Aumakhan Bulbulgul, Eick-Cost Angelia A, Oh Gi-Taik, Stahlman Shauna L, Johnson Robert
Epidemiology and Analysis Branch, Armed Forces Health Surveillance Division, Public Health Directorate, Defense Health Agency, Silver Spring, MD.
MSMR. 2025 Apr 20;32(4):13-20.
Despite significant efforts to further reduce HIV incidence, including the introduction and scaling of pre-exposure prophylaxis (PrEP) in 2012, the repeal of the "Don't Ask, Don't Tell" (DADT) policy in 2011, and test-and-treat initiatives aligned with the 2019 "Ending the HIV Epidemic" initiative, annual rates of HIV incidence in the U.S. Armed Forces have continued to show little to no annual declines. To better understand the nature of new infections in the U.S. military, this retrospective analysis examined cases and trends in greater depth to 1) identify and describe total HIV antibody seropositivity rates from 1990 to 2024, with stratification by demographic characteristics, and 2) identify and characterize potential shifts in the epidemiological profile of HIV cases during the course of the evolving HIV epidemic. From January 1990 through December 2024, over 46 million U.S. service members in the active component, Guard, and reserve were tested for HIV antibodies, and 11,280 (24.3 per 100,000 persons tested) were diagnosed with HIV. Male service members comprised 96.3% of all HIV infections. The total rate of new HIV diagnoses declined over the period of surveillance, with the steepest decline in the first decade. Overall rates stabilized in 1997, but differences persist between different age and population groups. New HIV diagnoses have risen among male service members under age 30 years, with non-Hispanic Black service members bearing the highest burden and Hispanic service members experiencing the largest relative increases. Since 1997, rates in all racial and ethnic groups have more than doubled for those under age 25 years; for Hispanic service members, the increase was nearly 10-fold.
尽管为进一步降低艾滋病毒感染率做出了重大努力，包括在2012年引入并扩大暴露前预防（PrEP）、2011年废除“不问，不说”（DADT）政策以及与2019年“终结艾滋病毒流行”倡议相一致的检测与治疗举措，但美国武装部队的艾滋病毒年感染率仍几乎没有年度下降。为了更好地了解美军新感染情况的本质，这项回顾性分析更深入地研究了病例和趋势，以1）确定并描述1990年至2024年的艾滋病毒抗体总血清阳性率，并按人口特征进行分层，以及2）确定并描述在不断演变的艾滋病毒流行过程中艾滋病毒病例流行病学特征的潜在变化。从1990年1月到2024年12月，对现役部队、国民警卫队和后备役中超过4600万美国军人进行了艾滋病毒抗体检测，其中11280人（每10万人检测中有24.3人）被诊断感染艾滋病毒。男性军人占所有艾滋病毒感染病例的96.3%。在监测期间，新艾滋病毒诊断的总发生率有所下降，在第一个十年下降最为陡峭。总体发生率在1997年趋于稳定，但不同年龄和人群之间的差异仍然存在。30岁以下男性军人中的新艾滋病毒诊断病例有所增加，非西班牙裔黑人军人负担最重，西班牙裔军人的相对增幅最大。自1997年以来，25岁以下所有种族和族裔群体的发生率都增加了一倍多；对于西班牙裔军人，增幅近10倍。
