D.C. suburbs lag behind city in efforts to fight AIDS, study says

By Darryl Fears
Washington Post Staff Writer
Tuesday, April 27, 2010; A01

Suburban governments lag behind the District in efforts to help slow the spread of AIDS even though they are home to nearly half of the Washington area residents infected with the disease, according to a study released Tuesday.

In what is billed as the first look at the scope of HIV/AIDS infection in suburban Washington, the study decries the lack of coordination that it says denies thousands of infected people the medical and support services they need and deserve, "regardless of where they live."

The study calls on local governments to establish standards so that everyone gets tested for HIV during routine medical visits, unless they opt out. The study also suggests that everyone who goes to an emergency room be offered a quick mouth swab to test for the disease.

The study, funded by the Washington AIDS Partnership, shows that 46 percent of the region's more than 17,000 AIDS patients live in the suburbs; 54 percent live in the District.

In addition to those who have AIDS, about 13,000 people in the D.C. area are HIV positive. However, the infection rate in the suburbs is much lower than in the District, where 3 percent of the city's residents have HIV or AIDS -- considered a major epidemic. Men having sex with men is the main mode of transmission in both areas.

"Nobody's really looked at the suburbs," said Emily Gantz McKay, president of Mosaica: The Center for Nonprofit Development and Pluralism, which wrote the study. "There tends to be a big focus on central cities."

The study suggests that the suburbs can do more to fight the disease, including improving sex education in schools, testing for infection in clinics and hospitals, and caring for the sick.

The study was commissioned by the Washington AIDS Partnership, which is an initiative of the Washington Regional Association of Grantmakers, and Kaiser Permanente. It is a suburban version of a 2005 critique of the District's response to HIV/AIDS.

"We were able to provide a blueprint for action," said Channing Wickham, the partnership's executive director. "We found that to be extremely successful. We are interested in funding next steps."

Wickham said the study was done because "it's alarming when you don't know what you don't know." Although the partnership grants about $1 million a year for HIV/AIDS efforts, few nonprofit groups in Virginia and Maryland apply, Wickham said.

"We're not giving grades, like a report card," he said. "We're trying to provide more information and get people talking."

The jurisdictions in the study were Montgomery, Prince George's, Arlington, Fairfax, Loudoun and Prince William counties, as well as the cities of Alexandria, Fairfax, Falls Church and Manassas.

Some local and state officials took issue with some of the findings.

Dale Schacherer, Montgomery's program manager for HIV client services, said that the county has put significant resources into treating and fighting the disease.

"Montgomery County has, from the beginning, been really out front," he said. "Montgomery is a county of a million people, and yet our infection rate is much lower than in the District. It's really comparing apples and oranges."

Schacherer agreed on the need for more testing and prevention. "Testing needs to become a mainstream issue and needs to be something that patients are asked to opt out of, rather than opt into. It needs to be routine, basically."

Elaine Martin, director of HIV prevention for Virginia, said the study's characterization of the state's efforts are not fair. "We do look at regional data on a regular basis," she said. Martin said that more needs to be done but that low federal funding creates a challenge.

"The entire state gets less funding than the District of Columbia," Martin said. "I don't think they have an unfair level of funding. Their positive rate is much higher than Virginia's. But in some cases, Virginia is underfunded."

Heather Hauck, director of the Maryland Department of Health and Mental Hygiene, also cited low federal funding.

The District produces an HIV/AIDS epidemiology update each year. Despite having one of the highest rates of HIV/AIDS infection in the nation, the city is on its way to becoming a model of aggressive prevention. In the past three years, it has issued millions of condoms citywide, created a sex education curriculum and offered tests for sexually transmitted diseases for all public high school and some charter school students.

Maryland and Virginia produce HIV/AIDS studies every five years, the study says, a federal requirement. But because of the relative infrequency of reports from the suburbs, it is difficult to assess the scale of problems there, the study says. Virginia's most recent report was completed in 2007 using data from 2005.

The study issued Tuesday faults Maryland's and Virginia's efforts to reach out to at-risk residents who do not visit clinics regularly. Virginia has no marketing campaigns urging prevention, and Maryland has few.

Some suburban school districts have refused to allow condoms in schools, and parents in Montgomery filed a lawsuit against the schools to stop some aspects of sex education, the study said.

"In many jurisdictions," McKay said, "teachers are visibly uncomfortable talking about sex. If it's going to change, parents in those jurisdictions would have to get involved with the schools."

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