AIDS Cases Missed In D.C.

By Rob Stein
Washington Post Staff Writer
Saturday, June 14, 2008

The District's system for reporting AIDS-related deaths missed more than half of the fatalities that occurred from 2000 to 2005, according to a new analysis.

Of the 2,460 deaths from AIDS-related illnesses during the six-year period, 1,337 had not been reported because the city's system for tracking the toll of the disease was inadequate, according to the analysis by the D.C. Department of Health and the federal Centers for Disease Control and Prevention.

At least 12,500 District residents have AIDS, giving it one of the highest rates in the country. Officials estimate that between 3 and 5 percent of people in the District are infected, twice the rate of New York, for example.

The new analysis indicates that the AIDS epidemic may be taking a far greater toll on the city than officials had realized.

"This tells us our surveillance system wasn't complete enough," said Shannon Hader, senior deputy director of the D.C. Health Department's HIV/AIDS Administration. "We're clearly underreporting."

The investigation was launched after health officials became increasingly concerned that they were undercounting the number of residents infected with the virus and those dying after contracting AIDS, in part because of the discovery of boxes of unexamined paper records.

As The Washington Post reported in 2006, the District's AIDS agency discovered five boxes containing files of 2,000 to 3,000 cases that had not been entered in the city's database and that had not been touched in more than a year. The information is considered crucial for managing the epidemic.

"We want to drive down the number of people living with HIV and make sure those who are infected are getting the care they need. To do that we have to have an accurate count," Hader said, noting that the amount of federal funding the city gets to fight AIDS is based on such estimates. "We want everything they owe us."

So working with the CDC, city health officials reviewed all death certificates from 2000 to 2005 to try to identify deaths that appeared to have been related to AIDS, and compared that with the number of deaths that had been reported, discovering the discrepancy. The results were published Thursday in the CDC's Morbidity and Mortality Weekly Report.

Based on the findings, the city has initiated several efforts aimed at improving its system, Hader said, including a mass mailing in January to about 4,000 doctors and laboratories to try to increase the number of diagnoses reported to the city. Officials also have begun routinely reviewing death records, and launched a campaign to increase HIV testing to try to identify more people before they get sick and die, she said.

"What we need to do is get more people who don't know they have HIV diagnosed and into care and treatment," she said. "Every time you go into a health-care provider they should be offering to test you for HIV. We want to drive down the number of people living with HIV and don't know about it."

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