HIV-1 infection among civilian applicants for US military service, 1985 to 2000: epidemiology and geography.

Objectives: This study examined demographic and geographic correlates of HIV-1 prevalence among civilian applicants for US military service.

Methods: HIV-1 test results and demographic and geographic data were available for 5.3 million applicants.

Results: Between October 1985 and December 2000, a total of 5,340,694 individuals applied to join one of the armed service branches of the US military. Overall, HIV-1 prevalence was 0.80 per 1000 applicants (95% CI: 0.78-0.82), with 4276 applicants testing positive for HIV-1 infection. Prevalence declined over the 16-year period from a high of 2.89 per 1000 applicants in 1985 to 0.36 per 1000 applicants in 2000. The majority of applicants (82.7%) were male, and the majority of HIV-1 cases (89.4%) occurred in men. HIV-1 prevalence was higher among African Americans (2.47/1000) and Hispanics (0.90/1000) than among white applicants (0.36/1000). HIV-1 prevalence was lowest in the West North Central region of the United States (0.33/1000) and highest in the Middle Atlantic region (1.61/1000) and Puerto Rico (3.56/1000).

Conclusions: Civilian applicants for US military service comprise a unique cohort for following trends in the evolving HIV-1 epidemic.