But there was a catch. Harrison had been diagnosed with HIV in 2012, which meant he was now, under the military’s long-standing medical regulations, ineligible to be commissioned as an officer, a prerequisite to accepting the position. When I interviewed him last October, he estimated that he’d lost out on roughly $50,000 since 2014 (comparing what he would have earned as an officer in the JAG Corps with what he currently earns as a reservist). “Whenever I’m called up, I’m brought in to do more menial tasks like armory cleanup,” he told me. “But my real skill set is in managing programs and analyzing legislation.”
Harrison, who rose to the rank of sergeant, is just one of many service members, and prospective members, whose lives have been upended by the military’s outdated approach to HIV. Recruits who test positive are barred from enlisting, even if they are otherwise healthy and have only trace amounts of the virus in their blood. Service members who test positive for the first time after they’ve enlisted face a labyrinthine set of regulations that make it difficult for them to serve as officers, hold certain jobs and deploy to combat zones.
The military also takes an active interest in the sex lives of its members living with HIV (some 1,200, according to an estimate by an outside group). Once diagnosed, they must routinely sign a document known as a “safe sex order,” which requires them, among other things, to verbally inform all sexual partners — military or civilian — of their HIV status before engaging in sexual activity, and to use condoms or other “proper methods” to prevent the transfer of bodily fluids during sex. Failure to follow these rules can result in criminal penalties under the Uniform Code of Military Justice.
Parts of the military’s approach might have made sense back when HIV infection almost always led quickly to severe illness, followed by premature death. But modern antiretroviral drugs can reduce HIV to levels undetectable by normal blood tests, allowing people with the virus to lead unimpaired lives.
Today, there is a strong case that the military’s HIV policies are outdated and needlessly discriminatory. The military must, of course, set rules that ensure combat readiness and the safety of the force. But its HIV policies do neither. Instead, the regulations keep out troops who are fit and eager to serve, and they entrench the stigma surrounding the virus. The policies also carry echoes of anti-gay animus.
The military’s HIV rules were developed in the 1980s, at the height of the AIDS epidemic. In October 1985, the Pentagon began a mandatory HIV-screening program for recruits, turning away anyone with a positive test. Active-duty members who tested positive could continue serving, at least officially, but the expectation was that they would soon become too sick to work. Personnel with HIV were prosecuted for sodomy, disobedience and other offenses, and some were discharged without medical coverage. At one Army post in Texas, HIV-positive troops were made to live in a special barracks wing that became known as “the leper colony.”
The military’s approach reflected the fear and paranoia of the epidemic’s early years. Until the Food and Drug Administration approved the first medication for AIDS in 1987 — some six years after the first cases were discovered — there was no treatment for the disease. HIV, initially dubbed the “gay cancer,” typically progressed to AIDS, leaving patients vulnerable to opportunistic infections that were nearly always fatal. People were scared. A Gallup poll from the late 1980s found that 21 percent of Americans believed that “people with AIDS should be isolated from the rest of society.”
But since then, medical advancements have transformed HIV from a deadly disease to a manageable chronic condition. Combination antiretroviral therapy, pioneered in 1996, can reduce a person’s viral load — the number of copies of the virus in the blood — from upward of 1 million per milliliter to roughly 20, a level that all but eliminates the possibility of transmission. (Less than 200 per milliliter is considered “virally suppressed.”) And while such therapy once required dozens of pills a day, now it requires just one. Thanks to the military’s first-class screening and treatment programs, nearly 100 percent of HIV-positive service members reach viral suppression within one year of starting treatment.
Advances in HIV prevention, meanwhile, have reduced the chance of sexual transmission even further. Daily preventive medication, known as pre-exposure prophylaxis (PrEP), can slash the risk by 99 percent, whether or not the HIV-positive partner has suppressed their viral load through other treatment. Merck is testing an arm implant that, if successful, could prevent HIV infection for a full year.
Yet the military has not updated its policies to reflect these advances. The Pentagon has maintained a ban on enlistment, for example, even though people who take daily medication are as healthy as anyone and pose effectively no risk of transmission. People who are not undergoing treatment or who display symptoms of AIDS may be justifiably prevented from serving, but the mere presence of HIV in the bloodstream should not be enough for a blanket ban. (Contacted by a Washington Post editor, the Pentagon’s public relations department did not provide a comment about the military’s policy toward service members with HIV.)
Other rules, too, fail to reflect that HIV has become a manageable chronic condition. Preventing HIV-positive personnel from being commissioned as officers accomplishes nothing more than preventing deserving troops from advancing their careers. And, as former Navy secretary Ray Mabus has pointed out, limiting opportunities for deployment has little grounding in science. Antiretroviral drugs require no special handling, for example, and can be taken in the field — just as soldiers take anti-malarial medication. True, HIV-positive service members cannot donate blood, but the armed services are generally not lacking for blood donations. Critics have mentioned the danger of transmission by blood spattering from an infected person, but blood splashes are not a well-documented source of transmission, and, in any case, suppressed or undetectable viral loads render that risk largely theoretical.
As the gap between the military’s policies and scientific reality has widened, service members living with HIV have begun to challenge the Pentagon’s policies in court. Harrison, for example, filed suit in 2018, alleging that the military’s regulations impermissibly discriminate against HIV-positive troops. In January 2020, the U.S. Court of Appeals for the 4th Circuit upheld a lower-court ruling preventing the Trump administration from discharging HIV-positive airmen. In that case, two pseudonymous airmen had been recommended for discharge — over the objections of their commanding officers and medical personnel — on the grounds that their HIV status made them ineligible for deployment.
Banning HIV-positive soldiers from deploying might have been justified when treatment was less effective, the 4th Circuit reasoned. But now, the court said, “any understanding of HIV that could justify this ban is outmoded and at odds with current science.”
Other courts may follow the 4th Circuit’s lead, but the U.S. armed services should not wait for the legal system to force their hand. Foreign militaries have updated their rules to reflect the latest science. The Israel Defense Forces, for example, drafted people with HIV for the first time in 2019. And at least one branch of the U.S. military — the Navy — has already started liberalizing its policies, allowing HIV-positive personnel to deploy to large-platform ships and certain bases worldwide.
Ending HIV restrictions — which stigmatize people with the virus and close doors to those willing to serve — would bring military practices in line with the medical truth of living with HIV today.