ALCOAST 266/25 - JUN 2025 HIV POLICY UPDATES - ACCESSIONS

R 101215Z JUN 25   MID120001996800U
FM COMDT COGARD WASHINGTON DC
TO ALCOAST
BT
UNCLAS
ALCOAST 266/25
SSIC 6110
SUBJ: HIV POLICY UPDATES - ACCESSIONS
A. Coast Guard Human Immunodeficiency Virus (HIV) Program,
COMDTINST 6230.9A
B. DOD Memorandum for Secretaries of the Military Departments,
18 October 2024: Exception to Policy to Comply with Court Order
in Wilkins v. Austin, Case No. 1:22-cv-1272 (E.D. Va.)
C. DODI 6130.03, Volume 1, Medical Standards for Military Service:
Appointment, Enlistment, or Induction, May 6, 2018, as amended.
D. DODI 6845.01, Human Immunodeficiency Virus (HIV) in Military
Service Members, June 7, 2013, as amended.
1. This ALCOAST updates REF (A) as promulgated in REF (B).
2. REF (B) directs a temporary exception to REF (C). This temporary
exception complies with the Federal court order, Wilkins v. Austin,
and allows accession of certain individuals living with
Human Immunodeficiency Virus (HIV).
3. The Coast Guard accession standards are IAW REF (C). Therefore,
the CG will adhere to this temporary exception to policy. REF (B)
specifically directs a temporary exception to the policy that would
bar accessions for individuals who are living with HIV, solely where
the individual is asymptomatic and has an undetectable viral load,
that would result from application of HIV-specific provisions of
REF (C), REF (D), and any other policy that would bar accessions for
individuals solely due to their HIV-positive status.
4. An individual living with HIV is "asymptomatic" when an
individual is not experiencing any HIV-related signs or symptoms, or
adverse effects associated with medical therapy, as determined by
the individual's HIV-treating provider and confirmed by an
authorized DoD or CG health care provider or other appropriately
qualified official. An "undetectable viral load" is defined as
having clinically confirmed viral suppression of HIV, as verified
by the individual's HIV-treating provider and confirmed by an
authorized DoD or CG health care provider or other appropriately
qualified official. To demonstrate clinically confirmed viral
suppression of HIV, an individual must show:
    a. Viral load measured as <200 copies/mL on all readings
(minimum of two, taken not less than 90 days apart) for a period of
at least 6 months;
    b. Cluster of differentiation 4 (CD4) count measured as >350
cells/mm3 within the past 12 months (or last CD4 count >500
cells/mm3);
    c. Continuous compliance with an antiretroviral regimen for at
least the previous 6 months [and attest to an intention to continue
compliance].
    d. No more than 90 days prior to shipment to initial training,
the medical status of HIV-positive applicants who are asymptomatic
with a clinically undetectable viral load will be confirmed,
consistent with the requirements set forth above and existing
processes.
5. This temporary exception supersedes any restrictions currently
in Chapter 1 of REF (A).
6. Coast Guard medical officers are authorized to provide
Pre-Exposure Prophylaxis (PrEP) to service members in accordance
with Centers for Disease Control (CDC) guidance for the prevention
of HIV. This is an update to Chapter 4 of REF (A). The link to CDC
guidance can be found on the following site:
(Copy and Paste URL Below into Browser)

https://www.cdc.gov/hivnexus/hcp/prep/index.html

7. POC: CDR Gretchen Buckler, Chief, Preventive Medicine and
Population Health and HIV Program Manager. COMDT (CG-1K21),
(202) 394-4440, Email: Aileen.G.Buckler@uscg.mil.
8. RADM Paul Jung, Assistant Commandant for Health, Safety, and
Work-Life (CG-1K), sends.
9. Internet release is authorized.