D.C. officials battle HIV/AIDS epidemic
Can the HIV/AIDS epidemic in the District of Columbia get any worse? Recent statistics suggest it already has.
The District's HIV/AIDS Administration's 2009 Epidemiology Update reported 3.2 percent of Washingtonians over the age of 12 were living with the virus at the end of 2008, compared to three percent of the District's residents who were living with HIV/AIDS at the end of 2007. The agency reported roughly 7.6 percent of Washingtonians between 40-49 and 5.8 percent of those between 50-59 were living with HIV/AIDS at the end of 2008, but its latest surveillance report reaffirmed the epidemic continues to disproportionately impact the District's black residents.
More than 7 percent of black men in the District were living with HIV/AIDS at the end of 2008, compared with 2.8 percent of white males and only .2 percent of white women. HIV/AIDS Administration figures show 6.5 percent of black men, 2.6 percent of white males and .2 percent of white women in the District were living with the virus at the end of 2007.
Blacks are 52.2 percent of the District's population, but they comprised 75.6 percent of the total HIV/AIDS cases at the end of 2008. The HIV/AIDS Administration further reported 4.7 percent of black Washingtonians were living with the virus through the same period.
The Centers for Disease Control defines an epidemic as a general prevalence of more than one percent-the District's rates rival those found in some sub-Saharan African countries. Why is the District's HIV/AIDS rate so high? The answer could lay in the fact more Washingtonians know their status than they did a decade ago.
Opt-out testing and condom distribution
The HIV/AIDS Administration launched an initiative in 2006 that encourages doctors and other health care providers to offer opt-out HIV testing to their patients. The number of publicly supported HIV tests has more than doubled over the last four years. And while HIV/AIDS rates have risen 22 percent since 2006, public health officials stress expanded testing and a more comprehensive names-based reporting system provide a much more accurate snapshot of the epidemic in the District.
"The lynch pin to our response is HIV/AIDS testing," said Dr. Nnemdi Kamanu Elias, interim director of the HIV/AIDS Administration. "We feel if people know their status, their behavior will be modified."
The HIV/AIDS Administration has also distributed more than three million free condoms and lubricant packages to bars, clubs, restaurants, barber shops, hair salons and even liquor stores throughout the city since Oct. 2008. "Everybody can be offered this really cost-effective prevention method," said Elias.
Fuk!T goes outside the box
The Fuk!T Campaign distributes kits that contain two condoms, lube and safer-sex information at the Green Lantern, Secrets and other gay bars, clubs and organizations in Washington. Gay porn stars Matthew Rush and Brent Corrigan also appear in campy, but sexually explicit PSAs.
Dan O'Neill, chair of the DC Center's Gay, Bi, Trans HIV Prevention Working Group who developed Fuk!T with Dr. Terence Gerace, said the campaign's goal is to eroticize safer-sex among MSMs. "This is a way to educate gay men," he said.
The District's Department of Health awarded the Center a $60,000 grant from the CDC to fund MSM-specific safer-sex programs. The CDC's 2010 National HIV Behavioral Surveillance Study (NHBSS) reported 14.1 percent of MSMs in the District are living with HIV, with men older than 30 comprising 75 percent of these cases. The Southern AIDS Coalition MSM Project estimates around 19 percent of the city's MSMs are living with HIV/AIDS.
Nearly 25 percent of black MSMs who participated in the CDC study were positive, but at least one HIV/AIDS service provider maintains safer-sex messages have begun to have a positive effect.
Even though the NHBSS concluded more MSMs of color are living with HIV/AIDS than white men, they were twice as likely to have used a condom during the last time they had sex. The HIV/AIDS Administration also reported 37.2 percent of new AIDS cases among black men in the District from 2004-2008 were from unprotected homosexual sex, compared with 20.9 through heterosexual sex and 20.8 percent through intravenous drug use.
"Blacks are using condoms, have less partners than whites and Latinos," concluded Ron Simmons, president of Us Helping Us, an organization that offers HIV/AIDS prevention and care services to MSMs in the District, suburban Maryland and Northern Virginia. "By not recognizing that, the assumption is black gay men are all having this wild gay sex. When you look at the data, it's just the opposite."
Simmons further questioned whether HIV/AIDS Administration's data is skewed towards white gay men. The NHBSS found younger men who bottomed for older men were less likely to use a condom. Younger men who participated in the study were twice as likely to have sex with an older man. But Dr. Ray Martins, medical director for Whitman-Walker Clinic, expressed doubt over whether safer-sex messages have taken hold.
"It sounds good, but they haven't worked in the degree [they should,]" said Dr. Ray Martins, medical director for Whitman-Walker Clinic. "We shouldn't give up on the behavioral; but they can't be the only way you fight the disease."
Poverty exacerbates the epidemic
Thirty-six percent of Ward 8 residents lived below the poverty level in 1999; compared with only 7.4 percent of those who live in Ward 3. The HIV/AIDS Administration reported 3.4 percent of Ward 8 residents were living with HIV/AIDS at the end of 2008, compared with only .4 percent of residents in Ward 3. Ironically; the Department of Health reported 81.4 percent of Ward 8 residents had taken an HIV test in 2004, compared with only 55.5 percent of those who lived in Ward 3.)
"Epidemics of poverty, of drug use, of gender disparities and homophobia and racism all play in and work together in promoting the spread of HIV," noted O'Neill. "Certainly in the District, it's been outlined in our epidemiology. There's a lot that's being done to address the groups most hard hit."
Mayor Adrian M. Fenty in January announced the $26.4 million DC Partnership for HIV/AIDS Progress with the National Institute of Allergy and Infectious Diseases to further combat the epidemic in the District. The number of new AIDS cases in the city dropped 33.2 percent from 2004-2008, while AIDS-related deaths decreased roughly 30 percent from 2004-2007. One of the initiative's primary objectives is to expand access to health care, medications and other services to those with HIV/AIDS.
"Medication intervention is the best bet at curbing the epidemic that's already so entrenched in the community here," acknowledged Martin. "If the majority of people go on medications with viral loads [that are] undetectable, that's probably the best bet."
The District has also worked with community and faith-based groups in the hardest hit wards. The Effi Barry HIV/AIDS Program, which is named in honor of former Mayor Marion Barry's third wife, has helped more than 100 organizations in Southeast expand their capacity to fight HIV/AIDS. "We're at where the epidemic is now," said Elias, stressing HIV/AIDS remains a citywide problem. "Even as the epidemic changes, we're prepared to change with it."
Gray "not just paying lip service" on HIV/AIDS
Some activists and HIV/AIDS service providers in the District questioned whether Fenty had done enough to tackle the epidemic. Doctor Shannon Hader abruptly resigned as head of the HIV/AIDS Administration in June, but O'Neill expressed confidence in Mayor-elect Vincent Gray's commitment to fight HIV/AIDS the District once he takes office in January.
"He's definitely worked with the HIV/AIDS community in DC in the past and seems to be well versed in issues around HIV/AIDS in the gay community," he said, noting he has met with representatives from DC Fights Back, Housing Works and other HIV/AIDS service organizations. "I'm comfortable moving forward. Vince Gray gets it, is invested, and that's not just paying lip service."