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SASEBO NAVAL BASE, Japan — More than nine months have passed since the Navy decided to open overseas and large-ship-platform assignments to HIV-positive sailors and Marines, but not a single sailor has gotten one.

The Navy’s Personnel Command is grappling with how to implement the instruction, which also covers blood-borne pathogens like hepatitis B and C.

Personnel Command officials declined to comment on when the policy — handed down by Secretary of the Navy Ray Mabus in August — would take effect. Instructions can take time to implement, Personnel Command spokesman Lt. Cmdr. Rob Lyon told Stars and Stripes in an email.

The Navy’s Personnel Command recently completed a review of Mabus’ instruction to ensure affected sailors will have the greatest opportunity to be successful, and to address any concerns by their receiving commands, Lyon said. “We will more than likely have more to discuss” once the implementation guidance has been reviewed by all parties, he said.

The policy opened the assignments to HIV-positive sailors and Marines who are stable and have minimal medical complications, Bureau of Medicine and Surgery spokeswoman Shoshona Pilip-Florea told Stars and Stripes in December.

The policy change is important because sailors barred from overseas and at-sea duty have few career options, which in turn can affect their advancement opportunities.

The change was made because of medical advances that allow someone who contracts the human immunodeficiency virus to live 20 to 30 years without adverse health effects, taking as few as one pill per day.

The implementation guidance gives medical personnel, detailers and receiving commanders veto power for each request “based on the medical risks and needs of the Navy,” depending on whether the command in question could “support care,” Pilip-Florea said. Prospective recruits are precluded from joining the services if they have the virus, which causes AIDS.

“The policy change better aligns the treatment of HIV with how other chronic illnesses are managed by Navy Medicine,” Pilip-Florea said. “In the case of HIV-positive servicemembers, these personnel and the services have put a lot of time and effort into their careers, and there is no medical reason for them not to be able to continue serving with pride.”

Pilip-Florea said the biggest change from the previous policy for HIV-positive sailors and Marines comes in added flexibility in case management. Those servicemembers no longer would be bound to stateside medical facilities and rules that dictated the frequency of clinical evaluations.

“The frequency of clinical evaluations for HIV-infected military personnel shall be determined by the member’s health status and by nationally accepted guidelines,” the instruction reads. “On a case-by-case basis, follow-up HIV evaluations may be performed at smaller naval medical treatment facilities with the results of those appointments being reported for tracking purposes.”

Pilip-Florea said Navy Medicine does not track cost data for specific conditions or long-term chronic illnesses, so treatment costs — stateside versus overseas — are not known.

The Navy policy is unique, officials from the other service branches said.

The Army prohibits HIV-­positive soldiers from being deployed or assigned overseas, according to Col. Andrew Wiesen, Western Region Medical Center’s chief of preventive medicine and the Army Surgeon General’s preventive medicine consultant. Any soldier found to be HIV-positive while overseas will be reassigned stateside.

There are numerous reasons for the Army’s policy, including host-nation restrictions, the incompatibility of medical treatment and supply of medications with deployment, and protection of the blood supply, Wiesen said. Soldiers often are asked to donate blood in emergencies, and testing is not always reliable or complete in a deployed setting.

The Air Force also limits HIV-positive airmen to stateside assignments, according to spokeswoman Donna Tinsley. However, active-duty airmen can apply for waivers if the receiving units can provide the needed care.

“Essentially, if the OCONUS (outside the continental United States) base is in need of the position and willing to take on the member and can provide adequate care, then it’s more likely to get accepted,” she said.

However, waivers are frowned upon, Air Force officials said. HIV-positive airmen are prohibited from donating blood.

“A major concern regarding deployment would be blood donation,” Air Force Capt. Candice Ismirle said. “Refusal to do so in cases of mass casualties, etc., will cause other members to question why and may make it difficult for the patient to keep their diagnosis confidential. Also, if there was pressure to donate blood and the patient did so, there could be HIV transmission in the deployed setting.”

Ismirle said all deploying airmen must be free of medical conditions that require special appliances, frequent treatment or follow-up by medical specialists or subspecialists. The virus is disqualifying and requires a waiver to remain on flying status.

The Navy addressed the issue as HIV rates have risen steadily in the U.S. military in recent years. The Navy began testing for HIV antibodies in 1985.

The Navy found 128 HIV-­positive sailors in 1992 and 315 in 2012, including 250 on active duty, Pilip-Florea said.

The Marine Corps had 90 HIV-positive Marines in 2012 — 71 on active duty — and the Air Force had 210 on active duty, officials said.

The Army could not provide up-to-date figures due to a transition between who keeps the figures, spokeswoman Margaret Tippy said. However, in 2008, there were more diagnoses than in any year since 1995, according to an Armed Forces Health Surveillance Center report from August.

Rates have remained high, the report said. In 2012, there were 333 active-duty, HIV-positive soldiers.

OutServe, an association of active LGBT military personnel, declined to comment when reached by Stars and Stripes on Monday. The group applauded the effort when it was announced last year.

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Matthew M. Burke has been reporting from Okinawa for Stars and Stripes since 2014. The Massachusetts native and UMass Amherst alumnus previously covered Sasebo Naval Base and Marine Corps Air Station Iwakuni, Japan, for the newspaper. His work has also appeared in the Boston Globe, Cape Cod Times and other publications.
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