By Susan Levine
Washington Post Staff Writer
Monday, November 26, 2007
The first statistics ever amassed on HIV in the District, released today in a sweeping report, reveal "a modern epidemic" remarkable for its size, complexity and reach into all parts of the city.
The numbers most starkly illustrate HIV's impact on the African American community. More than 80 percent of the 3,269 HIV cases identified between 2001 and 2006 were among black men, women and adolescents. Among women who tested positive, a rising percentage of local cases, nine of 10 were African American.
The 120-page report, which includes the city's first AIDS update since 2000, shows how a condition once considered a gay disease has moved into the general population. HIV was spread through heterosexual contact in more than 37 percent of the District's cases detected in that time period, in contrast to the 25 percent of cases attributable to men having sex with men.
"It blows the stereotype out of the water," said Shannon Hader, who became head of the District's HIV/AIDS Administration in October. Increases by sex, age and ward over the past six years underscore her blunt conclusion that "HIV is everybody's disease here."
The new numbers are a statistical snapshot, not an estimate of the prevalence of infection in the District, which is nearly 60 percent black. Hader, an epidemiologist and public health physician who has worked on the disease in this country and internationally, said previous projections remain valid: One in 20 city residents is thought to have HIV and 1 in 50 residents to have AIDS, the advanced manifestation of the virus.
Almost 12,500 people in the District were known to have HIV or AIDS in 2006, according to the report. Figures suggest that the number of new HIV cases began declining in 2003, but the administration said the drop more likely reflects underreporting or delayed reporting. A quarter-century into the epidemic, the city's cumulative number of AIDS cases exceeds 17,400.
"HIV/AIDS in the District has become a modern epidemic with complexities and challenges that continue to threaten the lives and well-being of far too many residents," the report states.
District health officials have long been faulted for the lack of HIV information and lagging AIDS data. Not until forced by federal funding requirements did the health department start tracking HIV.
Until that began in 2000, critics said, neither the government nor organizations responding to the disease knew whether their dollars and efforts were effectively addressing the problem.
The report notes that its comprehensive picture "offers the District a new tool to help improve the scope, quality and distribution of care and treatment and prevention services."
HIV information is particularly valuable because it represents the most recent infections and can indicate changes in transmission patterns. It is mainly collected through the investigation of cases forwarded by laboratories and health-care providers.
The compilation signifies a major step forward for the HIV/AIDS agency, which has gone through repeated program and leadership upheavals in recent years. "For us, this is a milestone," said Hader, its third administrator since 2004.
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."