District Earns Mixed Review In Fighting the Spread of HIV

By Susan Levine
Washington Post Staff Writer
Thursday, March 23, 2006

Six months after an independent study censured the District's response to the HIV/AIDS crisis, a follow-up report praises officials for focusing more attention on the epidemic but calls their progress uneven and indicates that the city is losing ground on condom distribution.

The latest review by the D.C. Appleseed Center for Law and Justice, released today, reveals how much work remains before a city with some of the country's highest infection rates experiences any real turnaround in the spread of the virus. Compared with the 290,000 condoms given out in 2004, for example, the District distributed only 125,000 last year, a quarter of its goal. The report calls condoms "one of the most basic, universal, safe and effective prevention methods."

And although D.C. Appleseed recognizes Mayor Anthony A. Williams (D) for being more outspoken about combating HIV/AIDS, it points out that he has yet to name an executive-level task force that the initial study recommended as critical to overseeing reforms. Superintendent Clifford B. Janey is months behind his school board's request for a plan to strengthen the school system's HIV/AIDS policy.

"Controlling HIV/AIDS requires determination and commitment from our public officials" that has not been fully shown, the report concludes.

Last August, the public service group released "HIV/AIDS in the Nation's Capital" in response to the mayor's concerns that tens of millions of dollars in programs were having little impact. The law firm of Hogan & Hartson donated more than 4,000 hours of research and writing toward the 170-page study and additional time toward today's report card -- the first in a series.

Today's report does not give the District a score for its overall effort to date but assigns grades of B+ to D for how the city has acted on each of 12 recommendations from the August study. In an interview, Appleseed Executive Director Walter Smith was cautiously hopeful that a quarter-century into the disease, a new counterattack might be possible. An estimated one in 20 District residents is infected with HIV, and the city's annual rate of new AIDS cases is almost 12 times the U.S. average.

"Have we seen forward movement? Have we seen forward progress?" Smith asked. "The answer is we have."

Leadership tops the evaluation criteria in symbolic and actual importance. The report describes a "surge of constructive energy" and applauds the efforts of a number of officials, including D.C. Council member David A. Catania (I-At Large) for the pressure he exerted to expand HIV testing at city-run facilities and to ensure timely payments to nonprofit groups delivering much of the care and counseling. Until a series of scathing hearings last summer, the city was so behind in reimbursing some organizations that several were on the verge of closing.

The report gives the most credit to Marsha Martin, the new head of the District's renamed Administration for HIV Policy and Programs. Health Director Gregg A. Pane hired her after firing her predecessor within days of Appleseed's findings last summer. Martin quickly began advocating expanded condom distribution -- talk that has yet to be followed by action -- and supporting needle exchange programs.

"She's saying things that haven't been said publicly before," Appleseed Deputy Director Josh Levinson said.

The executive director of Prevention Works agreed. Paola Barahona described "an attitude change within the administration" that soon could result in public funding of counseling and testing at her organization, the only group in the District doing needle exchange. Although a third of new AIDS cases in the District may result from intravenous drug use, Congress has prohibited the city from using government money to provide injection drug users with clean syringes.

Martin also is supporting a partnership with the George Washington University School of Public Health and Health Services that would take over her agency's data collection and monitoring. The school's senior epidemiologist is expected to direct some of the agency's hiring.

Pane yesterday defended the department and gave it much higher marks, including a "solid A for effort and solid B for performance." Pane added, "I still embrace the report, but I think they graded low."

Appleseed faults the District for inconsistent improvement on other fronts. The city's TB Clinic continues to offer HIV testing only to people with confirmed cases of active tuberculosis -- federal guidelines urge testing on suspected TB cases, too -- and it has not implemented the "rapid testing" that produces immediate results. "According to medical experts, this is a crucial missing link," today's report says.

The District received a D+ for its still limited number of substance abuse treatment options. In a city where 60,000 men, women and children are addicted to alcohol or other drugs, putting many of them at risk of HIV infection, funding for the Addiction Prevention and Recovery Administration has declined in the past eight years. Its detoxification center has 80 beds. In 2005, the mayor did not follow a recommendation of his own task force on substance abuse that $12 million be appropriated to increase bed numbers and other treatment services.

"The commitment has not been there," said Naomi Long of the Drug Policy Alliance, who is leading a new coalition of community groups to press for greater treatment options. "Even now, the money does not speak to a serious shift of priorities."

Staff writer Eric Weiss contributed to this report.

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