By Darryl Fears
Washington Post Staff Writer
Tuesday, January 12, 2010; 6:50 PM
The District government and the National Institutes of Health on Monday announced the launch of a $26.4 million initiative to attack the city's HIV/AIDS epidemic with expanded testing and treatment to reduce the level of the virus in its victims and hopefully decrease their chances of spreading the disease.
Mayor Adrian M. Fenty joined Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, a division of NIH, in making the announcement at an HIV/AIDS treatment clinic in Southeast Washington, home to one of the city's most at-risk populations.
The National Institute of Allergy and Infectious Diseases will work with the city Department of Health and the city's largest health care providers to evaluate the health of patients and measure the impact of testing and treatment. The effort will focus heavily on African Americans who represent 76 percent of the city's 15,000 HIV/AIDS cases. Two studies conducted by the George Washington University School of Public Health and Health Services will research the behaviors of the most at-risk groups, gay African American men, who comprise the largest group of cases, and heterosexual African American women, whose rate of new infections is rapidly growing.
"As the nation's capital and the national leader in the fight against HIV, the District of Columbia is excited," Fenty said in a statement. "This comprehensive collaboration will generate fresh ideas, new services and technical knowledge to assist the city . . . in preventing new infections and improve health care services for all residents living with HIV/AIDS."
The effort in the District and a similar effort in the Bronx has energized U.S. doctors and scientist who study AIDS because they are the first to approach aggressive treatment as a form of HIV prevention.
But the approach, based on a World Health Organization study, is so untested that Fauci said it's still hypothetical whether reducing the viral load in a city's infected population will reduce the transmission of the disease. A professor of medicine at the University of California at Los Angeles called its chances success unlikely "even under the best circumstances."
In recent months, the city's HIV/AIDS Administration has come under scrutiny for the way it has managed organizations that deliver services to victims and millions of dollars in grants that are provided to the groups. A Washington Post investigation revealed that one group received millions of dollars over several years while running a threadbare operation, and others provided fraudulent employee resumes and spent hundreds of thousands of dollars on executive travel.
In September, the federal department of Housing and Urban Development threatened to withhold $12 million in AIDS housing funds from the District when the Department of Health and the Office of the Chief Financial Officer failed to submitted a timely audit of programs as required by law. A HUD assistant secretary ended the threat only after city officials worked around the clock to complete the audit and address other major federal concerns about its financial oversight.
The District has the nation's highest HIV/AIDS prevalence rate, 3 percent, touching nearly every ward in the city, according to its 2008 Epidemiology Update, released last year in March.
A heterosexual behavior study that accompanied the update found that majorities of black men and women in the highest risk communities thought their partners engaged in sex with others and said that they themselves engaged in sex with others, often without a condom. Few were aware of their HIV status.
Over the two-year funding period, NIH experts will work with District clinics to modernize their patient records. In addition, the NIH will attempt to help clinics improve their treatment of illnesses such as diabetes, cardiovascular disease and hepatitis that cause death in HIV-infected patients.
"The goals . . . are to enhance subspecialty medical care for underinsured HIV-infected patients . . . and provide those patients with the latest treatments available," said Henry Masur, chief of the Critical Care Medicine Department in the NIH Clinical Center.