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Frank C. Garland, PhD; Cedric F. Garland, DrPH; Edward D. Gorham, MPH; Milan R. Miller; CAPT Steve O. Cunnion, MC; CAPT S. William Berg, MC; Louis L. Balazs, MS

Arch Intern Med. 1993;153(23):2685-2691.

Abstract
Background
The US Navy visits ports on all continents and many islands of the world, many of which are reported to have a high endemicity of human immunodeficiency virus (HIV) infection. The objective of this study was to determine whether visits to foreign ports by active-duty navy personnel were associated with increased risk of HIV infection.

Methods
The Naval Health Research Center in San Diego, Calif, maintains records of all HIV enzyme-linked immunosorbent assay and Western blot tests given in the navy. This information, along with career histories and ship movement data, was used in a nested case-control design to examine the relationship between visits to the 100 foreign ports most frequently visited by the navy and risk of HIV seroconversion. All visits to a port and total time in each port during the study period were examined. A total of 813 seroconverters were matched to 6993 seronegative active-duty controls by age, race, sex, occupational group, home port, and year of test.

Results
Estimated relative risks of seroconversion associated with visits to foreign ports showed no statistically significant excess risk of HIV infection for navy personnel after visits to any foreign port.

Conclusions
These results do not imply that an individual's risk of acquisition of HIV would be less in a foreign port if the individual engaged in high-risk activity there. Rather, they imply that despite the mobility of the US Navy and the large variation in HIV seroprevalence rates throughout the world, navy personnel generally do not appear to be acquiring HIV infections abroad.

(Arch Intern Med. 1993;153:2685-2691)

Author Affiliations
USN; USN

From the Epidemiology Division, Department of Health Sciences and Epidemiology, Naval Health Research Center, San Diego, Calif (Dr F. Garland and Messrs Gorham, Miller, and Balazs); Department of Family and Preventive Medicine, School of Medicine, University of California, San Diego, and US Public Health Service (Dr C. Garland); Uniformed Services University of the Health Sciences, Bethesda, Md (CAPT Cunnion); and Navy Environmental Health Center, Norfolk, Va (CAPT Berg).

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