March 18, 2011

It was not surprising to see the news that the District has lost ground in the fight against HIV/AIDS. Despite plenty of attention given to the pandemic in Washington, there has been no real systemic change. There are no new ideas or calls to action; just hollow statements like “leadership and public engagement must go deeper” and “the mayor has made the disease his No. 1 health priority.” These are about as meaningful as a coach at half-time saying “we need to execute better” when it’s the game plan that’s the problem.

News like this contains no content. To start, there is no distinction between “HIV” and “AIDS,” a constant oversight. Statements about making AIDS a priority say nothing. Mayor Vincent C. Gray has appointed a new commission? That step has been taken before, and rarely does it generate what’s needed. The system has become so entrenched that it lacks the ability to see any options outside of itself — and there are many.

Despite major advancements in testing, treatment and social outreach, there has been little change in the HIV/AIDS bureaucracy, and shamefully low bars set for action. The vision of the much-hyped “National Strategy” — to reduce new incidences of HIV transmission by 25 percent over five years — means 200,000 instead of 280,000 people get HIV.

This is unacceptable. Instead, we should be promoting bold visions and concrete community action. Here’s one idea: By the time the International AIDS Conference gathers in the District next summer, all people living and working in the District should know their HIV status. Knowledge is our best weapon, and knowing one’s status is essential to any effort to stop the spread of the virus.

I’m not suggesting some benign campaign about AIDS, but a real, all-out effort to get HIV tests out to all every arena possible. The capability exists; HIV tests are portable and fast and can be self-administered. We should be tapping their full potential to empower and educate people.

Here’s how it could work:

l Create a marketing campaign that encourages the District to be an example of a community of bold action rather than a city vying for attention with a tale of woe. As part of this campaign, call on all people who live and work in the District to “Know Their Status.” To overcome any stigma, the campaign should employ images demonstrating that “everyone” really means everyone.

l Train the helping professions, such as psychologists, social workers and professional counselors, about self-testing. If counseling is an issue, these professionals should be prepared to assist before, during and after the test is administered.

l Do away with pre-test screenings. They are essentially interrogations and, like most interrogations, result in suspect information.

l Enlist faith groups and people with HIV to help with the needed education and support. Build partnerships across the divides of this fragmented city. Encourage high schools to help make sure all 2012 graduates know their status, and hold events offering opportunities for testing. Similarly, all college campuses should be engaged.

l Consider “door-to-door” campaigns, engaging legions of volunteers.

This is just a starting point. No doubt there would be issues of concern (such as counseling and getting people into treatment), but concerns are not barriers, just considerations. We would also need federal exemptions related to all this self-testing, but if giving HIV medication to high-risk, uninfected people can be seriously considered by the National Institutes of Health, surely we can try to use self-tests more effectively.

Employing modern social networking, our existing coalitions and the right treatment resources, all of this is possible. The only thing missing is the will to free ourselves from the institutional myopia and blame that pervades the current system. Bold action now would allow us to greet the HIV/AIDS world in 2012 with our heads held high.

The writer is program coordinator at the William Penn House in Washington and founded the Mosaic Initiative, an HIV-prevention organization.