D.C. Criticized for Not Treating AIDS as a Citywide Health Crisis

Without accurate, complete statistics that such epidemiological studies would provide, prevention efforts and the allocation of resources for treatment and care are severely hampered, the report contends.

The city agency, it notes, did not begin collecting HIV case reports until December 2001 and has yet to release data from those, although other major cities do quarterly postings and make numbers available for independent analysis. The District's surveillance program suffers from long-standing employee vacancies of more than 50 percent and continuing interim leadership.

"We have no way to track our progress . . . no way to judge what we're doing," said Nicole Lurie, a primary care physician who works on health policy for the RAND Corp. "It's just a disgrace."

Among the report's other major findings:

· The District's coordination and supervision of government agencies and private service providers is insufficient on several fronts, including enrollment of individuals who need medical assistance, payment and management of grants and monitoring of programs' effectiveness. (A letter from Deputy Mayor Neil O. Albert, included as an appendix to the report, says officials are moving to consolidate eligibility and enrollment procedures to help those with HIV or AIDS get medical benefits.)

· The District's prevention efforts include no strategy for routinely offering HIV testing and counseling in such settings as its tuberculosis and sexually transmitted disease clinics, substance abuse centers and hospital emergency rooms. The city's initiative to purchase and distribute condoms, which distributed just half of its goal last year, requires "expansion and improvement."

· For certain at-risk groups, services need to be strengthened considerably. The public schools pay little attention to HIV education for teenagers, with a lack of "clear, consistently applied standards" for current programs. And while there are more than 10,000 intravenous drug users in the District, the city has no comprehensive HIV prevention strategy for this population, and budget shortages have limited major improvements in substance abuse programs. Finally, D.C.'s detention facilities, where the "vast majority" of inmates have a history of substance abuse, can offer treatment to less than 2 percent of them.

"The District is in some respects 10 to 15 years behind where it should be in mounting a concerted, effective response," the report says, citing a high-ranking city official whom it does not name.

Its lengthy recommendations include quickly filling those surveillance positions, combining HIV and AIDS databases, providing case managers with more specialized training and increasing interagency collaboration. Lagomarsino said the suggested task force, which would be charged with ensuring that reforms are implemented, makes sense. She said D.C. Appleseed's call for a fall public meeting to discuss how the government will move forward seems "very reasonable."

The public interest center has notified officials that it will follow up in six months. "We think the resources are there to get the job done," said D.C. Appleseed's executive director, Walter Smith. "What's been missing is commitment from the top to make sure we allocate the resources to address the epidemic and to do so expeditiously. People are dying."

Paola Barahona, executive director of Prevention Works, which runs the city's sole needle exchange program, said she hopes the report will help build a much stronger partnership between the D.C. Health Department, the HIV/AIDS Administration and community organizations.

City officials must focus on the District's tragically high infection rates, Barahona said. "They've got a lot to do. They've got a lot of issues. They need to be reminded," she said. "This report will remind people."

The full D.C. Appleseed report can be found athttp://www.dcappleseed.org. Philippe Chiliade, medical director for the Whitman-Walker Clinic, will answer questions online today at 1 p.m.; visithttp://www.washingtonpost.com/liveonlineto participate .