Monday, March 16 at 2 p.m. ET

HIV/AIDS in D.C.

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Reporter Darryl Fears speaks with D.C. Mayor Adrian Fenty about the HIV/AIDS statistics in the 2008 Epidemiology Annual Report scheduled to be released Monday. Video by Hamil Harris/washingtonpost.com

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Dr. Shannon Hader
Director of the HIV/AIDS Administration, D.C. Department of Health
Monday, March 16, 2009; 3:00 PM

Dr. Shannon Hader took your questions about the levels of HIV/AIDS cases in Washington, D.C.

The transcript follows.

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Washington, DC: Do we have any data on the primary drivers of HIV/AIDS cases in the District? Is it intravenous drug use, unprotected sex, transmission from mother to child in utero or through breast milk....

Dr. Shannon Hader: Our data reflect plenty of ongoing transmission by every mode: sex among men who have sex with men, among heterosexuals, and ongoing transmission related to injection drug use. In 2005, the District also had a number of cases related to mother-to-child transmission.

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Capitol Office: I have a test for new interns every semester. One of the questions is "which nation's capitol city has the highest rates of HIV?" I find it interesting that no one ever seems to know the answer.

Dr. Shannon Hader: Actually, plenty of other nations have capital cities with higher rates than the United States/Washington DC--but certainly Washington DC has the highest rates within the United States.

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Washington, DC: Why doesn't the report look more at context and draw comparisons with DC's neighbors. Both Maryland and Virginia are NHBS (National HIV Behavioral Surveillance) states and Baltimore has a special MSM NHBS component. Is D.C. so different from it's neighbors that this epidemic is out of control here, but not there? If so, why?

Dr. Shannon Hader: You are correct in that the NHBS study is part of a national study happening in many areas across the country. We look forward to CDC's publishing the national data, at which point we will be able to compare our local data to other places. For some answers, the behavioral description may be similar but the impact different: for example, a 30% condom use rate in an area like DC where the HIV rates are high is much more likely to result in an encounter with HIV compared to an area where, with the same behavior, there's little HIV to encounter.

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Washington, DC: What plans does the District has in place to tackle this epidemic? Surely being rated higher than Africa is a scary thought in itself. I hope people will wake up and care enough about themselves and others to get tested, early detection is the key.

This news is very unsettling, disappointing, and scary. I hope we find a cure soon. Thank you.

Dr. Shannon Hader: Because our epidemic in DC is both large and complex, with every mode of transmission represented, we often say we can't afford to do just one thing, we have to do it all. A lynchpin of our response--because it is the link between prevention and care/treatment-- is regular, routine, voluntary HIV testing as part of regular, routine medical care. Care strategies include increasing the linkage between testing positive and establishing an medical home, reaching out to bring people back into care, and making sure those participating in care benefit maximally from what care and treatment offers for health. For prevention, we seek to make sure people get the information and skills to prevention gettting or giving HIV, by providing info, community-level mobilization, free condom distribution, harm reduction including needle exchange, and other evidence-based prevention interventions.

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Philadelphia, PA: In light of this alarming data, do you foresee additional funding from the federal governemnt for prevention?

Dr. Shannon Hader: What these data point out for DC is that we have a serious HIV epidemic right here at home. What we also know is that the right combination of evidence-based interventions, including testing, condoms, and serious decisions around relationships, can make a large prevention difference. I believe strongly that we are entering a time where a strategic increased investment in and accountability for HIV prevention, as well as the platform of healthcare reform to ensure full coverage for persons living with HIV, will have a major impact.

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Shepherd Park, D.C.: I was confused by the statistics in yesterday's article. The headline claimed 3% HIV/AIDS infection rate in the city overall, yet the ward-by-ward graphic showed that every ward had an infection rate below 3%. How is this possible?

Dr. Shannon Hader: Great question. For 19% of cases, we do not have ward-level data available. Therefore the geo-maps are an UNDERESTIMATE of the true number of cases there. Details are available in the full reports at: www.doh.dc.gov/hiv.

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Nashville, TN: What is the cost of HAART treatment for the average infected individual in Washington DC? What support is available to the patient for this cost? Thank you.

Dr. Shannon Hader: The cost of HAART varies with the medications being used. However, we are fortunate in DC to be able to say, "It's Free to Treat your HIV". For persons that are uninsured or underinsured, several programs can cover HIV treatment, including some expanded Medicaid programs, a local DC health insurance called DC Alliance, and the locally-funded and ryan-white funded AIDS Drug Assistance Program. We anticipate that as more people are effectively diagnosed with HIV through our testing programs, the care programs will absolutely need to expand to serve more people. We are committed to high quality and effective treatment.

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Washington, D.C.: Dr Hader,

As a gay man living in the District (HIV Negative and test regularly) I am disgusted by the nonchalant attitude of many of my peers, that, "meh, you can just take a few pills and be okay." It seems to me, that unprotected sex is now accepted as a social norm. Does the HAA have any plans to conduct education or outreach concerning this?

Dr. Shannon Hader: HAA and DC do have plans to focus on the importance of safer sex. Starting in 2007, the District became the second jurisdiction in the country to support a public-sector condom distribution program. This program supplied 1.5million condoms in 2008, and is slated to expand greatly in 2009. We are developing a large scale social marketing campaign to support this expansion. But shifting social norms for healthier choices will take action on all fronts--the department of health, community leaders, friends and family. Afterall, friends can help friends make safer choices.

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Washington, DC: Dear Dr. Hader, What kinds of resources are available to young people in Washington, DC, that might enable them to protect themselves? Is HIV/AIDS comprehensively addressed in schools? For those who drop out, are there resources? Are young people in juvenile detention given information on prevention? Thank you.

Dr. Shannon Hader: Resources for young people in DC are expanding, and we look forward to them continuing to expand. At the end of 2007 DC finalized Health Learning Standards for all schools, to support the development and implementation of standardized health curriculum in schools. Starting last year, the Department of Health and many of our youth HIV providers have partnered with our Department of Parks and Recreation and the Department of Employment Services to provide STD/HIV information and testing outside of the school setting as well. For further information and a listing of youth partners, please visit www.doh.dc.gov/hiv to review our Youth HIV Prevention Plan; or visit www.realtalkdc.org a website & text messaging service for young people in the District that focuses on HIV and sexual health issues.

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Washington, D.C.: Why wait for CDC to publish NHBS data? People don't just practice risk behaviors in their own political jurisdiction. Why isn't DOH actively partnering -- in terms of prevention, surveillance, and evaluation of activities -- with public health in the neighboring states and counties.

Dr. Shannon Hader: We collaborate with neighboring jurisdictions regularly--but we're not waiting for everyone else to be ready in order to release the information to DC residents. This release should be seen as a first set of information, not a final set. We look forward to continuing to build on information as it becomes avaiable.

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Washington, D.C.: Will the District Department of Health and Council Chairman David Catania be revisiting their funding decisions that, since 2006, channel the majority of grant funding for HIV/AIDS services to Whitman Walker Clinic and Unity Healthcare which, in effect, shut down smaller, community-based/targeted providers who were addressing the problem based on the unique demographic that they served?

Dr. Shannon Hader: Actually the HIV/AIDS Administration supports over 70 organizations with over 150 grants. IN addition, the Effi Barry Capacity-Building Initiative, a 2-year organizational training program started in 2008, focuses on building the organizational and technical capacity of small, ward-based organizations both play a strong role in the HIV response and also become more competitive for funding--from local, private, or federal sources.

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Arlington, Va.: Considering people are surviving longer with HIV due to improved treatments, would it not be expected that the prevalence of the disease would be high?

In layman's terms, the high rate either means more people are getting it, or people who have got it are surviving. I know the latter is true, what about the former?

Also, given the increased number and availability of resources for HIV patients in the District compared to Virginia and Maryland, is the high rate a byproduct of people migrating into the city to live to take advantage of these resources?

Understanding the reasons behind the statistics would go a long way in ensuring that city resources are allocated properly to address the real issues driving the numbers, don't you think?

Dr. Shannon Hader: THere are definitely many reasons driving the high numbers. Yes--FORTUNATELY--many HIV-positive people are surviving and leading healthy lives due to the effective treatments available. Therefore, we do NOT expect the overall rates to go down--our goal is that everyone who is infected will lead long and healthy lives with the right care and treatment. However, it is also clear that we have not yet eliminated ongoing transmission and new infections. This requires a comprehensive response which we are building--one major part of that is helping folks find out they are hiv-infected as early as possible, because most people once they find out they are HIV positive they take measures to prevent ongoing transmsission.

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