New AIDS cases decline in District, but infection rate remains epidemic
Thursday, March 18, 2010
More than 3 percent of District residents older than 12 are living with HIV or AIDS, an epidemic rate of infection that continues to worry city health officials. But a report on the disease released Wednesday offered hope: New AIDS cases and AIDS-related deaths have dropped steadily in the past four years.
At the end of 2008, at least 16,513 residents in the city were aware from testing that they had a form of the disease, a 9 percent increase from the previous year, according to the 2009 Epidemiology Update, a report issued annually by the D.C. HIV/AIDS Administration (HAA). The disease remained at epidemic level in nearly every ward.
But the decline in new cases of full-blown AIDS and AIDS-related deaths signals that aggressive testing and treatment efforts are starting to work and could lead to a decrease in cases of HIV, the illness that causes AIDS, said HAA Director Shannon L. Hader. The number of people given diagnoses of AIDS declined from 786 in 2004 to 525 in 2008. AIDS deaths fell from 379 in 2004 to 274 in 2007, the report said.
"These are not easy gains," Hader said, crediting the improvement to an increase in testing and medical clinics that provide primary care to people with HIV or AIDS. Hader said her administration has improved services to people with HIV or AIDS, despite reports of financial missteps that dogged the agency throughout the year.
The HIV/AIDS Administration came under scrutiny after a Washington Post investigation revealed that some groups it contracted to provide services failed to obtain business licenses and file tax returns. Others gave false information about employee résumés and consulting contracts, or spent lavishly on travel and executive salaries.
The city and its community partners tested 75,000 people for HIV in 2008, compared with 43,000 the previous year. In 2009, the city tested 95,000 people and distributed 3.5 million condoms.
"We're finding people who were not served previously," Hader said. "But as we find these people, we're finding there is more to do."
Hader was joined by Mayor Adrian M. Fenty (D) and D.C. Council member David A. Catania (I-At Large) at a news conference Wednesday outside the Whitman-Walker Clinic's Max Robinson Center for HIV and AIDS testing, treatment and counseling.
Catania, chairman of the council's health committee, said the report is a step forward. "A few years ago, we were in the dark" about the city's level of infection, he said. "Now, we have the best data in the country."
The District is one of three cities praised by the federal Centers for Disease Control and Prevention as a top data collector in the last two years. "We no longer want to be in the dark," Catania said. "We choose to know."
Walter Smith, director of the D.C. Appleseed Center for Law and Justice, a nonprofit watchdog group that monitors how the city handles AIDS infections, also praised the District's data collection and the drop in AIDS cases, but said the city needs to do more to market and promote prevention.
"The bad news is that our prevalence rate is still unacceptably high by any measure," Smith said. "There are a lot of people in the highest-risk group that we seem to not be reaching. We have to saturate the city . . . about how critical this is."
The city's highest-risk group by far is African Americans. Black residents represent about half of the city's population, but 75 percent of residents with HIV and AIDS. That compares with white residents, who make up 35 percent of the population and 16 percent of those known to be infected. Hispanics represent 8 percent of the population and 5 percent of the infected.
The most commonly reported mode of HIV transmission was sex among men, at 37 percent, followed by heterosexual contact, 27 percent. Intravenous drug use accounted for 17 percent of transmissions. Nearly 15 percent of those who tested positive did not say how they contracted the disease.
Among African Americans, heterosexual contact is overtaking sex among men as a mode of transmission for the first time in the city's history. The number of black people who reported transmission through gay sex, 30 percent, and heterosexual sex, 29 percent, was nearly equal.
According to the report, one in 21 black residents has the disease. Among those who died of AIDS-related health complications, the news is more grim for African Americans. They represent nearly 90 percent of people who die from the disease.
As the percentage of white deaths from AIDS declined from 2004 to 2007, the percentage of black deaths increased. The age range in which most people died was 40-49, about 38 percent of the total, regardless of race. The second highest group was people 50-59.
Residents 13-29 were among the least likely to be infected with HIV or die from AIDS, but data show that they continue to risk infection.
Teenagers and adults younger than 30 made up 85 percent of people who tested positive for two sexually transmitted diseases (STDs), gonorrhea and chlamydia. High school-age teenagers represented 41 percent of cases.
STDs, including HIV, generally occur when sexual partners fail to use protection such as a condom. The District recently became one of two cities to offer free STD tests in all public high schools and some charter schools.
The city was scheduled Wednesday to release a companion study of men who have sex with men but abruptly decided against it. Several people who saw the study during a meeting at the HIV/AIDS Administration last week said it showed that the prevalence among gay men was 14 times higher than the city at large.
Gay African Americans who saw the study said its methodology was flawed because it sampled mostly white men who attended nightclubs and other haunts that black gays rarely visit.
"It's not a representative sample," said Ron Simmons, director of Us Helping Us, a support group for gay black men.