Study Calls HIV in D.C. A 'Modern Epidemic'

A letter from Mayor Adrian M. Fenty (D) accompanies the release: "We must take advantage of this information with the sense of urgency that this epidemic deserves."

The District's AIDS rate is the worst of any city in the country, nearly twice the rate in New York and more than four times the incidence in Detroit, and it has been climbing faster than that of many jurisdictions.

One explanation might be the high percentage of infected residents labeled "late testers," people who learn they have AIDS within a year of the HIV diagnosis. Although the proportion of adults and adolescents screened for HIV is greater in the city than nationally, the finding raises questions about the strategy of the District's "know your status" campaign.

People who learn of their infection late face serious consequences. By the time symptoms arise or infections occur, their immune systems have suffered considerable damage. They face increased medical costs and death rates.

More than two-thirds of local AIDS cases fell into this category during the past decade, according to the report, compared with 39 percent of cases in the United States. "I think that's dramatic information for our care and treatment providers," Hader said.

No longer is HIV a crisis primarily among younger adults. Starting in 2004, the number of new HIV cases among men and women ages 40 to 49 outpaced every other age group in the city.

But the data made public today expose an alarming dimension of pediatric HIV. Each of the three dozen District children to test positive in the past five years was infected during birth.

"This is a line that should be zero," said Hader, who is pushing for routine HIV testing during pregnancy, quick-results oral swabs during labor and "fast tracking" of the antiretroviral drugs that can prevent transmission during delivery.

The administration said it wants to use the report to begin asking and answering, "What next?" Given the scope of HIV and AIDS in the District, health leaders say they can't focus on just one aspect of the disease or one at-risk group.

"We don't have the luxury of only picking one," Hader said. "We have the imperative to do it all."