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D.C. AIDS program faces uncertainty after director resigns

By Darryl Fears
Washington Post Staff Writer
Thursday, June 10, 2010; 4:53 PM

The abrupt resignation of Shannon L. Hader leaves the HIV/AIDS Administration without a strong leader at a time when federal agencies are pouring millions of dollars into the District to study its epidemic infection rate, the city prepares to host the massive International AIDS Conference and Mayor Adrian M. Fenty campaigns for reelection.

Fenty will face voters in the gay community who want to know why he allowed the popular director to walk away from the agency that addressed what he described as his "Number 1 health priority."

And Fenty's choice of interim director, Nnemdi Kamanu Elias, will have to convince the National Institutes of Health and the Centers for Disease Control and Prevention that the HIV/AIDS Administration can continue to study AIDS in a way that allows them to target and treat people who are infected and those who are at a greater risk of being infected.

At the Tuesday news conference at which Fenty sent Hader on her way, he listed Elias's credentials: a medical degree from Yale University, a residency in internal medicine and primary care at the University of California at San Francisco, a master's degree in public health at the University of California at Berkeley and work abroad in the Netherlands and Tanzania.

"I don't think I've seen a résumé that impressive since the day we hired Dr. Hader," Fenty said.

But AIDS activists who at first doubted Hader when she took over an administration with a long record of failures in 2007 said she had lived up to her résumé in a way that others had not. And they quietly asked why the mayor allowed her to go.

The HIV/AIDS Administration is one of the most important agencies in the Department of Health, with an $88 million budget, consisting mostly of federal dollars.

The administration is responsible for distributing federal money to D.C. area governments such as Prince George's, Fairfax and Montgomery counties. It is tasked with gathering data and provides federal grants to community organizations for prevention efforts, such as condom distribution, tests for infection and distribution of drugs that lower the level of the virus in those infected.

Before Hader arrived, the HIV/AIDS Administration did few of those things well. The city largely relied on the Whitman Walker Clinic for epidemiology reports that were not exact. Last year, under Hader, the city produced its first report that showed exactly how many District residents were tested and confirmed to have HIV and AIDS: 15,120 -- about 3,000 in every 100,000 -- pointing to a dangerous epidemic.

Under Hader, HIV tests by physicians and community groups increased; 125,000 are projected this year. The number of condoms distributed rose from fewer than 1 million before her arrival to 3 million projected this year. The District's program is now a model for HIV/AIDS response.

Hader left under a cloud of speculation by city officials and AIDS activists, who said she did not get along with Pierre Vigilance, director of the Department of Health.

The activists declined to speak on the record because the city controls the grant money that allows them to operate. Some city officials declined to be identified because they serve at the mayor's pleasure, and others said they did not want any comment to potentially derail projects they are negotiating with the mayor.

D.C. Council member David A. Catania (I-At Large), one of two openly gay elected officials and a vocal advocate of increased efforts to combat HIV/AIDS, would not confirm or deny talk that he was dismayed at Vigilance.

Catania said Hader's departure leaves the city's efforts to fight AIDS in limbo. No one is likely to take the job before the mayoral contest between Fenty and Council Chairman Vincent Gray is decided in September. And it is unlikely that a permanent replacement will be appointed by a mayor before January, Catania said.

"Her loss in catastrophic," Catania said.

But Vigilance barely acknowledged Hader while praising Elias at her introduction Tuesday.

On Wednesday, activists circulated a blog item on a Web site maintained by Vigilance, under the Watchstone Health Consulting Group, in which he appeared to criticize the city's singular focus on HIV/AIDS.

"There are those who will try to get you to focus on one specific issue because it is politically appropriate to do so," he wrote. "It is a failing of public health agencies to allow this to be the case, especially in jurisdictions where multiple health issues challenge the current status and future of some communities."

Dena Iverson, a spokeswoman for the Department of Health, said Vigilance told her that that comment was referring to H1N1 and not HIV/AIDS.

A Department of Health spokeswoman said Vigilance was in an all-day meeting and could not be reached for comment.

Fenty hired Hader and lifted the HIV/AIDS Administration to prominence after telling gay residents during his first mayoral campaign that the disease was his top health priority.

"Dr. Hader's team has focused on pulling levers that drive change," said John Newsome, a vice president for the Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria that includes Nike, Facebook and the National Basketball Association. "That's why D.C. under her leadership is able to attract funds from NIH, CDC and the GBC."

Before the news conference, D.C. Attorney General Peter Nickles shook Newsome's hand and said Hader had done great work in addressing the city's AIDS epidemic.

Newsome squeezed Nickles's hand for second without smiling and looked him square in the eyes. "I hope it continues," Newsome said.

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