Chicago Tribune (CT) - SUNDAY June 5, 1988 Edition: FINAL EDITION Section: PERSPECTIVE Page: 1 Word Count: 1,445
David Evans, The Tribune's military affairs writer

After the 1983 terrorist attack on the Marine headquarters in Beirut, for example, the wounded were given direct transfusions from their more fortunate comrades. And whole-blood transfusions are a standard feature of Navy shipboard contingency plans for dealing with mass casualties caused by fires and explosions.

Although frozen blood is often stocked, supplies are not always sufficient. Moreover, the freezing of blood reduces the concentration of clotting agents, which complicates efforts to staunch bleeding from serious wounds.

"The troops are walking blood banks for each other," said Lt. Col. Charles Heberle, a staff officer with the Army's 18th Airborne Corps at Ft. Bragg, N.C. "An infected soldier who donates blood for his wounded buddy could give him AIDS."

The military has embarked on an ambitious program of testing the ranks and potential recruits for the HIV virus, which causes AIDS. But concern about the threat from the deadly disease dates back several years.

According to Dr. John Mazzuchi, a top Pentagon health official: "Two events really brought the problem home in 1985. We were finding HIV- contaminated blood in our military blood banks. Then a recruit became desperately ill after being injected with the vaccinia virus. It's a vaccination against smallpox."

The U.S. and the Soviet Union are the only two nations administering this virus to military recruits, Mazzuchi said, "to preclude the possibility of germ warfare, because that could really wipe us out."

"In caring for the recruit, we found his immune system was shot and that he suffered from the HIV complex," Mazzuchi said.

In addition to fears about the spread of AIDS among military personnel, the Pentagon is also concerned about the risks that infection can pose for those unaware that they carried the virus.

"We did not want to send people with weakened immune systems to jungles where they're exposed to exotic diseases that they wouldn't normally encounter here," he said.

Of more than 1.8 million applicants for military service tested so far, about 3,000 have been identified as HIV carriers and denied entry into the armed forces.

"We decided to treat this disease like any other chronic disease," Mazzuchi explained. "If you have asthma, you can't come into the military."

Test results of potential recruits have shown a surprisingly stable rate of HIV infections over the last three years-about 1 infection per 700 youths. And the initial blood testing of all in-service personnel, completed earlier this year, revealed roughly the same rate of infection.

However, infection rates vary sharply by military service, ranging from 1 per 1,000 for Air Force and Marine Corps personnel to 2.5 per 1,000 for Navy personnel. The Army falls in between, with 1.4 infected soldiers per 1,000.

"I'd be shocked if the Air Force was high and the Navy was low," Mazzuchi said. "It's been my experience the Navy tends to draw people who may want to get away from problems. In the past, we've seen the Navy with the highest drug and alcohol use figures, although the Navy's made a heroic effort to bring those figures way down."

Under current Defense Department policy, military personnel who test positive for the HIV virus are not automatically discharged.

"We decided to apply the rules and regulations as they already existed for other chronic diseases," Mazzuchi said. "Namely, if you were fit to do your duty, you stayed. If you develop asthma when you're in the military, you're not automatically out."

About 1,000 HIV carriers too sick to continue their military duties have been discharged so far. And infected personnel are barred from overseas assignments. "We keep a person who's HIV positive in the U.S.," said Mazzuchi. "We can give him better care here."

Mazzuchi justifies the retention policy on the grounds that much is still not known about AIDS.

"Homosexual activity and drug use are illicit acts and grounds for discharge," he said, "but AIDS can be caused by getting a tattoo with a contaminated needle. It was so essential for us to get information on this deadly disease. We felt that if we invited someone in and said let's talk about your disease, and the person says, well, I did have a homosexual experience, could you then come in and arrest this guy? No one's going to tell you the truth, so you'd never get at the cause."

Col. Don Burke, who directs virus research at the army's Walter Reed Institute of Research, agreed.

"It was an amazingly courageous decision on the part of our military leaders not to stigmatize this disease as a homosexual affliction. There are so many ways to get it that we have to deal with HIV and AIDS as a medical problem," he said.

Both military and Veterans Administration hospitals are treating AIDS patients.

"These people are entitled to care," Mazzuchi said. "We don't just say, there's the door, get out of here."

Mazzuchi conceded the decision to retain infected personnel until they're too ill to perform their military duties remains a matter of hot debate in the Pentagon. The Army consistently has argued for immediate discharge.

"We have always viewed AIDS as a readiness issue, because these soldiers are not deployable," declared Army spokesman Lt. Col. Greg Rixson.

In fact, the Army may be ignoring Pentagon policy. Ft. Bragg spokesman Lt. Col. David Kiernan said, "We PB board immediately anyone who tests positive." He was referring to the Physical Evaluation Board, a tribunal that evaluates a soldier's fitness for duty and is empowered to recommend discharge.

Aviators are another subject of disagreement.

"There's not sufficient evidence to make any sweeping generalizations that if you're HIV positive you cannot fly, period," Mazzuchi said.

However, Jean Forte, spokeswoman for the Air Force surgeon general, said that all aircrew personnel who test positive for HIV are grounded, without exception.

"The number is so low as to be relatively insignificant," Forte said.

The military recently launched a program of continuing HIV tests of all personnel in the active force.

"These repeat tests will give us much better insight into the frequency of new infections," said Col. Bill Bancroft, who directs infectious disease research at Walter Reed. "No one else is plotting the rate of new infections over time, except for targeted high-risk groups like hemophiliacs."

Preliminary results of the military's follow-up blood testing program indicate that almost 600 new infections are showing up annually among Army troops who previously tested negative for HIV. This rate is substantially less than the incidence of infection uncovered through the initial blood testing, suggesting the education programs now in place to warn of the dangers of the disease may be having a positive effect.

"We had to take a more active stand," Mazzuchi said, "by telling our people how this disease is transmitted, trying to debunk some of the myths, and also trying to get people to change their promiscuous behavior. We tell the troops very graphically about the dangers."

"Everybody on our ship got a two-hour seminar on the dangers of HIV infection, and condoms were readily available from the ship's medical department. Everyone who got off the ship in a foreign port was aware of the risks," said Navy Lt. Ken Ross, who's now in a shore assignment as a public affairs officer in Washington.

The Army and the Air Force have similar programs. Military personnel who spread the disease through unprotected sexual contact are subject to disciplinary action.

"The troops are told if they're HIV carriers and have sex with anybody, they'll be court-martialed," said Lt. Col. Heberle at Ft. Bragg.

According to Pentagon officials, six individuals have been convicted by courts-martial so far, although not specifically of homosexual conduct. The most recent trial was that of Navy Petty Officer 2d Class John Crawford, who was charged with assault by wrongfully exposing another person to HIV.

Although acquitted of this charge, he was convicted for the lesser offense of having a female visitor in his room after hours. Three other courts-martial are still pending.

Despite the internal Pentagon policy disputes and the occasional court- martial, military health officials are convinced the overall program is sound.

"We've demonstrated you can do wide-scale routine testing for HIV, and that you can implement a program to interrupt transmission," said Col. Burke. "We have a very powerful diagnostic tool for HIV, and that's more important than all the data we've produced."

CAPTION: Graphic: Illustration by Barbara Cummings/Los Angeles Times Syndicate (drawing of a cannon).

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