What are the new findings ?

From January 2023 through June 2024, approximately 1.8 million service members (active component, Guard, and reserve) were tested for antibodies to HIV, and 403 (0.22 per 1,000 tested) were identified as HIV-antibody positive. Of the 403 new HIV infections that were identified during this period, only 10 (2.5%) were among female service members.

What is the impact on readiness and force health protection?

The HIV-antibody seropositivity rates first reported in MSMR three decades ago remain comparable to rates presented in 2023, under scoring a continued value of HIV testing programs. The cost-effectiveness of HIV testing strategies, differentiated by universal or indications-based testing following military accession, may be instructive to further understand the value of current screening efforts in different clinical settings.

Background

The U.S. Department of Defense has conducted an active surveillance program for HIV since 1986, when reliable screening methods became widely available. This program consists of screening all service members at specific points in time: prior to entry (all accessions must be HIV-negative prior to the start of service), before deployment or any change in status (e.g., change in component, between branches, or commissioning), and once every two years while a member of the U.S. military.¹

While infection with HIV currently disqualifies applicants for entry into U.S. military service, this policy may be affected by a recent federal court ruling that the DOD cannot ban HIV-positive people with undetectable viral loads from joining the military.² Due to significant advances in the diagnosis, treatment, and prevention of HIV, in June 2022 the DOD amended policies to prevent HIV-positive service members with an undetectable viral load from being discharged or separated solely on the basis of their HIV status.¹ In addition, HIV-positive personnel are not non-deployable solely for a positive status; decisions related to deployability should be made on a case-by-case basis and must be justified by a service member’s inability to perform the duties to which he or she would be assigned.³

Summaries of HIV seropositivity for members of the U.S. military have been published with MSMR since 1995. The current report summarizes numbers and trends of newly identified HIV-antibody seropositivity from January 1, 2019 through June 30, 2024 among military members of five services under the active and reserve components of the U.S. Armed Forces, in addition to the Army and Air Force National Guard.

Methods

The surveillance population included all individuals eligible for HIV antibody screening from January 1, 2019 through June 30, 2024 while serving in the active or reserve components of the U.S. Army, Navy, Air Force, Marine Corps, or Coast Guard. Space Force service members were categorized as Air Force for this analysis. All individuals who were tested, and all initial detections of antibodies to HIV, through U.S. military medical testing programs were ascertained from the Department of Defense Serum Repository specimens accessioned to the Defense Medical Surveillance System. Due to changes in data processing, positive specimens for Navy and Marine Corps service members are no longer accessioned in DODSR and DMSS. To account for this limitation, data for the Navy and Marine Corps were obtained from the Navy Bloodborne Infection Management Center; the total number of HIV infections from 2022 through June 30, 2024 were ascertained from the Navy’s HIV Management System and NBMIC end-of-year reports.

An incident case of HIV-antibody seropositivity was defined as an individual with positive HIV test results on two different, serial specimens. Individuals who had just one positive result without a subsequent negative result were also defined as positive, to capture those who had yet to test positive for a second time.

Non-positive HIV samples from Navy service members remain documented in DODSR and accessioned through DMSS; thus, the total number of HIV-positive tests were acquired from DMSS to calculate seropositivity rates as a standardized methodology for all services. Annual rates of HIV seropositivity among service members were calculated by dividing the number of incident cases of HIV antibody seropositivity during each calendar year by the number of individuals who were tested at least once during the relevant calendar year. Rates were further stratified by service, component, and sex.

Results

From January 2023 through June 2024, approximately 1.8 million U.S. service members (of the active component, Guard, and reserve) were tested for antibodies to HIV, and of those individuals tested, 403 (0.22 per 1,000) were identified as HIV-antibody positive. Of the 403 new HIV infections identified during this period, only 10 (2.5%) occurred in female service members.

U.S. Army

Active component

From January 2023 through June 2024, a total of 458,315 U.S. Army active component soldiers were tested for HIV antibodies, and 97 were identified as HIV-antibody positive (seropositivity: 0.21 per 1,000 tested) (Table 1). During the surveillance period, annual seropositivity rates fluctuated between a low of 0.11 per 1,000 tested in 2024 (through June) and a high of 0.28 per 1,000 tested in 2021 (Table 1, Figure 1).

Annual seropositivity rates for male active component soldiers were considerably higher than those of female active component soldiers (Figure 1). In 2023, one new HIV infection on average was detected among active component soldiers per 4,682 screening tests (Table 1). Of the 401 active component soldiers diagnosed with HIV infections since 2019, a total of 250 (62.3%) were still in military service in 2024.

Army National Guard

From January 2023 through June 2024, a total of 283,865 U.S. Army National Guard members were tested for HIV antibodies, and 84 soldiers were identified as HIV-antibody positive (seropositivity: 0.30 per 1,000 tested) (Table 2). On average, one new HIV infection was detected in 2023 among Army National Guard soldiers per 4,466 screening tests. Of the 294 National Guard soldiers who tested positive for HIV since 2019, a total of 201 (68.4%) were still in service in 2024.

Army Reserve

From January 2023 through June 2024, a total of 111,713 U.S. Army Reserve members were tested for HIV antibodies, and 39 were identified as HIV-antibody positive (seropositivity: 0.35 per 1,000 tested) (Table 3). During 2023, on average one new HIV infection was detected among Army reservists per 3,308 screening tests. Of the 168 Army reservists diagnosed with HIV infections since 2019, a total of 107 (63.7%) were still in service in 2024.

U.S. Navy

Active component

A total of 286,804 members of the U.S. Navy active component were tested for HIV antibodies from January 2023 through June 2024, and 83 sailors were identified as HIV-antibody positive (seropositivity: 0.29 per 1,000 tested) (Table 4). During the surveillance period, annual seropositivity rates fluctuated between a low of 0.16 per 1,000 tested in 2020 and a high of 0.31 per 1,000 tested in 2022 (Table 4, Figure 2). Annual seropositivity rates for male active component sailors were considerably higher than those of female active component soldiers (Figure 2).

During 2023, on average, one new HIV infection was detected among active component sailors per 3,983 screening tests. Of the 283 active component sailors diagnosed with HIV infections since 2019, a total of 208 (73.5%) were still in service in 2024.

Navy Reserve

From January 2023 through June 2024, a total of 44,375 members of the U.S. Navy Reserve were tested for HIV antibodies, and 6 sailors were identified as HIV-antibody positive (seropositivity: 0.14 per 1,000 tested) (Table 5). On average, one new HIV infection was detected in 2023 among Navy reservists per 10,879 screening tests. Of the 38 reserve component sailors diagnosed with HIV infections since 2019, a total of 25 (65.8%) were still in military service in 2024.

U.S. Air Force

Active component

From January 2023 through June 2024, a total of 282,636 active component members of the U.S. Air Force were tested for HIV antibodies, and 39 Air Force members were diagnosed with HIV infection (seropositivity: 0.14 per 1,000 tested) (Table 6). On average, one new HIV infection was detected in 2023 among active component Air Force members per 8,595 screening tests. Of the 152 active component Air Force members diagnosed with HIV infections since 2019, 101 (66.4%) were still in military service in 2024. During the surveillance period, seropositivity rates among male members ranged from a low of 0.11 per 1,000 tested in 2020 to a high of 0.22 per 1,000 tested in 2022 (Figure 3).

Air National Guard

From January 2023 through June 2024, a total of 84,470 members of the Air National Guard were tested for HIV antibodies, and 8 Air National Guard members were diagnosed with HIV infection (seropositivity: 0.09 per 1,000 airmen tested) (Table 7). During 2023, on average one new HIV infection was detected among Air National Guard members per 14,137 screening tests. Of the 32 Air National Guard members diagnosed with HIV infections since 2019, 25 (78.1%) were still in service in 2024.

Air Force Reserve

From January 2023 through June 2024, a total of 49,078 members of the Air Force Reserve were tested for HIV antibodies, and 6 Air Force reservists were diagnosed with HIV infections (seropositivity: 0.12 per 1,000 tested) (Table 8). On average, in 2023 one new HIV infection was detected among Air Force reservists per 9,725 screening tests. Of the 38 reservists in the Air Force diagnosed with HIV infections since 2019, 28 (73.7%) were still in military service in 2024.

U.S. Marine Corps

Active component

From January 2023 through June 2024, a total of 161,928 U.S. Marine Corps active component members were tested for HIV antibodies, and 32 were identified as HIV-antibody positive (seropositivity: 0.20 per 1,000 tested) (Table 9). Annual seropositivity rates rose from a low of 0.12 per 1,000 tested in 2021 and a high of 0.26 per 1,000 tested at mid-year 2024 (Table 9, Figure 4).

In 2023, on average, one new HIV infection per 6,820 screening tests was detected among active component marines. Of the 102 active component marines diagnosed with HIV infections since 2019, a total of 54 (52.9%) were still in service in 2024.

Marine Corps Reserve

From January 2023 through June 2024, a total of 29,271 Marine Corps Reserve members were tested for antibodies to HIV, and eight reservists were identified as HIV-antibody positive (seropositivity: 0.27 per 1,000 tested) (Table 10). During 2023, on average, one new HIV infection was detected among Marine Corps reservists per 7,192 screening tests. All eight reservists diagnosed with HIV infection since 2023 were still in military service in 2024.

U.S. Coast Guard

Active component

From January 2023 through June 2024, a total of 27,709 U.S. Coast Guard active component members were tested for antibodies to HIV, and one was identified as HIV-antibody positive (Table 11). Of the five active component Coast Guardsmen diagnosed with HIV infections since 2019, a total of three (60.0%) were still in service in 2024.

Coast Guard Reserve

From January 2023 through June 2024, a total of 4,448 U.S. Coast Guard Reserve members were tested for HIV antibodies, with none identified as HIV-antibody positive (Table 12).

Discussion

The U.S. military has conducted routine screening for antibodies to HIV among all civilian applicants for service and all service members for more than 30 years.^4-7 In 1995 the U.S. Army tested approximately 1.1 million specimens a year, demonstrating an economically efficient, large-scale model for HIV testing.⁸ The first MSMR article to publish results from HIV screening programs indicates that antibody seropositivity rates in 1994 for the Army active duty (0.19 per 1,000 soldiers) and reserve component (0.23 per 1,000 soldiers) remain comparable to rates presented in 2023.⁹ Three decades later, this comparison underscores a continued value of HIV testing programs. The cost-effectiveness of HIV testing strategies, delineated by universal or indications-based testing after entry into the military, may be instructive to understand the value of current screening efforts in different clinical settings.

Archived surveillance data also reflect improved retention of HIV-positive service members, in alignment with recent DOD policy that recognizes significant advances in the diagnosis, prevention, and treatment of the disease. From 1990 to 1994, a total of 889 active and reserve component soldiers were diagnosed with HIV-1 infection. By 1995, only 234 (26.0%) were still in service.⁹ Today, a comparative retention figure for active component Army service members has increased to 62.3% (250 of 401 soldiers diagnosed since 2019 are still in service as of 2024). Retention of HIV-positive service members differs by component and service branch, with highest retention demonstrated for the Air Force National Guard (78.1%), Air Force Reserve (73.7%), and active component Navy (73.5%); however, these figures are not adjusted for overall retention differences across the force.

The most recent active component Army results indicate a substantial decline of new HIV infections as of June 2024, dropping from 0.26 per 1,000 soldiers in 2023 to 0.11 per 1,000 soldiers as of mid-year 2024. An inverse trend was observed for the active component Marines, doubling between 2021 and mid-year 2024 (from 0.12 per 1,000 marines to 0.26 per 1,000 marines). For both services, the mid-year 2024 HIV seropositivity rates were higher for the Army Reserve/National Guard and Marine Corps Reserves in comparison to the respective active component.

Routine screening of all civilian applicants for service and routine periodic testing of all active and reserve component members of the services have been fundamental components of the military’s HIV control and clinical management efforts.¹⁰ Previous MSMR reports presented HIV screening results for civilian applicants to the military service; however, these data are no longer available in the Defense Medical Surveillance System, as the U.S. Military Entrance Processing Command stopped reporting data to the DMSS at the end of calendar year 2020. Thus, the data presented in this report reflect service members who had a negative HIV test upon entry to military service, followed by a positive test during uniformed service.

The results presented in this report should not be generalized to the U.S. population. Data from HIV screening in U.S. military populations are based on a negative test prior to entry, as well as voluntary service. In countries with universal conscription, compulsory testing in samples of military recruits will be more representative of the young adult population.¹⁰ Following pre-accession screening of military recruits, routine screening represents relatively recently acquired HIV infections (i.e., infections acquired since the most recent negative test of each affected individual).

Acknowledgments

We would like to thank Julia Wolfrey and Vanessa Santiago-Miranda with the Navy Bloodborne Infection Management Center for providing Navy and Marine Corps HIV infection summary data presented in this report.

References

1. U.S. Department of Defense. Department of Defense Instruction 6485.01: Human Immunodeficiency Virus (HIV) in Military Service Members. Updated Jun. 6, 2022. Accessed Oct. 17, 2024. https://www.esd.whs.mil/portals/54/documents/dd/issuances/dodi/648501p.pdf 
2. Kime P. Federal judge rules Defense Department can't ban HIV-positive people from joining the military. Military.com. Updated Aug. 23, 2024. Accessed Sep. 13, 2024. https://www.military.com/daily-news/2024/08/23/military-cant-keep-hiv-positive-americans-enlisting-federal-judge-rules.html   
3. The Secretary of Defense. Secretary of Defense Memorandum for Senior Pentagon Leadership, Commanders of the Combatant Commands, Defense Agency and DOD Field Activity Directors: Policy Regarding Human Immunodeficiency Virus-Positive Personnel Within the Armed Forces. U.S. Dept. of Defense. Jun. 6, 2022. Accessed Oct. 17, 2024. https://media.defense.gov/2022/jun/07/2003013398/-1/-1/1/policy-regarding-human-immunodeficiency-virus-positive-personnel-within-the-armed-forces.pdf 
4. Brown AE, Brundage JF, Tomlinson JP, Burke DS. The U.S. Army HIV testing program: the first decade. Mil Med. 1996;161(2):117-122. 
5. Armed Forces Epidemiological Board. Testing Interval for Human Immunodeficiency Virus (HIV-1) Infection in Military Personnel–2003-05. U.S. Dept. of Defense. Updated Mar. 29, 2004. Accessed Oct. 17, 2024. https://www.health.mil/reference-center/policies/2004/03/29/policy-memorandum---human-immunodeficiency-virus-interval-testing   
6. Office of the Under Secretary of Defense for Personnel and Readiness. Department of Defense Instruction 6485.01: Human Immunodeficiency Virus (HIV) in Military Service Members. U.S. Dept. of Defense. Updated Jun. 6, 2022. Accessed Oct. 17, 2024. https://www.esd.whs.mil/portals/54/documents/dd/issuances/dodi/648501p.pdf   
7. Office of the Under Secretary of Defense for Personnel and Readiness. DoD Instruction 6130.03, Volume 1: Medical Standards for Appointment, Enlistment, or Induction. U.S. Dept. of Defense. Updated May 28, 2024. Accessed Oct. 17, 2024. https://www.esd.whs.mil/portals/54/documents/dd/issuances/dodi/613003_vol01.pdf?ver=b0uhh9e1k_mdtz4punu8aw%3d%3d 
8. Brown AE, Burke DS. The cost of HIV testing in the U.S. Army. NEJM. 1995;332(14):963. 
9. Army Medical Surveillance Activity. Supplement: HIV-1 in the Army. MSMR. 1995;1(3):12-15. 
10. Okulicz JF, Beckett CG, Blaylock JM, et al. Review of the U.S. military’s human immunodeficiency virus program: a legacy of progress and a future of promise. MSMR. 2017;24(9):2-7.