District Continues to Fail the Public on HIV-AIDS

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By Raymond S. Blanks
Thursday, January 4, 2007

The promises made by former mayor Anthony A. Williams more than a year ago to bolster the battle against HIV have not been realized.

The HIV-AIDS epidemic in the District remains disturbing and depressing. The rate of infection remains 10 times the national rate. African American women make up 90 percent of all infected female residents, and many thousands of residents with HIV do not know their status.

Black residents make up 60 percent of the District's population but represent more than 80 percent of AIDS cases. Nearly 20,000 of the city's residents are living with HIV. Recent tests indicate that, among the 16,700 persons tested, 580 tested positive, a new increase of nearly 4 percent.

The size of this epidemic requires an adequate scope of services to meet current and increasing demands. Despite the mayor's promises, real progress still eludes the Administration for HIV Policies and Programs. This deadly health crisis is still growing, while the city's ability to combat this disease with effective prevention and treatment services has not increased accordingly.

Last year, the D.C. Council appropriated a half-million dollars to establish HIV services in Ward 7, where no services had been provided, although it had the city's second-highest rate of infection. Today, Ward 7 is still without services, although a local consulting firm was hired to assist in developing services.

Even more distressing, an oversight hearing of the council's Committee on Health revealed that nearly 25 percent of the council's award was spent illegally in other sectors of the city and for other purposes. Regrettably, adequate prevention and treatment services have not been expanded to residents most in need and those who engage in high-risk behaviors, such as unprotected sex or shared needles. Yet AHPP has failed to spend more than $5 million dollars in allotted federal resources.

A year ago, the Office of the Inspector General audited AHPP and found substantial deficits in its management practices, especially those related to grant awards to community service providers. This year, the IG's office conducted a similar audit and found no evidence of progress in the effective management of public resources.

One organization secured a grant of $250,000, but the audit found no evidence of services provided to the public. AHPP personnel never once monitored the use of public funds awarded to the agency. The agency has failed to distribute condoms among residents. Epidemiological data is still not complete, timely or easily available, and surveillance remains below standards of competence.

A major testing campaign was kicked off in June with the goal of testing 400,000 residents between the ages of 14 and 84 by December. HIV testing is an effective prevention practice endorsed by the Centers for Disease Control and Prevention. More than $1.2 million was budgeted to support this massive testing initiative, yet it has achieved less than 4 percent of its campaign target. Two highly publicized testing events were held on Freedom Plaza at a cost of tens of thousands of dollars. But less than 200 people submitted to the test in each event. No special testing events were organized east of the river area, where the majority of infected people live.

Nearly a third of all residents recently tested are inmates at the D.C. jail. About 6 percent, or nearly 250 inmates, tested positive, but community providers lack the capacity to absorb this increased population that will need follow-up health services in the community once they are released from jail.

Perhaps the most important failure in the last year of the Williams administration is the consistent absence of any adequate effort to really engage community residents regarding this health crisis that affects one of every 20 residents. A health challenge of this magnitude requires citizen involvement to help to reverse alarming trends.

Walter Smith, president of the D.C. Appleseed Center for Law and Justice, emphasized recently the necessity for a community dialogue to better alert and engage residents, promote practices of prevention, distribute materials that foster harm reduction, and circulate information on treatment services and locations. The absence of residents from such a public dialogue prohibits collaborations by the city with its citizens, depresses a necessary synergy and diminishes the community's capacity to contribute in combating HIV.

Last year, the D.C. Appleseed Report on HIV and AIDS in the District asserted that the city was 15 years behind the scope and quality of services and management necessary to meet this growing health challenge. No appreciable improvements have been attained lately, while this disease continues to grow where people are most vulnerable. It's time for the District to truly deliver on its promises.

Raymond S. Blanks is a member of the District's Community HIV Planning Group.


© 2007 The Washington Post Company

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