DoD Plays a Leading Role in Combating HIV & Infectious Diseases

By Naval Health Research Center Public Affairs

SAN DIEGO – The U.S. military has always played a leading role in combating infectious diseases. During the Revolutionary War, General George Washington understood the potential for contagious diseases to devastate his troops and ordered that members of the Continental Army be inoculated to prevent smallpox.

Since that time, military medicine has made major contributions to fighting infectious diseases around the globe to protect our warfighters from dangerous pathogens and keep them mission ready. From typhoid and dengue to Japanese encephalitis and Ebola, military researchers have worked tirelessly to better understand these diseases, develop vaccines, and support improved care and treatment methods.

A U.S. Military HIV Research Program scientist at work. (Office of the Secretary of Defense Public Affairs photo)

A U.S. Military HIV Research Program scientist at work. (Office of the Secretary of Defense Public Affairs photo)

When the first cases of human immunodeficiency virus (HIV) infection were identified in U.S. military personnel in 1984, military medicine responded to this emerging threat. In 1986, mass screening of active duty military members for HIV infection began and HIV prevention programs were developed soon after.

By 2000, in addition to recognizing the threat HIV posed to U.S. troops, White House and DoD leaders recognized the potential impact of the virus on global security as well. In January of that year, the National Intelligence Council concluded that infectious diseases not only threatened global health, but also posed a threat to U.S. troops by exacerbating social and political instability in regions where they deploy. To help contain the threat posed by the HIV epidemic, the White House established the Leadership and Investment in Fighting an Epidemic (LIFE) initiative.

LIFE, a $100 million initiative, was designed to provide assistance to countries around the world that were fighting the HIV pandemic. In addition to the DoD, the White House asked the U.S. Agency for International Development and the Centers for Disease Control and Prevention (CDC) to support the initiative. The DoD’s role in the LIFE initiative was to approach foreign militaries and offer assistance in developing their own military HIV control programs using $10 million of the LIFE funding over the next two years.

Spc. Sarah Elliot, a Sacramento, Calif., resident and a combat medic with the California National Guard's Northern Medical Detachment, draws blood from Chief Warrant Officer John Ferrara, a Santa Cruz resident and the Maintenance Officer for the 49th Military Police Brigade, Headquarters and Headquarters Company during a PHA at the 49th MP's Fairfield Armory July 13. The blood can be tested for blood borne diseases that might hinder a soldier's performance, including sickle cell anemia and HIV. (U.S. Army National Guard photo/Spc. James Wilton/Released)

Spc. Sarah Elliot, a Sacramento, Calif., resident and a combat medic with the California National Guard’s Northern Medical Detachment, draws blood from Chief Warrant Officer John Ferrara, a Santa Cruz resident and the Maintenance Officer for the 49th Military Police Brigade, Headquarters and Headquarters Company during a PHA at the 49th MP’s Fairfield Armory July 13. The blood can be tested for blood borne diseases that might hinder a soldier’s performance, including sickle cell anemia and HIV. (U.S. Army National Guard photo/Spc. James Wilton/Released)

It’s very common for the U.S. and DoD to engage in military exercises and weapons training with partner militaries around the world in what’s known as security cooperation. When it became apparent that other militaries were struggling with the HIV problem, the U.S. military realized it could expand its typical security cooperation role to include medical education and training.

While there have always been individual medical training opportunities, the DoD LIFE program was the first to do this on a large scale, which meant there was no template or protocol for the work. Relationships with each country had to be established.

By March 2001, starting with South Africa, the DoD LIFE initiative had successfully established cooperative HIV assistance programs with the militaries of nine sub-Saharan African countries and added the militaries of four more countries by 2002. These programs focused on developing HIV policies and building medical infrastructure to support prevention, care and treatment efforts within the countries targeted for intervention. For the military personnel in the targeted countries, the team leveraged their epidemiology expertise and worked on developing prevention strategies and behavior changes to help prevent the virus from spreading.

In 2002, with global efforts to combat the spread of HIV well underway, the DoD LIFE initiative was renamed the DoD HIV/AIDS Prevention Program (DHAPP), and continued to grow the number of partner militaries. The success of the LIFE initiative was built on by the White House and, in 2003, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) was announced at the State of Union address as the largest international assistance program focused on a single disease.

Today, DHAPP has a staff of 100, forty at our headquarters at NHRC in San Diego and sixty attached to U.S. embassies around the world. The program also benefits from the involvement of the Walter Reed Army Institute of Research which supports several of our military HIV assistance programs. Under the PEPFAR program, additional U.S. government agencies were added to the global HIV/AIDS relief effort and funding for DHAPP increased from the initial $10 million in 2000 to over $100 million in 2015.

Rick Shaffer, Ph.D. and director of the DoD HIV/AIDS Prevention Program (DHAPP) at the Naval Health Research Center leads a discussion about the work the U.S. military has done in fighting the global HIV/AIDS pandemic during a World AIDS Day event on Dec. 1, 2016. (U.S. Navy photo by Regena Kowitz/Released)

Rick Shaffer, Ph.D. and director of the DoD HIV/AIDS Prevention Program (DHAPP) at the Naval Health Research Center leads a discussion about the work the U.S. military has done in fighting the global HIV/AIDS pandemic during a World AIDS Day event on Dec. 1, 2016. (U.S. Navy photo by Regena Kowitz/Released)

The number of DHAPP collaborations increased from the initial nine countries to a peak of 82 in 2010. There are currently 62 foreign military partners. DHAPP’s accomplishments include:

  • More than 20 militaries around the world that no longer need our help to operate their HIV control programs
  • HIV assistance is now a typical part of the U.S. DoD Security Cooperation Program and a formal part of Stability Operations
  • Foreign militaries that were once reluctant partners had taken steps towards better relationships with the U.S. military: the Russian military used the U.S. military as its model for establishing HIV policy; and HIV cooperation has played a role in the continuing reestablishment of connections between the U.S. and Vietnamese militaries
  • The existence of DHAPP has helped ensure that militaries who would not normally receive foreign assistance without U.S. military involvement are getting the support they need to fight HIV/AIDS

DHAPP’s mission today, just as it was from the beginning in 2000, is to provide assistance to partner militaries around the world with their HIV prevention, care, and treatment programs. In the early days, the program was more focused on policy development, education and training, testing, and infrastructure. Now, it’s data-driven, focusing on testing and treating as many HIV-positive individuals as possible while effectively managing funding.

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