Department of Defense HIV/AIDS Prevention Program [DHAPP] 2011 ANNUAL REPORT

Richard A. Shaffer, Ph.D. Executive Director

Colleagues,

Success is just around the corner! Winning the battle against HIV in military

populations is in sight. The year 2011 will be known as a period of exciting

accomplishments in fighting the HIV/AIDS epidemic worldwide. We’ve seen

successes in developing a vaccine, further indications of the effectiveness of

antiretroviral treatment as prevention, the potential widespread use of

preexposure prophylaxis, the likely elimination of vertical transmission from

mother to child, and the practical use of voluntary medical male circumcision as

part of a comprehensive prevention effort. If we can maintain the momentum

from this year and the last decade, we will soon see an AIDS-Free Generation.

But, as with any battle, it is important to push the hardest right up to the end.

This 2011 Annual DHAPP Report represents a continued escalation of support

to the countries that need it most. There are many examples of successful

partnerships between US Government agencies, partner militaries,

nongovernmental organizations, universities, community-based organizations,

faith-based organizations, and civilian society. Inside this report are the results of the work of thousands of dedicated military and civilian personnel from around the world who are working tirelessly to fight the HIV/AIDS epidemic occurring among military personnel, their families, and civilian communities

surrounding military bases. This report also documents the role of the US DoD in PEPFAR, the largest international health initiative dedicated to a single disease in US Government history. Through PEPFAR and DoD resources, the DoD

provides the world’s largest source of HIV assistance to militaries and works

with a worldwide cadre of military HIV experts to combat the harm and

devastation that HIV inflicts on the health and readiness of the world’s military

populations.

DHAPP, headquartered at the Naval Health Research Center in San Diego,

California, currently supports military HIV prevention, care, and treatment activities in 68 countries where programs impact 4.8 million military

members and at least as many dependent family members. We continue to

see growing evidence that this support is also reaching many civilian

communities that surround military bases and depend on these bases for

health care services. The entire health care systems of many militaries

around the world have benefited from the health education, health worker

training, laboratory capacity building, facilities construction, surveillance

tools, clinical treatment, and testing services provided through the collective

efforts of everyone involved in reaching military populations with HIV

services.

In 2011, PEPFAR began focusing on an accelerated country ownership

agenda so that partner countries can sustain the health sector response

and ensure that future health targets continue to be reached. The four

dimensions of country ownership as developed by PEPFAR are political

ownership and stewardship, institutional and community ownership,

capabilities, and mutual accountability, including finance. DHAPP has used

the partner-military ownership model since day one. We engage with partner

militaries at the highest levels during program design to gain leadership

commitment and ensure that HIV prevention programs are routine practice.

We work with implementing partners to emphasize capacity transfer with a

transition strategy for military ownership, support military capacity in

management and reporting for transparency, and facilitate engagement

with local institutions and stakeholders to coordinate a national and

regional response.

During the period from October 2010 to September 2011, 4,905 health

care workers were trained to provide HIV clinical services, and 68,670 HIVpositive

adults and children received a minimum of one clinical service. To

promote early and more effective treatment of HIV-infected persons, and to

encourage individuals to take preventive measures against new infections,

464,756 military and family members were counseled and tested for HIV

infection and received their test results, and 633,815 military and family

members were reached with comprehensive prevention messages.

Encouraging sustainability through the development of local capacity and

expansion of facilities remains an important priority for our program. During

this period, 174 new laboratories were equipped and supported for HIV

testing and diagnostics. New services were supported for the prevention of

mother-to-child transmission, 39,617 pregnant women knew their HIV

status based on testing and counseling services provided to them, and

2,457 HIV-positive pregnant women received antiretroviral drugs to reduce

their risk of mother-to-child transmission. This report also documents that

10,917 individuals were newly established on antiretroviral therapy, and

29,856 HIV-positive individuals received cotrimoxazole prophylaxis.

DHAPP country programs used PEPFAR’s Technical Considerations guidance

released in 2011 to identify and program the optimal combination of

prevention, care, and treatment activities to reduce new infections. Core

interventions were identified that prevent the most infections and should be

scaled up based on a country’s epidemiology and coordination with

stakeholders. In two of the core interventions, voluntary medical male

circumcision and Prevention with Positives interventions, the military has

scaled up significantly. This past year 17,941 men were circumcised as part

of the minimum package of male circumcision services for HIV prevention,

and 51,876 people living with HIV/AIDS were reached with a minimum

package of Prevention with Positives interventions.

Responding to the need to be able to document military-specific risk factors

for HIV infection, and the need to be able to quantify the impact of HIV/AIDS

on military readiness, DHAPP began the HIV Seroprevalence and Behavioral

Epidemiology Risk Survey (SABERS) last year. This initiative enables

militaries to develop effective HIV prevention programs targeted at salient

risk factors and to measure progress over time. At the end of this reporting

period, four partner militaries have completed their SABERS activities, four

are either completing data collection or analysis, and five more militaries

are developing the protocol for their SABERS.

It would be impossible to identify everyone responsible for the tremendous

success of the DoD international HIV prevention activities, but none of this

report would be possible without the contributions of DHAPP staff, members

within the offices of the Under Secretary of Defense for Policy and the

Assistant Secretary of Defense for Health Affairs, medical personnel from all

US Armed Services, personnel from each Unified Combatant Command, the

PEPFAR interagency team, members of the US Embassy Country Support

Teams, 64 nongovernmental organizations and universities, and, most

importantly, our partner military colleagues.

This is not the time to rest. We have not lost track of our original goal of

helping individual soldiers, sailors, airmen, marines, and their families. But

while achieving that goal, we have also been able to make a significant

impact on the entire military community worldwide. We should be very proud

of the work we all have done!!

Very respectfully,

Richard A. Shaffer, Ph.D.

Executive Director