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FOIA Number: 2015-0017-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Chief of Staff
Series/Staff Member:
George Stephanopoulos
Subseries:
OA/ID Number:
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FolderID:
Folder Title:
Gays in the Military Questionnaire
Stack:
Row:
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S
22
2
9
3
G:
OMB would
ukeyou to review
this Gaysin the
I
Military
I
Questianzirre.
DIFINE
GRS
03/26/98
13:00
2022257120
HNSC OFFICE OF THE DOD
SECRETARY OFFENSE
LA
mas, ARIZONA
''. a
NUNTER CALIFORNIA
G.V. M.
JOHN 9 KASH ONE
1996 HAR 26 Fif 1: 35
PATISCIA COLORATE
HEREANT a BATEMAN VIRGINIA
as FAILTOR, MISSOUN
- V. MANSEN. UTAM
NORMAN ESSAY, were
CURT WELDON, PENNSYLVANIA
JOHN M. BRATE N.
ROBIRT & DORNAM. CALFORNIA
SOLOMON OFTE THEAS
JOEL NEPLAY. COLORADO
COMMITTEE ON NATIONAL SECURITY
OWEN PICKETT. VAGNA
JM SAXTON. NEW JERSEY
AME EVANC EUROS
RANKET "oug" CURRENGHAM CALIFORNIA
JONN TANNER Tennessee
STEVE BUYER. DICLANA
GAIN BROWDER ALABAMA
PETER G. TOROLOGER MASSACHUSETTS
THE a. TOWER FLORIDA
U.S. house of Representatives
DENE TAYLOR
WILL PAWAII
JOHN M. NEW YORK
- FDAMODE TEXAS
MAME TALENT MISSOURI
IVEREYT. NASAMA
Blashington, DC 20515-6035
MAR EXPA TEARS
MARTIN T. MEMBER MARTH
a SARTLETT, MARYLAND
ROBIRT a UNDERVACCE. CUSN
HOWARD "BUCK" MORTGAL CALIFORNIA
ONE HUNDRED FOURTH CONGRESS
JAME KARLASH. CAUSE -
RON LEWIS, CENTURY
PAUL MARAL PENNSYLVANIA
J.C. WATTE a CELANOMA
FLOYD D. SPENCE, SOUTH CAROLINA, CHAIRMAN
PETE GAREN TIMES
MAC THORNBERRY, TEXAS
PETE TERSON PLORIDA
JOHN M. MOSTETTLER HOUSE
WILLIAM , "SCN.
SAXSY CHAMBLISE GEORGIA
ROSAL XMC. - CENTET
VAN MILLEARY, TENNESSER
MIKE WARD, AENTURY
JOE SCARBOROUGH, FLORIDA
March 25, 1996
PATRICK. MODE CL2N0
WALTER a JONES. R. NORTH CAROLINA
JAMES 9. LONGLEY. a MAINE
TOOD TLANKT. KANSAS
RICHARD '00C' HASTINGS WASHINGTON
ANDREW K folls STATE -
Honorable William J. Perry
Secretary of Defense
The Pentagon
Washington, D. C. 20301-1000
Dear Mr. Secretary:
I would appreciate answers to the following questions by each of the services as soon
as possible, but not later than Thursday, March 28.
1.
What is the total DoD annual spending on HIV/AIDS, including medical care
and research, from 1986 until the present?
2.
What is the total number of DoD personnel who tested positive each year 2.S
well as the total number who were on active duty at the end of each year from
1986 to the present?
3.
By service, what is the total number of permanent non-deployables compared
to the number of HIV-positive personnel from 1986 to the present?
4.
Regarding venereal diseases, especially syphilis, how do these diseases effect
deployability and retention?
5.
How many service personnel deployed or stationed overseas have been
returned to the United States as a result of becoming HIV positive (1992.
1993, 1994 and 1995)?
6.
What specific information from the services regarding HIV is reported 12 the
Center for Disease Control (CDC)?
7.
Is the mode of HIV transmission maintained in personal medical files any
other files? If not, where is such information maintained? What is the
breakdown of modes of HIV transmission within the HIV positive population
of the military?
U04291 196
30' d 012 ON
96.91 APP
ID:202-395-5691
03/26/96
13:01
2022257120
HNSC
+++ DOD LA
920
Honorable William J. Perry
March 25, 1996
Page two
8.
Where, for each of the services. are the personal medical records kep: of HIV-
positive personnel?
9.
How often are military personnel tested or checked for HIV?
10.
How many family members of HIV-positive military personnel are also HIV
positive?
11.
Do all of the infected dependents live with their military spouses? If not, how
many live apart?
12.
Of the current HIV-positive military personnel, how many have HIV 11? How
many have HIV E?
13.
How many cases of Hepatitis B are there currently in the military? What is
the status of personnel with Hepatitis B in terms of deployability/retention?
14.
How many current HIV-positive military personnel have their condition as a
direct result of blood transfusions?
Sincerely,
BobDornan Robert K. Doman
Chairman
Military Personnel Subcommittee
APR 16'96 10:55 No 012 P.04
INFORMATION PAPER
SUBJECT: Response to Representative Doman Questions Dated 25 March 1996
DISCUSSION:
Question 1: What was the total DoD annual spending on HIV/AIDS, including medical care
and research, from 1986 until the present?
Answer 1: The exact cost of medical care for HIV/AIDS care can not be determined due to
the inability to account directly for inpatient and outpatient care. However, some aspects of
cost can be estimated. The cost of DoD's HIV/AIDS testing and monitoring program is
approximately $12-$13 million per year. This figure includes:
-- the HIV testing programs for all military applicants, active duty and reserve component
members, and dependents
-- databases and repository which support the testing programs
-- the virological and immunological (CD4 cell) determinations of those infected
-- maintenance of reference labs and overall quality assurance programs
Approximate lifetime cost estimates of treating a person with HIV in the civilian sector have
been estimated to be $100,000 to $150,000 with a ten year life expectancy.
Over 3.5 million military applicants have been screened and over 3,860 infected applicants
have been excluded from military service at a little under $3.00 per test per person (at a cost
of $11,580 transferring into an estimated cost avoidance of $482,500,000).
The annual DoD research costs from FY 86 to the present are:
FY
86
87
88
89
90
91
92
93
94
95
Research Cost
$34
$18
$10
$27
$33
$44
$42
$50
$45
$40
(in Millions)
10:56 No 012 P.05
96.91 APR
69-6-:I
OMB/RDI
Question 2: What is the total number of DoD personnel who tested positive each year, as
well as the total number who were on active duty at the end of each year from 1986 to the
present?
Answer 2:
Newly Diagnosed HIV Positive
HIV Members at End of CY
CY
Army
Navy/USMC
Air Force
Army
Navy/USMC
Air Force
86
1040
1271/155
218
864
1271*
282
87
407
626/58
375
887
1015*
537
88
189
453/64
131
598
1095*
520
89
172
249/43
104
548
948*
468
90
145
249/49
65
520
831*
401
91
135
186/37
57
511
822*
358
92
125
183/29
51
440
785*
313
93
91
161/41
39
408
751*
251
94
65
118/28
31
372
634/82
187
95
63
83/16
17
314
507/62
99
USMC numbers are not available from 1986-1993.
Question 3: By Service, what is the total number of permanent non-deployables compared to
the number of HIV positive personnel from 1986 to the present?
Answer 3:
PERMANENT NON-DEPLOYABLES"
HIV POSITIVE MEMBERS
CY
Army
Navy/USMC
Air Force
Army
Navy/USMC
Air Force
86
Unk*
1657**
2737
864
1271**
282
87
Unk*
1292**
3400
887
1015**
537
88
Unk*
1459**
3600
598
1095**
520
89
Unk*
1283**
3340
548
948**
468
90
Unk*
1161**
3250
520
831**
401
91
Unk*
1196**
2850
511
822**
358
92
Unk*
1126**
2287
440
785**
313
93
Unk*
1034**
1779
408
751**
251
94
Unk*
864**
1888
372
634/82
187
95
3997
694/131
2134
314
507/62
99
$ Unk = Unknown Data. The Army did not begin compiling data on non-deployable
members Army wide until 1995.
** USMC numbers are not available.
90°d 012 ON 95:01
96.91 APR
OMB/RDI
Question 4: Regarding venereal diseases, especially syphilis, how do these diseases affect
deployability and retention?
Answer 4: Sexually transmitted diseases are treated as a temporary, curable medical
condition and, as such, are not disqualifying from deployability or retention. If a member has
symptomatic neurosyphilis or complications of the disease to a degree that the member is
incapable of performing military duty, the member will be referred to the disability
evaluation system (DES).
Question 5: How many Service personnel deployed or stationed overseas have been
returned to the United States as a result of becoming HIV positive (1992, 1993. 1994, and
1995)?
Answer 5:
CY
Army
Navy/USMC
Air Force
92
12
Unk
4
93
2
Unk
4
94
7
Unk
4
95
8
12
4
This data reflects only the number of service members currently on active duty who were
reassigned from overseas assignments upon being diagnosed HIV positive. Data is not
available for members who have left the service and who may have been reassigned from
overseas upon being diagnosed HIV positive.
The Navy retains information only on HIV positive personnel currently on active duty.
Of the 507 HIV positive on active duty at the end of CY95. 12 were re-assigned from
overseas duty assignments at the time of diagnosis (an additional 251 were re-assigned from
shipboard assignments that require overseas deployments).
Question 6: What specific information from the Services regarding HIV is reported to the
Center for Disease Control (CDC)?
Answer 6: The only data DoD reports directly to the CDC are periodic reports concerning
the results of HIV screening of potential military recruits. The Services do not report any
information directly to the CDC. It is DoD policy for military medical treatment facilities to
report HIV/AIDS statistics to local and state health agencies in accordance with local and
state laws and regulations. While all states are required to report AIDS statistics to the CDC,
only 26 states routinely report HIV seroconversion statistics and associated demographic
data. This data does not ordinarily contain information on suspected mode of transmission.
10:57 No 012 P.07
96.91 APR
ID:202-395-5691
OMB/RDI
Question 7: Is the mode of HIV transmission maintained in personal medical files or any
other files? If not, where is such information maintained? What is the current breakdown of
modes of HIV transmission within the HIV positive population of the military?
Answer 7: The "mode of transmission" can only be presumed. and not validated, from self-
reported questionnaire data. Each Service has collected, stored and processed HIV risk factor
data in the following manner.
Army
As HIV-positive soldiers are identified, the preventive medicine service is responsible for
conducting a public health interview for purposes of contact tracing and reporting in
accordance with local and state regulations. At this interview, risk factors for HIV
transmission are discussed. All information from this interview is maintained in secure files
separate from the medical record at each Army post. No attempt has ever been made to
assemble or analyze this information.
Because of the highly sensitive nature of some of the behavioral risk factors for HIV
infection, the validity and usefulness of risk factor data collected from military patients by
military physicians has always been limited. From 1986 through January 1995, Army
physicians interviewing newly identified HIV positive patients completed a clinical
evaluation form (CEF) that included questions on risk factors. These forms were forwarded
to the US Army HIV Data Systems (USAHDS) office, originally housed at the Walter Reed
Army Institute of Research. This limited access data base is now part of the Army Medical
Surveillance Activity of the Center for Health Promotion and Preventive Medicine. Because
of the poor response rate and concern about the lack of validity of these data, a new clinical
evaluation form with no risk factor questions has been used for submission of data to
USAHDS since January 1995. There is now no routine centralized collection of risk factor
data by the Army.
Separate from the above epidemiological interviews, most Army HIV risk research has
been conducted in collaboration with the Henry M. Jackson Foundation for the Advancement
of Military Medicine (HMJFAMM). HIV risk factor transmission data gathered for these
research protocols were collected, stored and processed according to clinical investigation
review board approved study protocols. In addition, the Walter Reed Army Institute of
Research independently conducted two research studies. Complete results of both studies
have been published in the medical literature.
Study 1: Risk factors for prevalent human immunodeficiency virus (HIV) infection
in active duty Army men who initially report no identified risk: a case control study.
Journal of Acquired Immune Deficiency Syndromes, Volume 3, pages 266-71, 1990.
For this study 26 HIV-positive soldiers with no previously identified risk factors and
74 HIV-negative (control) soldiers volunteered to participate in anonymous and
confidential interviews.
80°d 0112 ON 10:52
96.91 APP
69-6-0:0I
OMB/RDI
Study 2: HIV-1 seroconversion and risk behaviors among young men in the US
Army. American Journal of Public Health, Volume 85, Number 11, pages 1500-06,
November 1995. For this study, 128 HIV-positive men and 128 controls volunteered
to participate in anonymous and confidential interviews to determine behavioral risk
factors for infection with HIV.
These studies and those conducted in collaboration with HMJFAMM comprise all known
Army sources of research data concerning behavioral risk of HIV infection.
Navy
Risk factor information is gathered from individuals during a confidential epidemiologic
interview as part of the intake evaluation for those who have evidence of HIV
seroconversion. Stored separate from the medical records, information is forwarded to the
appropriate public health agency for contact tracing. The process to forward all but risk
behavior data is through the Adult HIV/AIDS Confidential Case Report form. This form is
used to report HIV seropositive cases to state health departments in accordance with state
law. Risk factors are neither recorded on the Confidential Case Report nor reported because
military.restrictions against risk relevant behavior make this information unreliable.
Between 1988 and 1991, an approved active research protocol included questions about risk
information. An unpublished document written in 1988, and discovered April 3, 1996, at the
Naval Health Research Center San Diego, indicates that NHRC staff asked 2500 Navy and
Marine Corps personnel to complete an anonymous personal history questionnaire during
their initial HIV evaluations. Only 200 of the 2500 patients completed the questionnaire.
Due to the poor response rate, the aggregated data was not considered representative of the
population and was not published and the anonymous questionnaire project was
discontinued. The Navy Medical Department has no plans to conduct further studies related
to risk factors and does not maintain a central data base with risk factor information.
Air Force
The U.S. Air Force Public Health epidemiology nurse (civilian GS-09) asks each HIV-
infected person on their initial evaluation to complete CDC Form 50.42A. This CDC form
contains the name of the individual being interviewed and thus is not anonymous. Because
the form is not anonymous, its accuracy is doubtful. This form is filed in the epidemiology
nurse's office until the individual develops CDC-defined AIDS or dies. At this time, this
form is sent to the appropriate state or local health agency who in turn forwards it to the
CDC. A copy is retained by the epidemiology nurse in her file.
At the inception of the USAF HIV Program at Wilford Hall Medical Center (WHMC) in
1985, the direction and management of the program was placed under the Department of
Infectious Diseases. At this time, a questionnaire was developed by the Department of
Infectious Diseases which included questions regarding HIV risk factor data. From 1985 to
1988, this information was obtained from each HIV positive individual who was referred to
10:58 No 012 P.09
96.91 APP
OMB/RDI
WHMC for evaluation. This form was not anonymous and the interview was conducted by
the Infectious Diseases fellows who completed the form in the presence of the individual.
Thus, the accuracy of these forms was questionable. These forms were initially retained with
copies of the periodic HIV evaluations and filed in the department. In 1988, these forms
were discontinued and they were all destroyed.
In October 1989, the Henry M. Jackson Foundation (HMJF) established a research unit at
WHMC to assist with the Tri-Service HIV Research Program. Major George Brown
(separated) and his colleagues in the Department of Psychiatry developed a psychiatric and
neuropsychiatric protocol to evaluate the natural history of psychiatric illness in HIV infected
persons for the Behavioral Science Program. This protocol was assigned a study number,
RV-26. Participation in this study was voluntary and included active duty, retired and
dependents. Part of the data collected included an anonymous questionnaire containing
questions regarding sexual practices and other factors including intravenous drug use. This
study was active from approximately 1990-1992. All of these study records are retained in
storage in San Antonio by the HMJF.
In 1990, the HMJF Behavioral Science program developed a second anonymous,
voluntary sexual questionnaire. This questionnaire was developed to identify HIV
transmission risk factors. Since 1990, this anonymous form has been voluntarily completed
by approximately 90% of individuals who have been referred to HMJF for their initial
evaluation. (This form is completed on their initial evaluation only.) To date, 213
individuals (active duty, dependent, retired) have completed the form. In this group, 191 of
the volunteers have been active duty males. Upon the completion of the form, the contents
are entered into the HMJF database and the original form is destroyed.
The Public Health epidemiology nurse at WHMC requests that each HIV infected person,
referred for an initial evaluation, complete an anonymous contact tracing form. The
epidemiology nurse reviews the contact tracing form and notifies the appropriate public
health officials. For contacts who are active duty Air Force, she notifies the Public Health
officials at their local base. For contacts who are civilian, she notifies the County Health
Department and for contacts who are active duty in other services, she notifies the HIV
Coordinator for the US Army or the US Navy in Washington, DC. Following the completion
of these notifications, these forms are destroyed.
Thus, the only form which makes any connection between the individual's name and
their HIV risk factor data is the CDC Form 50.42A.
There have been only two published references by Air Force personnel regarding HIV
risk factor data. The first was an abstract presented by Captain Robert Zajac (separated) at
the 1986 Air Force Regional Meeting of the American College of Physicians in San Antonio,
TX. The data source for the HIV risk factor data presented in this abstract was obtained from
the questionnaire developed by the Department of Infectious Disease referred to above.
Because this data was collected through a face-to-face interview, its accuracy is questionable.
In this abstract, Captain Zajac states that 16 individuals admitted to homo/bisexual activity
10:59 No 012 P.10
96.91 APP
OMB/RDI
and two individuals admitted to drug use. However, as noted above, these forms were all
destroyed in 1988. The second publication was a manuscript published by LtCol Janice
Rusnak in the Journal of Infectious Disease. In the last two paragraphs of the results
sections, she described some HIV risk behavior data obtained from a HMJF research study.
This data was obtained from the RV-26 behavioral science protocol that is referenced above.
As stated, all of the data for this study is maintained in storage by the HMJF in San Antonio,
TX. To our knowledge, these are the only published materials which refer to HIV risk factor
data by Air Force personnel.
Question 8: Where, for each of the services, are the personal medical records kept for HIV
positive personnel?
Answer 8: Personal medical records for HIV positive members are maintained at the local
hospital or clinic of the duty station to which they are assigned.
Question 9: How often are military personnel tested or checked for HIV?
Answer 9:
DoD: HIV testing is conducted on prospective applicants prior to entrance into the
Service, during periodic physical examinations or during Permanent Change of Station
transfers. Those who test positive at accession points are not accepted for entry. Specific
service requirements for HIV screening are as follows:
Army: All members will be tested at a minimum of biennially. All members are
tested prior to overseas Permanent Change of Station Transfers.
Navy/USMC: Active duty members in overseas and deployable units and all active
duty health care providers are tested on an annual basis. All others will be tested during
periodic physical examinations or at least every five years. All members will be tested prior
to Permanent Change of Station Transfers.
Air Force: Medical personnel are tested annually. Individuals who are on flying
status are tested during periodic physical examinations every three years. All others are
tested during their periodic physical examination at least every five years. All members are
tested prior to overseas Permanent Change of Station Transfers.
10:59 No .012 P.11
96.91 APP
OMB/RDI
Question 10: How many family members of HIV positive military personnel are also HIV
positive?
Answer 10: This data is incomplete and very limited because an unknown percentage of
spouses and other family members choose not to have HIV testing performed or do not report
the results of the testing to DoD. Listed below are the numbers of known HIV positive
family members of HIV positive members.
Army
Navy/USMC
Air Force
HIV Positive Dependents
7
31
5
Question 11: Do all of the infected dependents live with their military spouses? If not, how
many live apart?
Answer 11: This data is incomplete and very limited. For those family members whose HIV
status is known, not all of the HIV positive family members live with their military sponsors.
In the Navy for example 6 HIV positive members are living apart from HIV positive family
members. In the Air Force, all 5 known HIV positive family members live with the HIV
positive sponsor. This information is not available from the Army.
Question 12: Of the current HIV positive personnel, how many are HIV II? How many
have HIV E?
Answer 12: There are no known HIV-II positive members in any of the services. HIV-E is a
subtype of HIV-1 not normally differentiated from HIV-1 in serotyping done by the services.
However, the Navy does report 3 members have been identified as HIV-1 clade E positive.
Question 13: How many cases of Hepatitis B are there currently in the military? What is the
status of personnel with Hepatitis B in terms of deployability/retention?
Answer 13: The best available numbers of Hepatitis B cases are listed below. There are no
restrictions on deployability and retention of these personnel.
Army
Navy/USMC
Air Force
Reported Hepatitis B Cases
43*
49**
83***
*
- Data is from 1995 Hospital Admissions Data.
$8 - Data is from 1994 (last year available).
*** - Includes members diagnosed with acute hepatitis B and newly identified carriers of
hepatitis B (1995 Annual USAF Sexually Transmitted Disease Report)
APR 16'96 11:00 No .012 P.12
ID:202-395-5691
OMB/RDI
Question 14: How many current HIV positive military personnel have their condition as a
direct result of blood transfusions?
Answer 14: We are unable to ascertain with any degree of certainty exactly how any HIV
positive member acquired the disease. The following details the number of cases of HIV
positive members currently on active duty where blood transfusions were listed as one of the
potential risk factors following diagnosis:
Army
Navy/USMC
Air Force
Blood Transfusion
Unk
5
0
As a Risk Factor
I'd 012 ON 00:11
96.91 APP
ID:202-395-5691
OMB/RDI
Is the mode of HIV transmission maintained in personal medical files or any other
files? If not, where is such information maintained? What is the current
breakdown of modes of HIV transmission within the HIV positive population of the
military?
QUESTON FROM MR. JOHN CHAPLA PROF. Staff Member House
National Security COMMITTEE, SUBCOMMITTE JN MANPOWER
AND PERSONNEL
APR 16'96 11:01 No 012 P.14
OMB/RDI
OF DEPARTMENT
THE ASSISTANT SECRETARY OF DEFENSE
WASHINGTON, D.C. 20301-1200
HOMELAND
OFFICE
5
HEALTH AFFAIRS
Honorable Robert K. Dornan
Chairman, Subcommittee on Military Personnel
National Security Committee
House of Representatives
Washington, D.C. 20515
Dear Mr. Chairman:
In response to your follow-up questions, I directed the three Surgeons General to
conduct a thorough search back through each of their systems regarding any information
that would bear upon the "risk assessment" HIV issue. Enclosed is the material that
emerged from that review, divided into three categories:
1. Service-by-service description of the collection, storage, and use of risk
assessment data.
2. Descriptions and lists of presentations, etc. from the Henry M. Jackson
Foundation for the Advancement of Military Medicine's "Behavioral Prevention
Program." This program is funded by the Army, but the data and research materials are
under the purview of the Henry M. Jackson Foundation; further inquires should be
directed to them.
3. Publications that we are aware of that draw upon military risk assessment data.
I must re-emphasize what virtually all researchers who have dealt with this data
have previously stated: The process of asking (anonymously or not) risk assessment
questions in the military context yields results with a high probability of unreliability.
Further, the samples of patients from whom such data has been collected are not
adequately representative of the HIV-infected military population as a whole, nor do they
reliably reflect trends over time.
I realize that this material does not offer the kind of clear-cut answers you are
seeking, but that is the inherent limitation of the data.
Sincerely,
Stephen C. Joseph, M.D., M.P.H.
P.15 012 ON 11:01
96.91 APP
ID:202-395-5691
OMB/RDI
TABI
Is the mode of HIV transmission maintained in personal medical files or any other
files? If not, where is such information maintained? What is the current
breakdown of modes of HIV transmission within the HIV positive population of the
military?
The "mode of transmission" can only be presumed, and not validated, from self-
reported questionnaire data. Each Service has collected, stored and processed HIV risk
factor data in the following manner.
Army
As HIV-positive soldiers are identified, the preventive medicine service is
responsible for conducting a public health interview for purposes of contact tracing and
reporting in accordance with local and state regulations. At this interview, risk factors for
HIV transmission are discussed. All information from this interview is maintained in
secure files separate from the medical record at each Army post. No attempt has ever
been made to assemble or analyze this information.
Because of the highly sensitive nature of some of the behavioral risk factors for
HIV infection, the validity and usefulness of risk factor data collected from military
patients by military physicians has always been limited. From 1986 through January 1995,
Army physicians interviewing newly identified HIV positive patients completed a clinical
evaluation form (CEF) that included questions on risk factors. These forms were
forwarded to the US Army HIV Data Systems (USAHDS) office, originally housed at the
Walter Reed Army Institute of Research. This limited access data base is now part of the
Army Medical Surveillance Activity of the Center for Health Promotion and Preventive
Medicine. Because of the poor response rate and concern about the lack of validity of
these data, a new clinical evaluation form with no risk factor questions has been used for
submission of data to USAHDS since January 1995. There is now no routine centralized
collection of risk factor data by the Army.
Separate from the above epidemiological interviews, most Army HIV risk research
has been conducted in collaboration with the Henry M. Jackson Foundation for the
Advancement of Military Medicine (HMJFAMM). HIV risk factor transmission data
gathered for these research protocols were collected, stored and processed according to
clinical investigation review board approved study protocols. In addition, the Walter Reed
Army Institute of Research independently conducted two research studies. Complete
results of both studies have been published in the medical literature.
Study 1: Risk factors for prevalent human immunodeficiency virus (HIV)
infection in active duty Army men who initially report no identified risk: a case
control study. Journal of Acquired Immune Deficiency Syndromes, Volume 3,
pages 266-71, 1990. For this study 26 HIV-positive soldiers with no
previously identified risk factors and 74 HIV-negative (control) soldiers
volunteered to participate in anonymous and confidential interviews.
11:01 No 012 P.16
96.91
APR
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Study 2: HIV-1 seroconversion and risk behaviors among young men in the
US Army. American Journal of Public Health, Volume 85, Number 11, pages
1500-06, November 1995. For this study, 128 HIV-positive men and 128
controls volunteered to participate in anonymous and confidential interviews to
determine behavioral risk factors for infection with HIV.
These studies and those conducted in collaboration with HMJFAMM comprise all known
Army sources of research data concerning behavioral risk of HIV infection.
Navy
Risk factor information is gathered from individuals during a confidential
epidemiologic interview as part of the intake evaluation for those who have evidence of
HIV seroconversion. Stored separate from the medical records, information is forwarded
to the appropriate public health agency for contact tracing. The process to forward all but
risk behavior data is through the Adult HIV/AIDS Confidential Case Report form. This
form is used to report HIV seropositive cases to state health departments in accordance
with state law. Risk factors are neither recorded on the Confidential Case Report nor
reported because military restrictions against risk relevant behavior make this information
unreliable.
Between 1988 and 1991, an approved active research protocol included questions
about risk information. An unpublished document written in 1988, and discovered April
3, 1996, at the Naval Health Research Center San Diego, indicates that NHRC staff asked
2500 Navy and Marine Corps personnel to complete an anonymous personal history
questionnaire during their initial HIV evaluations. Only 200 of the 2500 patients
completed the questionnaire. Due to the poor response rate, the aggregated data was not
considered representative of the population and was not published and the anonymous
questionnaire project was discontinued. The Navy Medical Department has no plans to
conduct further studies related to risk factors and does not maintain a central data base
with risk factor information.
Air Force
The Public Health epidemiology nurse (civilian GS-09) asks each HIV-infected
person on their initial evaluation to complete CDC Form 50.42A. This CDC form
contains the name of the individual being interviewed and thus is not anonymous. Because
the form is not anonymous, its accuracy is doubtful. This form is filed in the Public Health
epidemiology nurse's office until the individual develops CDC-defined AIDS or dies. At
this time, this form is forwarded to CDC and a copy is retained by the epidemiology nurse
in her file.
At the inception of the USAF HIV Program at Wilford Hall Medical Center
(WHMC) in 1985, the direction and management of the program was placed under the
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Department of Infectious Diseases. At this time, a questionnaire was developed by the
Department of Infectious Diseases which included questions regarding HIV risk factor
data. From 1985 to 1988, this information was obtained from each HIV positive
individual who was referred to WHMC for evaluation. This form was not anonymous and
the interview was conducted by the Infectious Diseases fellows who completed the form in
the presence of the individual. Thus, the accuracy of these forms was questionable. These
forms were initially retained with copies of the periodic HIV evaluations and filed in the
department. In 1988, these forms were discontinued and they were all destroyed.
In October 1989, the Henry M. Jackson Foundation (HMJF) established a research
unit at WHMC to assist with the Tri-Service HIV Research Program. Major George
Brown (separated) and his colleagues in the Department of Psychiatry developed a
psychiatric and neuropsychiatric protocol to evaluate the natural history of psychiatric
illness in HIV infected persons for the Behavioral Science Program. This protocol was
assigned a study number, RV-26. Participation in this study was voluntary and included
active duty, retired and dependents. Part of the data collected included an anonymous
questionnaire containing questions regarding sexual practices and other factors including
intravenous drug use. This study was active from approximately 1990-1992. All of these
study records are retained in storage in San Antonio by the HMJF.
In 1990, the HMJF Behavioral Science program developed a second anonymous,
voluntary sexual questionnaire. This questionnaire was developed to identify HIV
transmission risk factors. Since 1990, this anonymous form has been voluntarily
completed by approximately 90% of individuals who have been referred to HMJF for their
initial evaluation. (This form is completed on their initial evaluation only.) To date, 213
individuals (active duty, dependent, retired) have completed the form. In this group, 191
of the volunteers have been active duty males. Upon the completion of the form, the
contents are entered into the HMJF database and the original form is destroyed.
The Public Health epidemiology nurse at WHMC requests that each HIV infected
person, referred for an initial evaluation, complete an anonymous contact tracing form.
The epidemiology nurse reviews the contact tracing form and notifies the appropriate
public health officials. For contacts who are active duty Air Force, she notifies the Public
Health officials at their local base. For contacts who are civilian, she notifies the County
Health Department and for contacts who are active duty in other services, she notifies the
HIV Coordinator for the US Army or the US Navy in Washington, DC. Following the
completion of these notifications, these forms are destroyed.
Thus, the only form which makes any connection between the individual's name
and their HIV risk factor data is the CDC Form 50.42A.
There have been only two published references by Air Force personnel regarding
HIV risk factor data. The first was an abstract presented by Captain Robert Zajac
(separated) at the 1986 Air Force Regional Meeting of the American College of Physicians
in San Antonio, TX. The data source for the HIV risk factor data presented in this
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abstract was obtained from the questionnaire developed by the Department of Infectious
Disease referred to above. Because this data was collected through a face-to-face
interview, its accuracy is questionable. In this abstract, Captain Zajac states that 16
individuals admitted to homo/bisexual activity and two individuals admitted to drug use.
However, as noted above, these forms were all destroyed in 1988. The second publication
was a manuscript published by LtCol Janice Rusnak in the Journal of Infectious Disease.
In the last two paragraphs of the results sections, she described some HIV risk behavior
data obtained from a HMJF research study. This data was obtained from the RV-26
behavioral science protocol that is referenced above. As stated, all of the data for this
study is maintained in storage by the HMJF in San Antonio, TX. To our knowledge, these
are the only published materials which refer to HIV risk factor data by Air Force
personnel.
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JACKSON TON
TAB2
The Behavioral Prevention Program
Co-Directors:
Ellen D. Nannis, Ph.D.
Scientific Director
Henry M. Jackson Foundation
F.D. Daniell, CAPT, MC, USN
Chief, Behavioral Prevention
Department, WRAIR
Research Objectives:
In support of MMCARR's primary mission, the reduction of HIV incidence in
military populations, the Behavioral Prevention Program:
1.
Develops and evaluates behavioral interventions for the three
services to reduce the exposure to HIV by individuals at higher risk
for infection.
2.
Provides support to the Preventive Medicine Departments of the
three services by evaluating existing operational HIV education
and prevention efforts.
3.
Supports HIV vaccine and chemotherapy drug trials through
research designed to understand behavioral factors.
4.
Develops and evaluates behavioral interventions to reduce
transmission by HIV infected military medical beneficiaries.
Introduction:
The primary focus of the BPP research program is to develop and evaluate
behavioral interventions designed to reduce the transmission of HIV in military
populations. The secondary focus of the program is to support preventive
vaccine trials and other studies with behavioral data and assessments. This past
year has been a period of transition from the collection of descriptive behavioral
data, which formed the foundation for the initial behavioral interventions
(through the Army Wide AIDS/HIV Survey - AWAS- and the Seropositive
Behavioral Survey - SBS), to initiation of behavioral intervention protocols and
development of a field site capability to assess the interventions.
Approach/Strategy:
The basic principle underlying this research program is that interventions must
be developed based on extensive knowledge about the population for whom the
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interventions are designed. For this reason, the AWAS and SBS data have been
invaluable in assisting in designing the initial interventions.
In addition, sexual behavior is influenced by biological factors was well as by
learned social and cultural patterns. Because of this, changes in sexual behavior
are difficult to achieve and interventions will be differentially effective. Thus,
behavioral, sociodemographic factors such as age, race, ethnicity, and gender,
and neurobehavioral factors such as coping and cognitive style, will influence the
impact of these preventive interventions. One of the goals of BPP interventions
is to identify individuals or clusters of individuals, as defined by the above
factors, who are most amenable to the different interventions being evaluated.
In order to ensure maximum comparability across BPP studies, we have
developed a core set of assessment measures for seropositive and seronegative
samples. Hence questions about risk behavior are asked in identical ways with
identical measurement units. Although sampling procedures for studies differ,
thereby limiting exact comparisons, rough comparisons can be made concerning
behavior and intervention efficacy across the three services. The core measures
were developed based on the preliminary analysis of AWAS and SBS data. We
narrowed the range of questions to the most specific behavioral and associated
risk factors that had a sound psychometric basis. This allowed development of a
more abbreviated assessment measure for further study populations.
The Behavioral Prevention Program has developed a field capability at four sites,
for the purpose of evaluating a series of research protocois. These field sites are
located at Ft. Bragg, NC (USA); San Antonio, TX (USAF); San Diego, CA (USN);
and in the Washington area. Information gained from the first interventions at
each site will be analyzed by the Fall of 1995, and a plan to transition potential
interventions to the services' operational HIV Prevention Programs will be
enacted.
Current Status/Accomplishments/Plans:
Over the past twenty-four months, the Behavioral Prevention Program has
increased the momentum of its program, moving towards intervention
development focusing on populations at highest risk within the military. In
addition, the Program has developed a plan to support active field utilization of
behavioral interventions.
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1993
Completed Tri-Service HIV Biopsychosocial Study including:
1.
Seropositive Behavior Survey
2.
Psychosocial Questionnaires
3.
Neuropsychological Assessment
Completed Army-Wide AIDS/HIV Study.
Assessed Psychological Factors related to Adherence to Vaccine and Drug
Trials.
1994
Initiated RV81 - Comparison of three behavioral interventions to reduce
HIV exposure in a STD population.
Initiated RV76 - Comparison of two formats to deliver HIV education in
large group forum (Basic Trainees).
Initiated RV89 - Impact of Uncertainty and Affective Reactions of
Obstetrician Gynecologists in delivering HIV education.
Completed development of three behavioral interventions to reduce HIV
transmission in HIV+ population.
Program Successfully Reorganized to a Field Site Structure.
Current Status:
Data collection ongoing and will be completed for:
1.
RV81 - Comparison of three behavioral interventions to prevent
HIV exposure in an STD sample. (30%)
2.
RV76 - Comparison of two formats to deliver HIV education in a
large group forum. (10%)
3.
RV72 - Evaluation of an LAVD for seropositive individuals. (< 5%)
4.
RV82 - Alpha testing of two behavioral interventions to reduce HIV
transmission in HIV+ individuals. (10%)
Data collection ongoing and will be completed for Operational
Evaluations of existing HIV education efforts in each of the three services.
(30%)
Completion of RV89 . "Obstetricians-Gynecologists Affective Reactions to
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Uncertainty and Discussing HIV/AIDS During Routine Gynecologic
Care".
Preparation of manuscripts from research data bases. (15%)
Phase-out of BPP Program. ( < 5%)
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EXECUTIVE OFFICE OF THE PRESIDENT
COUNCIL OF ECONOMIC ADVISERS
WASHINGTON, D.C. 20500
'96 APR 17 A8:59
April 17, 1996
MEMORANDUM FOR WHITE HOUSE SENIOR STAFF
FROM:
MARTIN N. BAILY Madr V. Baily
SUBJECT:
March Housing Starts, Commerce Department Release,
Wednesday, 8:30 a.m.
Total housing starts fell 3.9 percent in March to an annual
rate of 1.45 million units--in line with market expectations.
The drop might be an early consequence of the March increase in
mortgage rates (chart at lower right). Despite the decline, the
level of starts in March was in the same range as during the
second half of last year.
Both single- and multi-family starts fell in March.
The decline in March was concentrated in the Western part of
the country--the same section that had seen the largest
increases in January and February.
Because starts precede residential spending by several
months, the pattern of housing starts suggests that
residential construction will make a solid contribution to
real GDP growth in the first quarter.
Building permits--an alternate and somewhat more stable
indicator of housing activity--was unchanged in March, about the
same as market expectations.
HOUSING STARTS AND BUILDING PERMITS
MORTGAGE COMMITMENT RATE
30-Year Fixed
1.70
10.00
1.60
9.00
1.50
Storts
Millions of Units (Annual Rate)
R
1.40
1.30
Permits
Percent per Annum
6.00
1.20
7.00
1.10
1.00
6.00
MAR 94
AL 94
NOV 94
MAR 95
AL
96
NOV 95
MAR 96
MAR 94 JUL 94 NOV 94 MAR 95 JUL 95 NOV 95 MAR 96