Employability and HIV infection: can the military claim to be an exception?

To determine whether policies that exclude HIV-positive recruits from military service are scientifically and ethically justified, we reviewed the literature for evidence regarding their capacity to undertake rigorous exercise, the risks and benefits of exercise regimes, their risks from opportunistic infections and the extra burden of care, within military contexts. The literature suggests that HIV-infected persons with CD4 counts within the normal range have the exercise capacity and training benefits similar to uninfected persons. Subjects with modest CD4 depression are capable of moderate to strenuous exercise, without adverse consequences. Risks from opportunistic infections are mitigated with normal CD4 counts. Neurobehavioral impairment in asymptomatic HNV-positive patients is unlikely to reduce work capacity for most military occupations and can be easily identified by appropriate neurobehavioral testing. HIV testing alone is poorly predictive of competencies required for military employment. Testing should be used to promote access to care. Use for exclusionary purposes is discriminatory.