HIV Preexposure Prophylaxis in the U.S. Military Services - 2014-2016

Abstract

Human immunodeficiency virus (HIV) infection is a substantial health concern for the U.S. Department of Defense (DoD) and for service members stationed throughout the world. Each year, approximately 350 new HIV infections are diagnosed in members of the U.S. military services, with most infections acquired within the United States (1). The DoD populations most affected by HIV mirror those in the U.S. civilian population; the highest rates of new military diagnoses are in men and blacks or African Americans (blacks) (1). Blacks are disproportionally affected, and most new diagnoses occur among men who have sex with men (MSM). HIV preexposure prophylaxis (PrEP) is approximately 90% effective in preventing HIV infection when used properly (2), and an increasing number of active duty personnel have used HIV prevention services and PrEP in the military health system since the repeal of "Don't Ask, Don't Tell"* in 2011 (3). Military health system and service records were reviewed to describe HIV PrEP use among military personnel, and military health care providers were surveyed to assess HIV PrEP knowledge and attitudes. Among 769 service members prescribed PrEP during February 1, 2014-June 10, 2016, 60% received prescriptions from an infectious disease provider, 19% were black men, and 42% were aged >28 years. Half of surveyed military health care providers self-rated their PrEP knowledge as poor. DoD is developing new policy to address access to care challenges by defining requirements and establishing pathways for universal patient access to PrEP.

FIGURE 1

Number of military service members who initiated human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) among U.S. military personnel on active service who did not have HIV infection, by month — 2014–2016 * Any patient without HIV infection who received an initial prescription for Truvada paid by the U.S. Department of Defense during February 1, 2014–June 10, 2016 was considered to have received HIV PrEP.

FIGURE 2

Number of military service members who initiated human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) among U.S. military personnel on active service who did not have HIV infection, by location of duty and prescribing clinic type — 2014–2016 * Any patient without HIV infection who received an initial prescription for Truvada paid by the U.S. Department of Defense during February 1, 2014–June 10, 2016 was considered to have received HIV PrEP.