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

Adam Tenner, who heads Metro TeenAIDS, says his group also tested 100 teenagers at a go-go event in Northeast Washington last summer. One test came back positive.

Only recently did AHPP begin rapid HIV testing on inmates inside the D.C. jail, which revealed an infection rate there of between 5 and 7 percent.

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In March 1986, the District became one of the first cities to put an individual in charge of monitoring AIDS. The year before, 110 AIDS cases had been diagnosed. The following year, 222 cases. The year after that, 333. "It was something that had to be done," says Jean C. Tapscott, the city's first AIDS coordinator, who attended so many funerals in her first months on the job that she became known as the "funeral lady."

That early aggressive action gradually deteriorated in the face of leadership turnover, bureaucratic malaise and political battles.

"This didn't happen overnight," says Cornelius Baker, who has headed both the National Association of People With AIDS and the Whitman-Walker Clinic, the largest provider of HIV/AIDS services in the District. "You have to understand that all these community-based organizations are busy serving their clients. And it's not like people didn't complain. People did complain. Very often.

"But there's never really been a shakeup, an overhaul. No one has really looked at the system from top to bottom and said, 'Okay, this is not working.' "

Of all the agencies in the Department of Health, the AIDS office has the highest turnover in the top job. Martin is the 11th director in 20 years. One director after another has either thrown up his or her hands in frustration and resigned or been forced out in the heat of controversy -- over funding issues, over racially tinged battles, over questions of competence.

"How can an office possibly have any kind of stability when it goes through so many directors in that period of time?" asks Hamilton, who's worked with all 11 AIDS directors in her 25 years running the Family & Medical Counseling Service. "It cannot. It's been a quick fix after a quick fix without solid planning."

During the late 1980s and early 1990s, the AIDS epidemic made its dramatic demographic shift, expanding among two populations -- gay men having unprotected sex and intravenous drug users sharing needles. This period also corresponded with a time of bureaucratic tumult in the capital. The city went bankrupt, and Congress took over. Most agencies struggled, but the persistent stigma of the disease made running an efficient AIDS office even more complicated. In 1984, the city recorded 103 deaths from AIDS complications. By 1994, it recorded 660.

Meanwhile, more than 30 community-based organizations, clinics and service providers across the city have vied for local and federal funds over the years. Divvying up those resources was a major challenge for the department, past directors say. Without precise data, armed often with no more than anecdotal evidence, they struggled to fund the right programs, cut checks in a timely fashion and then ensure compliance.

Since the first AIDS director was hired in 1986, the city has spent hundreds of millions of dollars in public funds combating HIV/AIDS. Exactly how much is unclear. The District's Office of the Chief Financial Officer could track down the annual budgets beginning only in Fiscal 1999. A review of those records indicates that spending from Fiscal 1999 through Fiscal 2006 will reach more than $500 million -- with most of that money going to community-based organizations that provide primary medical care, HIV testing and counseling, HIV prevention services and housing, among others, and to the city's AIDS Drug Assistance Program that helps residents with HIV and AIDS pay for medicine.