Annotated Bib, post 3

Hannah, William N., Shilpa Hakre, Peter Dawson, Hao Wu, Sheila A. Peel, Nelson L. Michael, Paul T. Scott, and Jason F. Okulicz. “Clinical Indicators Associated with HIV Acquisition in the United States Air Force.” AIDS Care 29, no. 6 (June 2017): 724–28.





Development of a successful HIV-1 prevention program depends on the identification of HIV risk factors and testing of at-risk individuals to reduce HIV acquisition and sharing. The United States Air Force (USAF) has mandated HIV testing for active duty members about every 2 days. About one-third of those infected with HIV are unaware of their harboring of the virus. Early detection can be difficult because there are several risk factors, such as intravenous drug use (IDU) and illicit substance abuse. By mandated screening, about 75% of incident cases in the USAF allow disruption in forward HIV transmission.


The USAF conducts HIV screenings every 2 years and for peri-deployment. In this source’s study, the study population consisted of active duty USAF members at any time during January 1996 and December 2011 with available demographic information. All persons with a new HIV diagnosis during the study were considered cases. Individuals were matched into controls by age, length of service, sex, race, branch, service component (active duty, National Guard, or Reserve), and HIV test collection date.


462 total cases of HIV were identified among USAF personnel that served actively during January 1996 and December 2011. Because of the small numbers, the 10 female cases were removed. In unadjusted analyses within the last two years before HIV diagnosis, having clinical signs and symptoms of HIV infection, having a clinical syndrome consistent with HIV clinical history of a mental health disorder, or history of a STI had significantly higher odds of HIV infection. Five indicators had notably higher odds of HIV infection: having signs of HIV infection, clinical syndrome consistent with HIV infection, a clinical syndrome consistent with HIV, more frequent medical encounters, clinical history of a mental health disorder and history of a STI. This source recommends that the USAF screen those with HIV indicators more than the mandated screenings. Numerous studies have proven that the association “between HIV infection and serious mental health illness, and the prevalence rate of HIV infection in patients with serious mental illness is higher than expected in the general population for the same demographic area.” Severe mental illness in the military, however, undergoes an in-depth evaluation that ultimately leads to discharge. “The results of this study suggest that less debilitating forms of mental illness, such as depression, adjustment reactions, and anxiety may also play a contributory role in HIV acquisition in the active duty population.” This source also suggests that those with mental illness are likely to have riskier sexual behavior (including lack of condom with the same sex) and alcohol and drug use.


Final Thoughts

The goal of the study was to “identify and assess clinical indicators associated with HIV infection in the USAF.” It also suggests, based on findings, that the USAF should consider an increase of HIV testing for persons at risk, which would be GB men, relating this back to the first annotation. This source offered a different, more specific side of the HIV scenario in the military. This source focuses on the USAF, but it also surprised me that this branch had mandatory HIV screenings.


The source identifies its own limitations, indicating that the study included exclusive use of ICD-9 diagnosis codes which weren’t available the entire study period. Many of the diagnoses also lacked specificity. Politically, this testing of HIV is mandated through the USAF, but socially this source provides a glimpse at the indicators that relate to higher odds of HIV acquisition.



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