The Naval Health Research Center (NHRC), San Diego, California, under the oversight of the Navy Surgeon General, has been tasked to serve as the US Department of Defense (DoD) Executive Agent for the DoD HIV/AIDS Prevention Program (DHAPP; BUMED Letter 5400 Ser 00/MED-26 of 9 Nov 00). The DHAPP Management Office at NHRC reports to the Deputy Assistant Secretary of Defense (DASD) via the Bureau of Medicine and Surgery (BUMED) and normal chain of command.
In 1999 the United States joined the International Partnership Against HIV/AIDS in Africa (IPAA) to mitigate the HIV pandemic and stop the spread of the AIDS virus. The African continent is the area of the world hardest hit by the HIV/AIDS epidemic and many militaries are experiencing readiness problems due to high rates of morbidity and mortality among their personnel. The US government began the Leadership and Investment in Fighting an Epidemic (LIFE) Initiative in fiscal year (FY) 2001 to help fight the HIV/AIDS epidemic in Africa and India. For FY 2000, the US Congress provided $100 million in support for HIV/AIDS prevention, care, and treatment in sub-Saharan Africa and India. Of this funding, $10 million was provided to DoD to reduce the spread of HIV among military personnel in selected African countries.
The US Navy serves as Executive Agent for DoD international HIV/AIDS prevention activities. NHRC manages DHAPP (formerly the LIFE Initiative). In FY 2001 Congress appropriated $10 million to begin DHAPP and funding has continued annually, totaling $35.25M through FY 2004.
DHAPP has successfully engaged 35 countries in efforts to combat HIV/AIDS among their respective military services. Working closely with US Departments of State and Defense, US Unified Combatant Commanders, Joint United Nations Programme on HIV/AIDS, US Agency for International Development, Centers for Disease Control and Prevention, university collaborators, and other nongovernmental organizations, DHAPP assists countries in establishing HIV/AIDS prevention programs and/or strengthening their capabilities to combat HIV. Most recently, DHAPP has joined with the Global AIDS Program (GAP) coordinator as part of the President's Emergency Plan for AIDS Relief (PEPFAR). DoD representatives are participating in PEPFAR core team visits to help formulate the final plan to use GAP funds in the assault against HIV.
HIV prevalence in military and uniformed personnel may exceed that of civilian populations. Experience with HIV prevention in the US military and among basic trainees in Thailand provides potential models for effective intervention in selected non-US military populations. It has been demonstrated that assessment of knowledge, attitudes, and behaviors, coupled with epidemiological measurements, can be done while maintaining confidentiality and with a high level of voluntary participation. Assessment of the components of HIV risk in non-US military populations will facilitate development of culturally appropriate prevention activities through the following strategies:
Assist selected non-US militaries in establishing HIV/AIDS-specific policies for their personnel
Assist selected non-US militaries in adapting and providing HIV prevention programs
Train military personnel in selected non-US military countries to implement, maintain, and evaluate HIV prevention programs
Assist selected non-US countries in the development of military culture interventions to diminish high-risk HIV attitudes and behaviors
Integrate with, and make use of, other US government programs and those managed by allies and the United Nations