Epidemiologic Notes and Reports Trends in Human
Immunodeficiency Virus Infection Among Civilian Applicants for
Military Service -- United States, October 1985-December
1986
Since October 1985, the U.S. Department of Defense has
routinely
tested civilian applicants for serologic evidence of infection with
human immunodeficiency virus (HIV) as part of their preinduction
medical evaluation (1). Results from the first 6 months of testing
have been reported previously (2,3). Results for the first 15
months
provide the opportunity to observe trends of infection in this
population.
Between October 1985 and December 1986, 789,578 civilian
applicants for military service were screened. Of these, 1,186
were
confirmed as HIV-antibody positive by enzyme immunoassay and
Western
blot immunoelectrophoresis, for an overall rate of 1.5/1,000
individuals tested. Seroprevalence per 1,000 varied by age, sex,
race
and ethnicity, and region of residence. By age, it was 0.6 for
17-20
year-olds, 2.5 for 21-25 year-olds, and 4.1 for those greater than
or
equal to 26 years of age. By sex, it was 1.6 for males and 0.6
for
females. By race and ethnicity, seroprevalence per 1,000 was 0.8
for
whites, 4.1 for blacks, 2.3 for Hispanics, 1.0 for American Indians
or
Alaskan Natives and Asian or Pacific Islanders. Table 1 shows the
seroprevalence among civilian applicants by region of residence.
During the 15-month observation period, the seroprevalence did
not
change significantly, either in the aggregate or when analyzed by
age,
sex, race and ethnicity (Figure 1), or geographic region. However,
seroprevalence among white males showed a small but significant
decline of 0.02/1,000 applicants tested per month (p = 0.016 by Chi
Square test for trends in proportions using a logistic regression
linear model).
Reported by: Health Studies Task Force, Office of the Assistant
Secretary of Defense (Health Affairs), US Dept of Defense,
Washington,
DC. Div of Preventive Medicine and Div of Communicable Diseases
and
Immunology, Walter Reed Army Institute of Research, Washington, DC.
Surveillance and Evaluation Br, AIDS Program, Center for Infectious
Diseases, CDC.
Editorial Note
Editorial Note: AIDS cases reported to CDC continue to increase*.
However, because of the lengthy incubation period of AIDS (4),
these
cases represent infection occurring at least several years prior to
the report of disease. There has been little information to
indicate
current trends in HIV infection. Analysis of the results of the
testing of civilian applicants thus far basically shows neither an
increase nor a decrease in infection level for the group as a whole
or
for individual subgroups. The significance of this apparent
absence
of change in antibody prevalence during the 15-month period studied
is
not yet clear.
Volunteers for military service, who are verbally screened by
the
recruiting official prior to arrival at the medical evaluation
center,
are not fully representative of the overall population in that they
underrepresent the three groups in the United States with the
highest
prevalence of HIV infection**. Moreover, applicants do not equally
represent all socioeconomic and demographic groups in the
population.
A growing awareness of the military serologic screening program may
have increased self-deferral by persons who are HIV-antibody
positive
or who feel they may have been exposed to the virus. If so, this
could have masked an increased frequency of infection in the
population from which the applicants are drawn.
Monitoring trends in infection among civilian applicants for
military service as well as among blood donorsS remains important.
It
is also critical to compare trends in infection among these
volunteer
groups with similar trends among groups not affected by
self-selection
bias. One such surveillance approach, in which anonymously tested
sample populations without AIDS-like disease are monitored at
participating hospitals, has been initiated recently by CDC.
Trends
in exposure risks among seropositive individuals should also be
monitored to assess possible changes in the relative frequency of
the
various modes of transmission. Follow-up interviews of a small
number
of seropositive applicants have found a high proportion with
typical
risk exposures for AIDS (5). CDC is collaborating with the U.S.
Department of Defense, the National Cancer Institute of the
National
Institutes of Health, and certain state and local health
departments
to develop a systematic follow-up evaluation of seropositive
civilian
applicants in selected cities and states.
References
Herbold JR. AIDS policy development within the Department of
Defense. Milit Med 1986;151:623-7.
CDC. Human T-lymphotropic virus type
III/lymphadenopathy-associated virus antibody prevalence in
U.S.
military recruit applicants. MMWR 1986;35:421-4.
Burke DS, Brundage JF, Bernier W, et al. Demography of HIV
infections among civilian applicants for military service in
four
counties in New York City: a preliminary analysis. New York
State Med J (In press).
Lui KJ, Lawrence DN, Morgan WM, Peterman TA, Haverkos HW,
Bregman
DJ. A model-based approach for estimating the mean incubation
period of transfusion-associated acquired immunodeficiency
syndrome. Proc Natl Acad Sci 1986;83:3051-5.
Stoneburner RL, Chiasson MA, Solomon K, Rosenthal S. Risk
factors
in military recruits positive for HIV antibody (Letter). N
Engl J
Med 1986;315:1355.
*An average of 38.3 AIDS cases per day were reported for the period
October-December 1986, compared with an average of 26.3 per day for
the period October-December 1985.
**Active intravenous drug abusers, homosexual men, and
hemophiliacs.
SLong-term data are not yet available for this group.
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