Once at Front Line of AIDS War, District Is Now Fighting Blind

By Jose Antonio Vargas
Washington Post Staff Writer
Sunday, March 26, 2006

This is what the AIDS epidemic looks like in the District of Columbia: a disease traveling generations.

Inside the Correctional Treatment Facility, right next to the D.C. jail, there's the 34-year-old who has full-blown AIDS. She was infected with HIV by the same man who infected her mother. A few miles away, on the second floor of an apartment building in Southeast Washington, there's the 29-year-old who was infected by a childhood friend. She's four months pregnant. He's dead. And in a Northwest Washington home, there's the entire family -- the mother, 36, the father, 34, their 1-year-old baby girl -- living with HIV.

Twenty years ago this month, the District was a pioneer, one of the first U.S. cities to appoint an AIDS director and create an AIDS office to monitor the epidemic and care for those afflicted. Yet, despite the city's decades-long fight against the disease -- and amid long-standing, well-known problems in the AIDS office -- the District's new top AIDS official says the work in tracking the epidemic's scope is "beginning all over again." She can tell you how many people in the District have AIDS -- nearly 10,000. She won't be able to tell you anytime soon how many have HIV, the virus that causes AIDS.

"It's pretty pathetic, and I mean, you know, I gotta tell you, I keep this little thing up," says Marsha A. Martin, pointing to a brochure on her desk called "HIV: Getting the Facts."

"It's symbolic, emblematic of 'Let's get the facts here, folks. Let's go to the facts. Let's do straight talk.' You can argue with estimates all over the place. We don't know here."

The city's efforts to meet the basic needs of AIDS education, condom distribution and tracking HIV rates have lagged years behind the spread of the disease, an independent study has noted. By the early 1990s, the disease that had ravaged gay men began a silent march through the city's poor, predominantly black neighborhoods. The epidemic broadened its course. The city, for the most part, did not. It spent money. Nearly half a billion dollars in federal and local funds in the past eight years, city records show, were distributed to the dozens of community groups charged with prevention, housing and health care. But without a map of new HIV infections, the city was unable to recognize where AIDS was heading.

"We captured the early epidemic," says Martin, a former head of the national advocacy group AIDS Action, who took over the Administration for HIV Policy and Programs (AHPP) in September. "We are not capturing today's epidemic."

AHPP reports that nearly 1 out of 50 District residents is living with AIDS. The nation's capital has the highest rate of new AIDS cases in the country -- 179.2 per 100,000 in 2004 -- according to the Centers for Disease Control and Prevention, which ranks the District alongside the 50 states. AHPP has yet to report the city's rate of HIV infection, although it has been collecting those data since December 2001 through a "code-based" system that shields a person's identity, an alternative to a "name-based" system. "We have some data," Martin says. "We're not sure what it means."

"There is no one in D.C. who believes our HIV data is reliable," Martin continues, adding that the District is behind all major cities in monitoring the epidemic. Baltimore also collects HIV data through a "code-based" system but issues detailed quarterly reports of its new HIV numbers. "We can't tell you how accurate our HIV data is."

HIV can incubate for years. To understand what was happening with the epidemic a decade ago, experts say, look at current AIDS data. To understand what is happening right now and what will happen in the future, look at the HIV data.

A report card issued Thursday as a six-month update to the independent study by the D.C. Appleseed Center earned AHPP a rare round of applause from local AIDS advocates: a B-minus for making AIDS a top priority in the District, a B for providing rapid HIV testing at city-run facilities. But the situation was so bad before the center issued its report, say AIDS workers, that the only place to go was up.

Most telling about the report card was the grade it assigned for reporting and collecting HIV data: "Incomplete."

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New AIDS Cases in the District
Number of people living with AIDS who were diagnosed in 2004.
New AIDS Cases in the District
SOURCE: District of Columbia Department of Health, AHPP | GRAPHIC: The Washington Post - March 26, 2006
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