AIDS in D.C.
Monday, March 27, 2006; 12:00 PM
This is the 25th year of the AIDS epidemic, and the District was one of the first cities in the country to create an AIDS office.
Washington Post staff writer Jose Antonio Vargas , who's writing a series of stories about AIDS in the District this year, was online Thursday, March 27, at Noon ET to discuss the history behind the Administration for HIV Policy and Programs department, the city's AIDS office, now in its 20th and most critical year.
Full Coverage: Including Audio Interview and Roundtable Segment and Graphics
A transcript follows.
Jose Antonio Vargas: Hi,
Thanks for joining us. This is the first in series of stories about AIDS in the District. I started reporting on yesterday's piece in late December, and what really got me hooked on the issue is a study that came out three years ago comparing D.C. for the first time to other cities, not states, as the CDC continually does. (I wrote about that study while I was a summer intern for The Post's city desk.)In that study, D.C., with a rate of 119 new AIDS cases per 100,000 population, ranked the highest, ahead of Baltimore, New York, San Francisco, etc.
Arlington, Va.: Very nice piece. And very sad. What kind of changes do you see happening? And how much time did that article take to do?
Jose Antonio Vargas: Lots of changes, or so I've been told. Sources tell me that the mood inside the Administration for HIV Policy and Programs (AHPP) has definitely changed since Marsha A. Martin took over. The partnership with George Washington University, to be spearheaded by Alan Greenberg, a veteran at the CDC, is a very good sign. AHPP needs to get a handle on its HIV data, and the partnership with GWU should help.
AHPP cannot work alone, though. Mayor Williams, with his task force, and the superintendent of D.C. public schools are important players here. As I noted in yesterday's article, there is no prevention campaign targeting teens in the city. Look around the city. Outside of Logan Circle and Dupont Circle, do you see any signs about HIV and AIDS?
Washington, D.C.: How much has Congress hindered D.C.'s ability to locally combat the spread of HIV/AIDS, if any? Didn't Congress block the local counting of ballots for needle exchange programs in D.C. (late 1990s), or threaten to withold federal dollars?
Jose Antonio Vargas: Great question. In 2004, I wrote a profile of Ron Daniels, who helps run PreventionWorks!, the nonprofit that has put itself in charge of the city's needle exchange program. The District is the only city in the country that's barred from using its local tax dollars to fund a needle exchange program. Needle exchange is a very political issue of course. Here's an upswing: it's likely that PreventionWorks! will get some help from the city in terms of HIV testing and counseling.
Washington, D.C.: I found your article to be very insightful, but also depressing. I am a teacher in SE D.C., and this year I have two HIV positive second- grade students. Needless to say, this is extremely upsetting and alarming. What do you think will help slow the spread in the poorer neighborhoods in the city (the disparity between Ward 3 and all other wards was truly shocking).
Jose Antonio Vargas: That is very depressing. Again, what we had set to lay out in the story is that this disease has spread generations, and your students are sad proof of that.
The ward disparity is what I'm investigating right now. HIV turns into AIDS much earlier without proper treatment -- and proper treatment means good insurance which means dollars. What AIDS workers are seeing in the predominantly black, poor neighborhoods of Wards 7 and 8, east of the Anacostia River, away from Official Washington, shall we say, is that 1) people are not getting the treatment they need as early as they need it; and 2) people are not getting tested early enough.
Washington, D.C.: How does the media measure success in a deadly epidemic? Who contributes to the success -- government (at what level), community organizations, media, etc.?
Jose Antonio Vargas: Everyone contributes to the success, and everyone is responsible.
I'm interested in people's stories. As a journalist, especially writing for Style, that's what I focus on. I care about people; I care about stories. But of course I also must look at the numbers coming from the District's AIDS office and from the CDC. And, clearly, we've got a crisis here -- an emergency. The District, as we noted, was a pioneer 20 years ago. And as far back as 20 years ago, there's been the Whitman Walker Clinic, the giant among community-based organizations in providing HIV and AIDS servies, and Family & Medical Counseling Services in Anacostia. Community groups have been doing their job as best as they can do them. The District was aggressive, and the City Council keeps doling out the dollars, $11 million for fiscal year 2006. But is there a city-wide discussion --in schools, in prisons, in all neighborhoods -- about AIDS?
Washington, D.C.: I'm interested in volunteering with an organization that does prevention and awareness work with young people. Do you have any suggestions?
I've spent a lot of time living and working in Africa and it always shocks me how much more awareness there is there than here in D.C. In some countries there are AIDS awareness billboards, parades, stickers and T-shirts everywhere you go, yet here in D.C. it seems to actually be more hidden and stigmatized.
Jose Antonio Vargas: Hi,
Thanks for your note. Please contact Adam Tenner at Metro TeenAIDS. Their offices are a few away from the Eastern Market Metro stop. Check out their Web site at http://www.metroteenaids.org/.
Ft. Washington, Md.: Dear Jose,
Why is the District of Columbia the lead in the AIDS epidemic? Is is because Washingtonians are uneducated, not listening/paying attention, or simply do not care? There is more than enough information circulating from Metro bus ads, to the local newspapers. Why is this happening to Washingtonians?
Jose Antonio Vargas: Patricia D. Hawkins, a longtime AIDS activist in the city and an associate executive director at the Whitman-Walker Clinic, said something very interesting to me. I, too, asked that question -- what makes the District unique? And she said: The District has "a very high poor population," a "very high African American population," a "very high gay male population," "a very high intravenous drug population," all at-risk groups for HIV. "We've got them all here."
And is there enough information out there? In the gay community, yes. (Look at Metro Weekly and the Washington Blade; I read those two very good weeklies for research, by the way.)
washingtonpost.com: Metro TeenAIDS/
Fairfax, Va.: I read in your story that only a few friends know about Patricia's disease. Without criticizing her, I think that people's fear of the disease is one of the main problems. It causes ingnorance and denial, and that is how the disease spreads. Proper education may reduce the fear, but it won't eliminate it. And then there will always be those who don't care if they infect others. This is a fight that will go on for many more years. It's a sad story.
Jose Antonio Vargas: That's an interesting insight. There's a great amount of stigma in the black community about this disease. There's always been one. And I think that contributes to the problem. And it's an issue I'm also investigating for a future story.
Patricia's story. I had to cut this part of the story, which I'll share here. I wrote: "Patricia says she's been celibate since 2002. Before that, she would tell her sexual partners that she had "the virus," that she has HIV. But they didn't care, she says. They wanted sex anyway. "But some guilt come over me," she says. "And what used to feel good didn't feel good."
Alexandria, Va.: What a heartbreaking and important article. Do you know how other cities have handled tracking HIV incidence? Are there models that D.C. can learn from in this area as they try to get a handle on this terrible disease?
Jose Antonio Vargas: That's a great question.
New York City, San Francisco and nearby Baltimore all have sophisticated surveillance models. (NYC collects HIV data through names, San Francisco and Baltimore through codes, and that's a controversy in of itself.) Baltimore, in a recent HIV report, actually broke down HIV cases per zip code.
Greenbelt 20770: What role has so-called "down low" behavior by men who have sex with other men and also with women fueled this epidemic? I know some women who are afraid to have intimate relationships with men because of the risk of transmission of STDs and HIV.
Jose Antonio Vargas: I knew a "down-low" question was coming, and here it is. I, too, have written about the "down-low" phenomenom. Lots of journalists have. It is fueling the epidemic, though how much we don't know. And let me say this: men on the "DL" is not specific to black men -- there are white men, Asian men, Latino men, etc., on the "DL." It's a matter of stigma, and there's still a great amount of stigma in all groups, though I think it's especially pronounced in the black and Latino communities.
Washington, D.C.: In the graphic in yesterday's article, there was a line for HIV cases in prison. Is that from D.C. Jail and the CTF? Or old stats from before Lorton closed?
Jose Antonio Vargas: Yes, that's from D.C. jail and CTF.
Falls Church, Va.: Mr. Vargas,
With so much information out there about the causes and consequences of AIDS, why are the rates still increasing?
What is the leading cause of HIV/AIDS in the District? Are people just being lazy and not protecting themselves?
Jose Antonio Vargas: This is the question to beat all questions. This is the 25th year of a still incurable (though treatable) disease.
In the District, nearly a third of cases are attributed to injection drug users, more than a third through "men sleeping with men," and about 20 percent through heterosexual contact.
AIDS to me is the most political of all diseases. It's about sex, it's about drugs, it's about sexuality, it's about class, it's about race. That makes it all the more complex and fascinating to write about.
Alexandria, Va.: Hi, the article was brought to my attention. I just don't understand what is going on. Why? Information about this disease has been around for decades. We can blame administrators for not being organized, etc. But the fact of the matter is people aren't listening, and they are still participating in risky behavior. When I read the sentence about the 34-year-old getting infected by the same man that infected her mother my heart sank. What type of behavior is that? I mean unless there was a crime committed against the 34-year-old woman. Baring that, in what world does a mother and daughter share a man. As an African American woman, I wanna know what is going on?
Jose Antonio Vargas: I'm glad that the article was brought to your attention. AIDS is ultimately about behavior. It's easy and simple to say: don't have unprotectex sex, don't share needles, be mindful of who you're sleeping with. But, clearly, the messages haven't gotten across. So it comes down to who's sending the messages, and how loudly, and who's hearing them?
As for the 34-year-old. She has full-blown AIDS now, and she was infected at 13 years old. Her case manager told me that her mother's boyfriend and her mother would get high, and then the boyfriend would force himself to her. The mother died two years ago.
Washington, D.C.: Hello Jose,
Thank you for writing such a great piece on such an important issue. Your article stated that the AIDS office is understaffed. How can an individual passionate about the cause become employed and make a difference in this community?
Jose Antonio Vargas: Thanks very much. I appreciate that.
Contact AHPP! If you're an epidemiologist, and you're qualified, send over a resume. As we said in the story yesterday, 11 of the 25 vacancies are in the surveillance division.
Fairfax, Va.: Is the information you write about from 2004? Why aren't there figures more up to date? That was two, almost three years ago. What's happening now? This is the Internet age.
Jose Antonio Vargas: That's the latest numbers available from the CDC. The 2005 figures should come out soon.
Let me also say that HIV monitoring takes five years to mature. AHPP, the AIDS office, is only about to get a handle on it now. That means that it will be years since we really know the scope of the epidemic in this city.
Bloomington, Ind.: Are some people immune to HIV? If so, why?
Jose Antonio Vargas: Again, let me state that AIDS is about behavior. (Unless you're a baby born to a mother with HIV or AIDS.) You can choose to protect yourself and be immune to it, and you can choose not to be careful.
Jose Antonio Vargas: Thanks for all your questions. Please feel free to e-mail me at email@example.com.
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