to remain on flying status.
The Navy addressed the issue as HIV rates have risen steadily over much of the U.S. military in recent years. The Navy began testing for HIV antibodies in 1985.
The Navy found 128 HIV-positive sailors in 1992 and 315 in 2012, including 250 on active duty, Pilip-Florea said.
The Marine Corps had 90 HIV-positive Marines in 2012 — 71 on active duty — and the Air Force had 210 on active duty, officials said.
The Army could not provide up-to-date figures due to a transition between who keeps the figures, spokeswoman Margaret Tippy said. However, in 2008 there were more diagnoses than in any year since 1995, according to an Armed Forces Health Surveillance Center report from August.
Rates have remained high, the report said. In 2012, there were 333 active-duty HIV-positive soldiers.
OutServe, an association of active LGBT military personnel, declined to comment when reached by Stars and Stripes on Monday. The group applauded the effort when it was announced last year.
For more information, see the Secretary of the Navy instruction at http://doni.daps.dla.mil/Directives/05000%20General%20Management%20Security%20and%20Safety%20Services/05-300%20Manpower%20Personnel%20Support/5300.30E.pdf.
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