How does the prevention of HIV and AIDS around the globe lead to better cooperation with our international partners and, in turn, a heightened level of security and stability around the world?

The Defense Health Agency's Department of Defense HIV/AIDS Prevention Program (DHAPP), is responsible for assisting foreign militaries with the development and implementation of culturally-focused, military-specific HIV/AIDS prevention, care, and treatment programs in 52 countries worldwide, located primarily in Africa and South America.

The DHAPP's military-centric mission zeroes in on foreign militaries' force health protection, leading to enhanced readiness both for them and for the United States.

As Dr. Brad Hale, DHAPP's chief, based at the program's headquarters at Naval Base Point Loma in San Diego, California, explains it, "The health impact of prevention translates directly into a more fit and effective force and those forces contribute to internal and, potentially, regional security."

"Investing in partner military health is an investment in their force health protection, and we have seen improvements in partner force readiness," said Hale. "A more fit military partner can contribute more significantly to national and international stability. If they are doing that, U.S. forces may not have to, which improves our own readiness by reducing U.S. military taskings."

The program was created in 2001 and was executed by the Navy on behalf of the Department of Defense in its early years. In 2003, under then-President George W. Bush, the President's Emergency Plan for AIDS Relief (PEPFAR) was established, putting the program wholly under the DOD as part of the U.S. government's international AIDS response.

Under PEPFAR, other government agencies including the U.S. Agency for International Development, Department of State, Health and Human Services and Peace Corps support foreign outreach and AIDS prevention efforts in the civilian sector, while DHAPP focuses specifically on partner militaries.

DHAPP's collaboration with partner militaries includes funding non-governmental organizations and universities in-country to do work "on the ground" in places like Ghana, Zambia and Mozambique. They also maintain program managers at embassies in every country that is part of the program as their "eyes and ears."

The Defense Health Agency took over the program in 2017, bringing with it increased oversight and support.

"When global health became an area of focus, we had already been doing it for a while, but the DHA has impacted the DHAPP program in several key areas, especially administrative and operational support," Hale said.

"Since coming over to the DHA, we have improved support for grants and contracts, fiscal operations, and administrative support. That helps us to be able to maintain more focus on our mission. We're also now grouped with other activities more aligned with what we do. Overall, it's been easier to accomplish our mission than it was before."

The relationships forged with military health care professionals throughout the world often lead to conversations beyond the scope of medicine.

"DHAPP opens doors for other conversations with partner militaries that may not have to do with health. They may have to do with other safety and security topics and other DOD priorities, and DHAPP has many longstanding relationships with these countries," said Hale.

"One key to build effective global health engagement is time," he said. "It takes a long time to gain the trust of partner militaries, to really understand the relevant issues, and to make sustainable changes. Since our mission is executed over years, we have the opportunity to create those trust relationships and make those sustainable changes.

An unintended benefit of the COVID-19 pandemic, and a function of DHAPP's international mission, was that many of its programs in-country were able to continue during the height of the pandemic because embassy workers executing them were citizens of the countries they were working in. The program was also able to make a case for the adjustment of dispensing medications more than just one month at a time.

"The traditional practice was to just give out a month's worth of pills at a time, which leads to extra burden on the patient and the facility," explained Hale. "During the pandemic, we were able to accelerate this 'multi-month dispensing' which helped relieve crowding on health care facilities and helped patients avoid frequent visits to a facility they were a bit reluctant to visit."

In the past, military physicians from partner nations participated in residencies at stateside military medical treatment facilities like Naval Medical Center in San Diego as part of the program. Now, all of the clinical training that was once done in-person has now been transitioned to an online format, which actually allows more people to participate.

Global Health Engagement activities like DHAPP serve to build trust and confidence, share information, coordinate mutual activities, maintain influence, and achieve interoperability in support of U.S. national security policy and military strategy.

Hale said, if there is any single thing that he wants people to know about DHAPP, it's that they are working to fulfill part of a mission that was started by President George W. Bush, and has been sustained by Presidents Obama, Trump and now Biden to decrease the impact of HIV across the globe to the point of creating an "AIDS-free generation."

"Our part is doing that in militaries, and I think it's working very well. I think it's actually the most successful foreign government initiative I have ever worked on," said Hale. "I think it's a really worthy cause worth finishing, but it's not done yet."