Skip main navigation

Military Health System

Clear Your Browser Cache

This website has recently undergone changes. Users finding unexpected concerns may care to clear their browser's cache to ensure a seamless experience.

Surveillance Snapshot: A Comparison of the Rate of HIV Incidence in the Active Component U.S. Military with the U.S. Population in 2021

Image of 36019063. The annual crude rate of new HIV infections in the U.S. military between 2018 and 2023 was 21 per 100,000 population.

The 2022-2025 National HIV/AIDS Strategy to end the HIV epidemic by 2030 includes an implementation plan that directs the Department of Defense (DOD) to “continue to implement interventions, testing, education, and training on the prevention of transmission of HIV infection as described in DODI [DOD Instruction] 6485.01, DHA-PI [Defense Health Agency-Procedural Instruction] 6025.29, and DHA-PI 6485.01.”1,2 

The annual crude rate of new HIV infections in the U.S. military between 2018 and 2023 was 21 per 100,000 population,3 much higher than the estimated 11.5 per 100,000 in the U.S. general population in 2021.4 A comparison of U.S. military and general population rates of HIV infection, adjusted for relevant confounding variables, has not been published, neither for U.S. military HIV incidence rates among different races and ethnicities. This Surveillance Snapshot presents a comparison of U.S. active component military and general population HIV incidence rates in 2021,4 the most recent year for which stratified U.S. data were available, using indirect standardization by sex, age, and race and ethnicity. 

There were 174 observed cases of HIV in the U.S. military in 2021 who self-identified their race and ethnicity as Black, Hispanic, or White, compared to an expected number of 335 based on U.S. population rates,5 resulting in an overall standardized morbidity ratio of 0.52 (Table). The rate of HIV in the active component U.S. military was 48% lower than the U.S. general population rate after adjusting for sex, age, and race and ethnicity. SMR estimates stratified by race and ethnicity were similar for non-Hispanic Black and White service members (0.59 and 0.60, respectively) but lower for Hispanic service members (SMR=0.32). SMRs for racial and ethnic groups other than White, Black, and Hispanic cannot be presented because U.S. general population rates have not been not published for additional groups.4

Click on the table to access a 508-compliant PDF version

Since the U.S. military requires HIV testing at least biennially,6 it is unlikely that significant numbers of cases in the U.S. military are being missed, whereas infected individuals might be undiagnosed for longer periods of time in the general population if untested, leading to underestimates in younger populations. 

The findings from this Snapshot may help to contextualize lower use (24%) of HIV pre-exposure prophylaxis in 2021 among those in the U.S. military with indications for its use, published in this issue of the MSMR,7 compared to those at risk in the general population (30%). The lower adjusted U.S. military rate of HIV infection may be due to unmeasured behavioral or other factors rather than increased use of PrEP. These findings are consistent with the presence of a selection bias (or ‘healthy warrior effect’) resulting from the exclusion of HIV-infected individuals from entry into service,8 as some of those with higher-risk sexual behaviors would have already been infected. Despite the lower adjusted rate of HIV infection in the U.S. military, HIV remains a threat to force health protection due to its costs, health consequences, and impact on military readiness.9 

Author Affiliations

Uniformed Services University Department of Preventive Medicine and Biostatistics: Dr. Mancuso; Epidemiology and Analysis Branch, Armed Forces Health Surveillance Division, Defense Health Agency: Dr. Mabila 


The contents of this publication are the sole responsibility of the authors and do not necessarily reflect the views, assertions, opinions, nor policies of the Uniformed Services University of the Health Sciences, the Defense Health Agency, or the Department of Defense. 


  1. The White House. National HIV/AIDS Strategy for the United States 2022-2025. Accessed Jul. 9, 2023. 
  2. The White House. National HIV/AIDS Strategy Federal Implementation Plan. Updated Aug. 21, 2023. Accessed Nov. 4, 2023. 
  3. Armed Forces Health Surveillance Division. Update: routine screening for antibodies to human immunodeficiency virus, U.S. Armed Forces, active and reserve components, January 2018-June 2023. MSMR. 2023;30(9):2-10. 
  4. Centers for Disease Control and Prevention. Estimated HIV Incidence and Prevalence in the United States 2017-2021. Updated May 23, 2023. Accessed Nov. 4, 2023. 
  5. Inskip H, Beral V, Fraser P, Haskey J. Methods for age-adjustment of rates. Stat Med. 1983;2(4):455-466. doi:10.1002/sim.4780020404
  6. Under Secretary of Defense for Personnel and Readiness. DOD Instruction 6485.01: Human Immunodeficiency Virus (HIV) in Military Service Members. Department of Defense. Updated Jun. 6, 2022. Accessed Nov. 4, 2023. 
  7. Mancuso JD, Ahmed AE. Coverage of HIV pre-exposure prophylaxis (PrEP) in the active duty U.S. military, 2023. MSMR. 2024;31(3):13-16. 
  8. Office of the Under Secretary of Defense for Personnel and Readiness. Department of Defense Instruction 6130.03, Volume 1. Medical Standards for Military Service: Appointment, Enlistment, or Induction. Department of Defense. Updated Nov. 16, 2022. Accessed Jul. 7, 2023. 
  9. Cavanaugh JS, Murray CK, Chang D, Ake JA. The purpose and impact of the U.S. military HIV research program. JFQ. 2023;110(3rd quarter):69-74.

You also may be interested in...

Apr 1, 2024

Reportable Medical Events at Military Health System Facilities Through Week 9, Ending March 2, 2024

This report provides a monthly updatea of Reportable Medical Events documented in the Disease Reporting System internet (DRSi) by health care providers and public health officials throughout the Military Health System. Reportable Medical Events are a critical tool for monitoring, controlling, and preventing the occurrence and spread of diseases of ...

Mar 1, 2024

Coverage of HIV Pre-Exposure Prophylaxis Within the Active Duty U.S. Military, 2023

This study provides the first estimate of HIV pre-exposure prophylaxis coverage in the U.S. military, defined as the proportion of the persons taking HIV PrEP out of the estimated number of persons who had indications for it, that is also comparable to U.S. civilian estimates. The population with indications for HIV PrEP was obtained from the ...

Mar 1, 2024

Mid-Season Influenza Vaccine Effectiveness Estimates Among DOD Populations: A Composite of Data Presented at VRBPAC—the Vaccines and Related Biological Products Advisory Committee—2024 Meeting on Influenza Vaccine Strain Selection for the 2024-2025 Influenza Season

This is an introduction to a composite of three Surveillance Snapshots of Department of Defense data on mid-season influenza vaccine effectiveness that were presented at the 2024 VRBPAC meeting.

Mar 1, 2024

Tobacco and Nicotine Use Among Active Component U.S. Military Service Members: A Comparison of 2018 Estimates from the Health Related Behaviors Survey and the Periodic Health Assessment

This study compared estimates of the prevalence of and risk factors for tobacco and nicotine use obtained from the 2018 Health Related Behaviors Survey and Periodic Health Assessment survey. The HRBS and the PHA are important Department of Defense sources of data on health behavior collected from U.S. military service members.

Mar 1, 2024

MSMR Vol. 31 No. 3 - March 2024

.PDF | 1.34 MB

The March 2024 MSMR features a comparison of 2018 estimates from the HRBS and the PHA on tobacco and nicotine use among the U.S. military active component; followed by a report on coverage of HIV PrEP among active duty service members in 2023; supplemented by a Surveillance Snapshot of HIV PrEP prescriptions in 2023 in the active component; then a ...

Skip subpage navigation
Refine your search
Last Updated: May 07, 2024
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on X Follow us on YouTube Sign up on GovDelivery