From Bad to Worse

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Wednesday, March 18, 2009

WE'VE LONG known that HIV and AIDS stalk the District. But the startling "District of Columbia HIV/AIDS Epidemiology Update 2008" released Monday shows the breathtaking devastation that the disease with no cure has unleashed on the District. According to the report, in defining an HIV epidemic as "generalized and severe," the Centers for Disease Control and Prevention and the United Nations Joint Program on HIV/AIDS have said that "the overall percentage of disease among residents of a specific geographic area exceeds 1 percent."

It's 3 percent here.

Every ward except Ward 3 is above the 1 percent threshold. And continuing a grim trend from the 2007 report, African Americans are bearing the brunt of this epidemic: 4.3 percent of African Americans in the District are living with HIV/AIDS; 6.5 percent of black men in the city have the disease, and African Americans account for 76 percent of HIV/AIDS cases in the District. But this is no more a black epidemic than it was a gay one when it roared to life in the 1980s. That 1 percent epidemic threshold is crossed by just about every racial group and age group. Three percent of Hispanic men, as well as 2.6 percent of white men and black women live with HIV/AIDS. The 40-to-49 age group has the highest proportion of those with the disease (7.2 percent) followed by 50- to 59-year-olds (5.2 percent) and 30- to 39-year-olds (3.4 percent). Men who have sex with men, heterosexual transmission and intravenous drug use are the top three ways the epidemic is spreading. Overall, the number of cases increased by 22 percent over 2006. In a separate study on heterosexual relationships and HIV released Monday, 5 percent of the 750 District residents surveyed tested HIV-positive. More than 70 percent of the study participants had not used condoms.

A combination of factors allowed a bad situation to get worse. D.C. Council member David A. Catania (I-At Large), who chairs the council's health committee, told us that the District's HIV/AIDS Administration was rendered slow and ineffective by bureaucracy, patronage and a dearth of expertise. There have been 14 directors of that office since it was created in 1986. Shannon L. Hader has run the office since 2007 and is the third full-time director in the past five years. In addition, the city was prevented from spending its own funds on a needle-exchange program until the nearly 10-year-old ban was stripped from federal legislation authorizing the District's budget last year. Mr. Catania calls Ms. Hader "top drawer" and praises Mayor Adrian M. Fenty (D) for his commitment to fighting the epidemic.

As horrifying as these latest statistics are, they offer a reason for hope. They reflect increased efforts by the District to get people tested and into treatment (i.e. making HIV testing a routine part of health care) and to educate them about staying uninfected (free condom distribution). More important, the data provide the most accurate picture to date of where and how the disease is being transmitted and who is becoming infected. With accurate data and an agency finally equipped with talent and resources, the District stands a chance of driving those numbers down in a sustained and targeted way to save lives.

© 2009 The Washington Post Company

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