Navy HIV infections, already high, continue to rise

PORTSMOUTH

The good news: The virus that causes AIDS is more treatable than ever - and with treatment, individuals infected with HIV can live into old age.

The bad news: The Navy's HIV infection rate has been rising for a decade and is significantly higher than any other military branch. In 2008, the Navy discovered 36 HIV cases for every 100,000 sailors tested - more than double its 1999 numbers.

Officials say they don't know why the Navy's rate is on the rise.

Dr. Rick Shaffer, a retired Navy physician who heads the Department of Defense's HIV/AIDS effort in San Diego, said military

personnel are less scared about HIV now than they were at the height of the AIDS crisis in the 1980s.

Their attitude reflects that of society at large. If people are less fearful of contracting the disease, or more confident it can be controlled, Shaffer said, they may be less inclined to use condoms.

One thing is certain, though: Military personnel with HIV have access to individualized, long-term care that often lasts well beyond retirement.

The Navy says it does not calculate the cost of treating HIV-positive sailors. However, it has cited a study that estimates the cost of a year's care at $14,000 to $37,000. So in 2008, caring for about 560 infected sailors, the Navy likely spent $7.8 million to $20. 7 million.

There are also career implications for the sailors. Once diagnosed, they can't serve on sea duty or be stationed overseas.

Defense and Navy medical experts can't say why the gap is widening between the Navy and the other services. They do know that military members acquire the virus predominantly through sexual contact, not intravenous drug use.

It's difficult to compare military infection rates with the general population, because only a small portion of the public is tested for the virus.

Condom use is a closely studied factor in the military.

According to Pentagon statistics, condom use is on the rise across the military and hovers around 50 percent.

A 2005 survey found that just under half of all sexually active, unmarried sailors used a condom in their last encounter. But some sailors reported much lower rates - for example, among unmarried officers, condom use decreased from 40 percent in 2002 to 30 percent in 2005. It also declined slightly among Navy women during the same span.

Shaffer said the services' education efforts have evolved from simply informing people about the risks of unprotected sex to helping them act on the information.

"What we're literally working on now is taking our education programs beyond providing knowledge to providing skills," Shaffer said.

The best example: If a service member is planning to use a condom, leaders must ensure condoms are accessible.

The Navy and Marine Corps Public Health Center, based in Portsmouth, encourages commands to make condoms freely available to sailors.

"Although sailors and Marines can and should buy condoms if they want to use them, making condoms easy to get, at strategic times and places, may increase the likelihood that people" will use a condom, a May 2009 report from the health center's Sexual Health and Responsibility Program said.

Leaders should not push condoms on sailors and should be sensitive to "community concerns and perceptions," the report noted. Still, it called for "leadership

courage." The authors included in the 28-page report an image of something that might appeal to sailors and Marines: a condom wrapped in a camouflage-colored pack age.

Alcohol use is another factor being studied in relation to HIV in the military.

Shaffer said soldiers and sailors who are "overly drunk" aren't as much of a concern as those who are "sort of drunk," because extreme inebriation limits sexual function, while alcohol in lesser amounts tends to make people less inhibited and more apt to take chances they wouldn't when sober.

Service members are tested for HIV at least every two years, and sailors and Marines are tested before each deployment. Each year, about 100 sailors and Marines are diagnosed with HIV.

They receive treatment in one of three places: San Diego; Bethesda, Md.; or Portsmouth Naval Medical Center.

Gerry Tarr, a clinical nurse specialist at Portsmouth, has been working with HIV-positive military members since 1990.

The medical center's clinic treats more than 400 HIV patients. About 180 are on active duty; the bulk are dependents or military retirees. Ninety percent are men.

Tarr gets to know them well.

Local service members diagnosed with HIV - typically 30 to 40 per year - spend two to three weeks at the hospital, learning everything from the specifics of viral loads and blood counts to how to tell sexual partners

they need to be tested, too. Dietitians, social workers and chaplains are made available. There are also group counseling sessions.

One of Tarr's most important jobs is making newly diagnosed sailors understand that they will probably live "to be a ripe old age."

That's not an impossible goal with clinical disease management techniques, the latest anti-retroviral drugs and dedication to keeping themselves healthy in other ways.

Tarr said sailors quickly come to understand that because they have access to comprehensive, continuous care, their opportunities to manage the disease "far exceed their civilian counterparts."

Cmdr. Jason Maguire, a physician at Portsmouth who specializes in infectious diseases, said fewer than 1 percent of military members diagnosed with HIV decide to leave the service.

Decades ago, once the infection progressed to full-blown AIDS, sailors would have been medically retired from the Navy. But today's medications do such a good job at stopping the virus from reproducing that most patients stay on active duty.

There are some limitations for HIV-positive sailors. They can't remain on sea duty or serve in most overseas billets. Those conditions can especially hurt pilots, air crew members, submariners and sailors in ship-based specialties such as boatswain's mates.

One of the major topics of conversation among sailors in the clinic, Tarr said, is "how this has affected their careers. You can make E6 (first class petty officer) but making E7 (chief) is going to be difficult, particularly if you don't have any sea time."

For many patients, though, not getting promoted is a small price to pay for health care that can keep HIV in check indefinitely.

"In the five years that I've been here, we have not medically retired a single patient we've seen in our clinic," Maguire said.

One of the reasons military HIV patients do so well is that they are typically young and healthy when they contract the virus, Maguire noted.

Tarr thinks the Navy's thorough education of its HIV patients - and continued attention to them for years and decades after diagnosis - makes a difference, too.

The clinic has had only one HIV-related death in the past eight years, Tarr said. And according to Maguire, more than 40 Portsmouth patients have had HIV for 20 years or longer.

"When they come in for their appointments," Maguire said, "we spend more time discussing controlling their hypertension or diabetes, because their HIV is very well-controlled."

Kate Wiltrout, (757) 446-2629, kate.wiltrout@pilotonline.com