Air Force Approves HIV-Prevention Drug; Waiver Still Needed

Pre-Exposure Prophylaxis (PrEP) pill to help prevent HIV. (Getty Images/MarcBruxelle)
Pre-Exposure Prophylaxis (PrEP) pill to help prevent HIV. (Getty Images/MarcBruxelle)

The U.S. Air Force has approved the use of a medication designed to prevent HIV infection for pilots and aircrew, overriding an older policy that prohibited its use.

The service in September officially approved the use of the pre-exposure prophylaxis treatment (PrEP) medication, commonly known as Truvada, which helps reduce the risk of contracting the human immunodeficiency virus, the Air Force Surgeon General's office recently told Military.com. Last year, Military.com profiled pilots whose careers were negatively affected because PrEP had not been authorized for them.

But there's a catch: Pilots and aircrew who wish to use PrEP must apply for a waiver, said Air Force Surgeon General spokeswoman Angelica Lopez.

"As of September 2018, airmen in a flying status were able to request a waiver to use Truvada," Lopez said in an email statement. "The waiver, once approved, will help ensure providers are monitoring the safety of the medication and aircrew compliance."

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Airmen in flying status had tried to use waivers before, but their attempts were unsuccessful. Since 2012, when Truvada was approved for HIV PrEP by the Food and Drug Administration, no Air Force waivers had gone out to the rated community before the service sanctioned its use for the group, according to Col. John Oh, chief of flight and operational medicine branch.

The Air Force has since approved five waivers, while three are awaiting final determination, Lopez said.

Waivers for PrEP normally are not required for airmen in a non-flying status, said Oh, who previously served as chief of preventive medicine for the Air Force Medical Support Agency at Defense Health Headquarters.

Airmen on a flying status, however, were required have an aeromedical waiver in place to take Truvada, because it was not on the approved list of medications, Oh previously said.

The Air Force began reviewing a number of medications that pertain to aerospace medicine in August.

"The Air Force Medical Standards Working Group has been actively investigating the use of Truvada (emtricitabine/tenofovir combination drug) for HIV Pre-exposure Prophylaxis (PrEP) by airmen in a flying status," Lopez said. "The working group met to discuss the use of the drug and its impact to flying safety."

The review's results were then sent to the Air Force Flight and Operational Medicine board for a final review. The members voted to add Truvada to the approved aircrew medication list before Sept. 1.

The Surgeon General's office said waivers are necessary because they allow physicians to better monitor how a pilot or aircrew member react to the drug, Lopez said.

"Numerous medications on the approved medication list require aeromedical waivers for continued flying or special operational duties," she said. "The waiver includes a systematic, comprehensive risk assessment of the individual's condition managed by the medication."

She added, "A time-limited waiver, subject to periodic renewal, ensures the medication remains clinically necessary, [that] the medication is being taken as prescribed, and [that] the patient is free from adverse effects that could jeopardize his/her health or operational safety."

Airmen who previously spoke to Military.com said they were frustrated with the lack of clarity on the policy, knowing that some of their friends had been on the drug because their Air Force flight doctors turn a blind eye to its use, while they -- working through proper waiver channels -- had been denied.

The airmen at the time said they believe the Air Force is the least forward-thinking service when it comes to the medical needs of men who have sex with men.

They expressed concern that a confusing medical policy makes the service less attractive to gay men.

Oh said that airmen developing HIV has a clear, adverse effect on operational readiness.

But some pilots who asked to remain anonymous said being forced to choose between protecting their health and their careers also affects readiness.

Service officials, including Chief of Staff Gen. David Goldfein, say the Air Force invests between $3 million and $12 million into each pilot over the course of his or her career.

"If you lose just one fighter pilot, you can't tell me that if a congressman or congresswoman doesn't get told that [millions of dollars] was simply wasted, that they wouldn't care at the congressional level," said an Air Force major who is a special operations pilot and combat systems officer. "I would bet money that they would."

-- Oriana Pawlyk can be reached at oriana.pawlyk@military.com. Follow her on Twitter at @Oriana0214.

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