A federal appeals court ruling on Wednesday reaffirmed broad judicial deference to the U.S. military and dealt a major setback to HIV and LGBTQ+ advocates by reinstating the Pentagon’s longstanding ban on people living with HIV from enlisting in the military, reversing a lower court ruling that briefly opened the door to qualified recruits with undetectable viral loads.
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The 4th U.S. Circuit Court of Appeals in Richmond, Virginia, overturned a 2024 district court ruling that declared the ban unconstitutional and out of step with modern medicine. The decision reinstates a categorical exclusion that advocates have tried to repeal for years, and it does so by relying heavily on one of the judiciary’s most enduring habits: deference to the military.
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The three-judge panel consists of Judge Paul V. Niemeyer, appointed by George H.W. Bush, and Judges Julius N. Richardson and Allison Jones Rushing, appointed by President Donald Trump. Niemeyer wrote the opinion, which was joined in its entirety by Richardson and Rushing.
The case was brought by three people living with HIV, Isaiah Wilkins, Carol Coe and Natalie Noe, and Minority Veterans of America, a nonprofit that supports service members from marginalized communities. All three plaintiffs had undetectable viral loads and were maintained on daily antiretroviral medications. From a clinical perspective, this detail is decisive: people with persistently undetectable viral loads do not transmit HIV and live long and healthy lives. The scientific basis for this is not controversial. From a public health perspective, this has been resolved.
But the court did not view the case as a referendum on science.
Niemeyer describes the debate as one about the role of institutions and constitutional boundaries. He emphasized that the Constitution gives Congress and the President, not the courts, primary authority over the composition and supervision of the armed forces. When judges review military policy, even policy involving constitutional rights, they do so with respect.
From this perspective, the HIV enlistment ban remains in place.
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The Defense Department and Army argue that even when HIV is managed properly, it creates operational complications: Service members must have uninterrupted access to daily medications, require regular laboratory monitoring, and cannot participate in the Army’s “mobile blood bank” system—an emergency practice in combat zones in which soldiers donate blood directly to each other. The government also noted that restricting the presence of people living with HIV in countries would lead to higher long-term medical costs and diplomatic complications.
The court said that any of these reasons would be sufficient under the permissive “rational basis” standard of review, particularly in a military context where the court has “high regard” for professional judgment regarding preparation and deployment. The panel concluded that together they were sufficient.
The ruling erases a major victory for the plaintiffs in August 2024, when a federal judge in Virginia found the policy “unreasonable, arbitrary and capricious” and barred the government from enforcing HIV-specific draft rules. The decision also orders the Army to reconsider removing Wilkins from its military readiness program. For more than a year, the military accepted qualified recruits with well-managed HIV, until the 4th Circuit Court in December put the ban on hold. Supporters say the experiment proves the policy’s underlying assumptions are wrong.
“The military’s success in admitting qualified personnel with well-managed HIV from August 2024 until the moratorium takes effect demonstrates that people living with HIV can serve effectively alongside their comrades,” Lambda Legal said in a statement after Wednesday’s ruling. “Today’s decision ignores real-world evidence and returns to outdated policies rooted in stigma rather than science.”
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Lambda Legal, representing the plaintiffs, roundly condemned the decision. “We are deeply disappointed that the Fourth Circuit chose to uphold discrimination against a medical reality,” said Gregory Nevins, the group’s senior counsel and director of the Employment Equity Project. “Modern science is clear that HIV is a chronic, treatable disease. People with undetectable viral loads can be deployed anywhere, perform all duties without restrictions, and pose no risk of transmission to others. This ruling ignores decades of medical advancement and the proven ability to serve people living with HIV.”
Scott Schoettes, who argued the case on appeal, said the court’s reliance on deference went too far. “As the Fourth Circuit and district courts have previously held, respect for the military does not imply irrational decision-making,” he said. “Today, service members living with HIV serve in a variety of roles within the military and are fully deployable into combat. Denying others the opportunity to join their ranks is just as unreasonable as the military’s previous refusal to deploy service members living with HIV.”
Supporters had hoped the court would follow the logic of earlier cases that forced the military to abandon sweeping restrictions on service members who contracted HIV while in uniform. In these cases, the justices recognized that modern treatments had transformed HIV from a fatal diagnosis to a manageable chronic disease, and that policies based on old fears no longer made sense.
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The Fourth Circuit distinguished between these precedents. The panel noted that in these cases, people are already serving and sometimes receive individualized exemptions. In contrast, this case concerns the front door: who can attempt to provide service. The court said the military had the right to take a tougher stance.
As a result, many supporters see this legal posture as disconnected from life outside the courts. In civil society, people living with HIV serve as doctors, teachers and first responders. In public health, “U=U” — undetectable equals untransmittable — has become a cornerstone of education. In federal courts, however, HIV remains a legally sufficient reason for absolute exclusion, as long as the excluding agency is the U.S. military and the judiciary is willing to defer.
What happens next is uncertain. The plaintiffs could seek a rehearing in the Fourth Circuit or ask the U.S. Supreme Court to take up the case.
This article originally appeared in The Advocate: Federal appeals court upholds Pentagon’s push against science, reinstates U.S. military’s AIDS enlistment ban
