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OutServe Magazine | August 2, 2014

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Military Reverses Course on HIV+ People Serving Overseas

Military Reverses Course on HIV+ People Serving Overseas
Katie Miller

Navy Releases Major Updates to Service Member HIV Policy

By Katie Miller

This past year, the United States hosted the 19th International AIDS Conference for the first time since 1990. Although the United States has established itself as a global leader in HIV/AIDS research and funding, it wasn’t until 2010 that the government lifted the entry ban on HIV positive people wishing to travel to America, thereby making the International AIDS Conference possible in this country. Before then, the United States stood out as one of only a handful of countries worldwide that barred people living with HIV from visiting or immigrating to the country.

ATLANTIC OCEAN (March 5, 2008) Hospital Corpsman 3rd Class Michael Ousley draws blood from a patient to test for Human Immuno-deficiency Virus (HIV) during a physical health assessment aboard the aircraft carrier USS Theodore Roosevelt (CVN 71). Theodore Roosevelt is conducting carrier qualifications. U.S. Navy photo by Mass Communication Specialist Seaman Andrew Skipworth

However, the U.S. military continues its own form of a travel ban. Military policy prohibits HIV-positive service members from being stationed outside the United States. But on Aug. 13 the Pentagon quietly released a revision to the Department of the Navy policy, which now allows HIV-positive Sailors to be stationed at U.S. military installations outside of the country and on select large ship platforms. The policy change, listed under Secretary of the Navy Instruction (SECNAVINST) 5300.30E, is intended to “reflect current knowledge” of HIV and marks the biggest change in military HIV policy since the late 1980s when mass testing for HIV went into effect. Though the update removes logistical barriers to service, it does nothing to dissolve the space for discrimination which falls under commanders’ discretion. As long as the policy allows good Soldiers, Sailors, Airmen, and Marines to be subjected to the prejudices of their superiors, our mission of equality in the military will be unaccomplished

An Overview of U.S. Military HIV Policies
Although each branch of service maintains its own policies relating to HIV-positive people, the services have several major commonalities. First, all service members are tested for HIV every two years at a minimum, when given overseas assignments and when reservists transition to active duty.

The second commonality concerns enlistment; people with HIV are not eligible for general enlistment or enrollment in officer accession programs. The medical evaluation mandates all potential enlistees be physically and psychologically equipped to survive battlefield conditions. Unsurprisingly, those dependent on prescription medication are unqualified for service, as the military cannot guarantee access to medications in all situations. HIV, which causes immune deficiency, poses an additional risk for potential enlistees because of mandatory live-virus vaccinations administered at basic training, which could be deadly for persons living with the virus. This section of the policy is uncontested.

The third addresses retention of personnel who become HIV positive while serving in the armed forces. When service members are notified of their status, they undergo a separate medical evaluation to determine if they are fit to continue serving. If they wish to remain in the service and the medical evaluations yield positive reviews, they are reassigned to posts near military medical facilities that retain an infectious disease doctor. For those serving overseas, this means relocating to a post within the continental United States. The entire duration of an HIV-positive member’s careers will be spent stateside for the purpose of visiting an infectious disease doctor every three to six months, so OCONUS assignments and deployments are prohibited.

Interestingly, cadets and midshipmen enrolled in officer accession programs are not eligible to continue serving, regardless of physical condition. However, if a cadet or officer candidate is prior service, a return to enlisted status is allowed if his or her contract has not yet ended.

Finally, the military issues “safe sex” orders to personnel with HIV, informing them that they will be criminally prosecuted if they fail to disclose their status to sexual partners or engage in unprotected sex. Similar laws are in effect in a majority of U.S. states, though ranging in extremity.

The Impact on Service Members with HIV
OutServe Magazine interviewed three active-duty, HIV-positive Soldiers and Sailors and an LGBT health professional about military HIV policies and their impact on service members. Names have been changed to protect the identities of the service members.

When asked about the quality of health care they received, the three service members were unanimously positive. Roger, an NCO and moderator of what was previously known as the OutServe HIV Working Group, said, “My care is better in the military than it would be in the civilian world. I don’t have to worry about the cost of medication. It’s mandatory for us to go see the doctor regularly.”

Alex, a junior officer in the Navy, concurred. He expressed considerable praise of the hospital personnel, who offered to reach out to his friends and family to help them learn more about HIV. “I had about seven friends who came in, sat down with someone from the infectious disease clinic, and talked with the staff. The hospital said to me, ‘Alex, if they’re important to you, it’s important that we educate them.’ It was phenomenal.”

But outside of the medical facilities, service members with HIV face a different challenge that military has yet to address: the possible prejudices of their units Because HIV-positive personnel take TDY every three to six months for medical testing, it’s imperative that command be aware of a service member’s ongoing needs.

Alex found himself rather fortunate in this regard. “It would be bad if someone gave me a negative fitness report. I’ve heard horror stories like that, but that hasn’t been my experience. I’ve been met with nothing but understanding from my unit. They’re like, ‘Everyone has medical issues. Take care of yourself. That’s what’s important.’”

Roger also felt lucky to be part of an accepting unit, but realized his experience is not universal. “It’s not going to be like that for everybody. It’s not going to be this good across the board.”

Matthew Rose, formerly of the National Coalition for LGBT Health and friend of OutServe-SLDN, describes military HIV policy as similar to “Don’t Ask, Don’t Tell.” He explained: “If you get the right commanding officer, your life can be good. Some people were out to their units and experienced no problems. But, if you get a commanding officer who doesn’t agree with your sexuality or has preconceived notions about HIV, there’s not much you can do about it.”

Since the disease still carries a significant level of stigma, the autonomy of the commander is the single biggest flaw in military HIV policy, as discrimination is sure to be as rampant in the military community as it is the civilian world. Lack of guidance means room for abuse.

Jesse found himself at the crux of this problem, in the middle of the space left open for discrimination. Since he was enlisted before attending a service academy and has yet to experience any symptoms of HIV, the policy would permit him to leave the academy at the end of the semester and continue serving in the enlisted ranks. However, his company officer immediately took action to separate him from not only the academy but the military altogether because he did not believe people with HIV should be allowed to continue their service Jesse filed a complaint with the inspector general, which only served to expedite the commander’s intent to separate Jesse.

As policy dictated, Jesse’s enlistment contract was eventually reinstated, and he continues to serve on active duty. But the process demonstrated how current policy left him vulnerable to his command leadership.

The current lack of non-discrimination policies for HIV-positive personnel makes it impossible for the military to abide by industry standard human resources principles that guide many organizations’ personnel policies. One of those standards, procedural justice rules, states that policies must be, among other things, consistent. It must apply equally across all people and time. The current policy does not apply across all people since commanders can make independent decisions regarding the assignments and missions for which HIV-positive service members are eligible. Another principle, interpersonal justice rules, maintains that all employees must be treated with respect. Again, with the lack of a non-discrimination policy in place, commanders have such a high level of individual discretion that can be, at times, disrespectful to those service members.

Policy Update: Navy Begins the March toward Equality
One of the issues most important to these servicemen was the ban on overseas assignments. At first glance, the regulation appears to be in the best interest of the service member’s health: because they must regularly visit one of the military’s hospitals with an infectious disease clinic, stateside assignments are closest in proximity and therefore ideal.

Rose argues against this logic. Referring to the U.S. Military HIV Research Program, “The military delivers HIV care in the most impoverished places on the planet, like Sub-Saharan Africa. Yet for some reason, they don’t believe they can deliver care for service members outside the United States. What’s more, in any major industrialized city you can find a [infectious disease] doctor or at least a place that can run labs and interpret results.”

Feasibility aside, the negative impacts of the overseas assignment ban on service members’ careers has become well known in recent years. Roger is quick to note the assignments available often offer little potential for moving up the ranks. When Alex’s commander was informed of his status, she took special care to ensure he would be placed in a position that would not prevent him from being promoted. She ordered, “Do not stick him in a billet that will end his career.”

The updated Navy HIV policy also points to this limitation as having “made this subset of personnel less competitive in achieving career milestones or warrior qualifications.” With HIV resembling more of a “chronic condition than anything else,” says Alex, the only performance barrier for service members with HIV is policy, not physical capability. The Navy and the interview participants agree: current military HIV policies have career-ending effects.
However, the other services have yet to similarly update their policies. Still, recognizing the difference in the nature of deployment for the other branches, the service members we interviewed understood the challenges. Roger stated bluntly, “I don’t believe we should be discussing combat zones. Whether you’re sitting behind a desk in Afghanistan or out doing patrols, everyone has the same risk of getting hurt. Medics don’t have time to consider if a person has HIV or not.”

But he does believe personnel could be managed better. “Take Kuwait, for example. It’s not a combat zone. But when the wars in Afghanistan and Iraq were full on, people were getting sent there, and they could have been used in better places, like in deployable units. All I would need is enough medication for the length of the tour, and I could have taken their place.”

Jesse expressed a similar sentiment. “In my MOS, I’d be doing the same thing in Kuwait that I would be doing in the United States. It wouldn’t change. I hope to stay in the military for a long time, and if my subordinates look at me and see that I don’t have any time overseas, they’re not going to respect me.”

OutServe-SLDN Executive Director, Allyson Robinson, applauds the Navy’s first step toward ending HIV-discrimination in the military and their efforts to remove barriers to career advancement for Sailor and Marines. But Robinson, an Army veteran and West Point graduate, also points out that the policy does nothing to ensure commanders do the right thing:

“The new policy is a modest improvement at best. The latitude it gives to individual commanders to deny these newly opened assignments to HIV-positive Sailors and Marines will likely prove problematic. Misinformation, stigma, and stereotypes should never be allowed to dictate military assignments. Until that kind of discrimination is prevented, policy changes like this may prove not to be worth any more than the paper they’re printed on.”

As President Barack Obama stated when the HIV travel ban was ended in 2009, “If we want to be the global leader in combating HIV/AIDS, we need to act like it.” And if America is going to lead the world in ending the pandemic, properly addressing it in its own armed forces would be a good starting point. Although many of the military’s health and personnel policies are satisfactory, further updates are obviously needed to reflect current knowledge of the virus and to remove the stigma which has pervaded policy formation in the past. With the release of the new policy, the Navy has raised the bar for equality in the military. But consistent with all tasks in the military, the only commendable performance is one which not only meets, but exceeds the standard.

Katie Miller can be contacted at KatieMiller@OutServe.org.