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DoD's international HIV/AIDS prevention program saves lives, builds lasting relationships

Air Force Capt. Crystal Karahan, U.S. Air Forces in Europe, Air Forces Africa international health specialist, talks to Cameroonian nursing students during a clean site delivery workshop in Douala, Cameroon. (Courtesy photo) Air Force Capt. Crystal Karahan, U.S. Air Forces in Europe, Air Forces Africa international health specialist, talks to Cameroonian nursing students during a clean site delivery workshop in Douala, Cameroon. (Courtesy photo)

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Navy Capt. Gregg Montalto remembers the first time he met the young Ugandan teenager a couple of years ago sitting across the table. The boy was HIV positive with AIDS.

“He’s a pretty shy kid,” said Montalto, a pediatrician now stationed at Naval Medical Center San Diego. He met the boy through DHAPP, the Department of Defense HIV/AIDS Prevention Program. DHAPP is the DoD’s implementing arm of the President’s Emergency Plan for AIDS Relief, also known as PEPFAR, which is the largest commitment by any nation in history to combat a single disease.

“We talked a little bit, and I learned he was severely underweight at just 38 kilograms [about 83 pounds] and orphaned,” said Montalto. He recalled that the boy’s CD4 count, the amount of HIV virus-killing cells in the body, read just four. Anything below 200 means the AIDS virus is allowing other infections to attack the body.

The Department of Defense recognizes World AIDS Day Dec. 1 as a time to commemorate not just this Ugandan teenager but the millions of lives that have been impacted by HIV/AIDS in the last 35 years. It is an epidemic that continues to infect more than 37,000 people globally every week, and threatens the health and prosperity of families and communities.

According to the Centers for Disease Control and Prevention, an estimated 35 million people worldwide live with HIV/AIDS; more than two-thirds are in Sub-Saharan Africa. Nearly 75 percent of the 2.1 million new HIV infections in 2013 occurred in this area. The Navy was previously the Department of Defense executive agent for DHAPP, which includes Army, Navy, and Air Force medical assets. Recently, DHAPP transitioned to the Defense Health Agency for oversight.

“We identify partner militaries and approach their medical folks,” said Richard Shaffer, DHAPP’s division chief and an epidemiologist. “We ask if there’s anything the U.S. military can help with when it comes to their medical programs that support their military members and family members with HIV.”

DHAPP collaborates with partner militaries to plan activities and implement programs to combat HIV/AIDS in their military services. Through direct military-to-military cooperation, its goal is to maximize program impact by focusing on the HIV epidemic specific to the partner military. DHAPP’s support includes training health care workers to provide HIV clinical services and implementing testing strategies, such as the use of mobile testing units, to reach individuals most at-risk. It also helps equip laboratories and clinics for testing and diagnostics, links HIV-positive individuals into treatment, promotes health education, and provides training against stigma and discrimination.

Fifteen years after its inception, DHAPP’s partnership with 57 other countries’ militaries, mostly in Africa, works to help lower the incidence of HIV and AIDS in those countries. Shaffer said not only does the program make a difference for the people living in those countries; it benefits American troops who may one day operate in those areas.

“Any time we can develop capable partners, it takes a health care burden off our U.S. military,” he said, adding that medical aid is a great foot in the door to help develop deeper relationships with other militaries and the larger civilian population.

In addition, American military doctors get to see other diseases firsthand they might have only read about. “We’ve got people who have learned about yellow fever in the United States through medical school, but never saw a case until they went with us to southern Africa to work on an HIV program,” said Shaffer. “Our medical departments are getting more experience than what they did before DHAPP.”

Moving responsibility of DHAPP to the Defense Health Agency gives the program a more defined DoD-wide role, said Shaffer. “There are so many organizational benefits I see coming out of this. We already had a good relationship with the combatant commands, and being part of the Defense Health Agency will help to improve that relationship. This transition gives us the ability to engage more at the military Joint Staff and interagency levels.”

Montalto recently saw the Ugandan boy again. He had gained about 45 pounds in two years, and his CD4 count was at about 300-400, meaning his immune system was far better equipped to keep him healthy. The captain said the youth had improved in part because he was taking better care of himself, when many in that condition might have just given up.

“I asked him what motivated him to take care of himself,” said Montalto. “He said, ‘I looked around and saw a lot of other kids who were having problems, and I wanted to help other people. The only way to do that is by helping myself.’”

Helping people who help themselves and improving HIV outcomes is what DHAPP is all about. Montalto waved off any credit he may have had in the process, crediting the local doctors for making DHAPP a success, especially in parts of Africa where it’s still a big issue despite gains made since HIV/AIDS was at extreme epidemic levels in the 1990s.

“The members of the team in the HIV treatment clinic in Uganda are the ones doing the heavy lifting,” said Montalto. “They sit down with these kids and talk. The team we send from San Diego brings a concept of adolescent health to the clinicians already on the ground there.”

Montalto encouraged other military doctors and other health care providers to get involved in DHAPP by contacting the program. Then DHAPP can assess skills and match the provider to a program area or country where the skill set can be best utilized.

“You never want to go somewhere, take a few pictures, feel good about yourself, and never show up again,” said Montalto, who wants the program to continue until AIDS is eradicated.

“The reason programs such as DHAPP work is not because the people in it come and go,” he said. “They bring hope and stay.”

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