1 in 20
IN THE UNITED STATES, approximately three out of every 1,000 people are HIV-positive. In the nation's capital, it's closer to 50 out of 1,000. That's a whopping 5 percent of D.C. residents: 1 in 20. Based on CIA statistics, if the District were a country, it would rank 11th in the world in HIV prevalence, between Mozambique (1 in 14) and Tanzania (1 in 23).
How did this happen?
An exhaustive report released last week by the DC Appleseed Center for Law and Justice points to a failure of leadership, one key result of which is that there are no statistics available on the number of HIV cases in the District. That's right, the 1-in-20 figure is an estimate -- widely accepted as accurate -- calculated using a formula based on national trends. The city's HIV/AIDS Administration (HAA) does report AIDS cases, but it has not yet published information about HIV infections and how they were transmitted -- information that is vital for effective targeting of services for prevention, testing and treatment.
Why should the District rely on estimates to track this deadly virus, especially when major cities including Baltimore and New York manage to publish quarterly reports on new HIV cases? The HAA ought to have at least three years' worth of HIV data. Why not release it? Part of the problem reportedly is severe staffing shortages. More than half of the positions in the HAA's surveillance division, which is responsible for compiling the statistics, are vacant. The money to fill these positions has already been allocated -- the agency should have started hiring long ago. There is one vacancy, however, that requires much more thoughtful consideration. Lydia L. Watts, head of the HAA, was fired yesterday. Now Mayor Anthony A. Williams has an opportunity to find someone who is competent, dedicated (it is rare for an HAA chief to last more than a year) and willing to fix the problems plaguing this poorly managed agency.
The HAA does not lack money. In the past, however, funds have gone unspent or have been spent unwisely, such when Ms. Watts decided to plow more than $400,000 into a World AIDS Day event last year. New leadership should direct resources where they are most needed: to existing clinics around the city where same-day HIV tests should be offered; to public schools so youth can receive information on how to prevent the spread of the disease; and to treatment service providers desperately in need of assistance in navigating the complicated grant process. Grant money is allocated by the federal government based on need. The District's failure to produce data on HIV infection rates as well as the mismanagement of programs put funding -- and lives -- at risk.
The mayor has pledged to take a hands-on approach to the problem. It's about time. After all, the city led by Mr. Williams, president of the National League of Cities, has the unenviable distinction of being neck and neck with developing countries for the world's HIV Top 10.