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Area's Approaches Reflect Diverse Values
By Amy Goldstein In the District, the Whitman-Walker Clinic distributes a small pamphlet with a shadowy, naked male figure on the cover. "Oral sex with a man. Do the safe thing," the pamphlet says. Inside are explicit illustrations and plain advice on when to use condoms and "dental dams." Whitman-Walker doesn't stock the pamphlet at its Northern Virginia branch. Instead, it distributes a tamer brochure, "HIV/AIDS — What you need to know," with a cover that depicts a person walking along a sun-dappled stretch of empty road. And the clinic gives Northern Virginians another pamphlet, not found in the District, in which two smiling teenagers are raising their hands in a "stop" gesture. "Saying 'no' to sex," the pamphlet says. "It makes sense." The differences in theme and tone of the literature supplied by Whitman-Walker, the largest provider of AIDS services locally, attest to the divergent sensibilities even within the Washington area about how communities should try to prevent the spread of the disease. Only in the District and in Alexandria, for example, can high school students pick up condoms at school. And only in the District do AIDS workers visit street corners where illegal drugs are sold, offering clean needles to intravenous drug users. In the three years since the federal government decentralized the nation's approach to AIDS prevention, the increased local control has created a trade-off for metropolitan Washington: More money is being devoted to niches in the population that are especially vulnerable to HIV, but the effectiveness of local efforts has in some cases been questionable, according to AIDS experts. Whether AIDS prevention efforts work is especially relevant in the Washington area, where the epidemic has made deeper inroads than in most parts of the country. Last year, Washington ranked third among the nation's large metropolitan areas in the number of new AIDS cases that were reported and 12th in its case rate per 100,000 residents, according to the federal Centers for Disease Control and Prevention (CDC). Nearly 16,000 area residents have developed AIDS since the epidemic began in the early 1980s; about 10,000 of them have died. The local epidemic is concentrated in the District, where an estimated 15,000 people are living with HIV and the rate of full-blown AIDS remains among the highest for large U.S. cities, according the D.C. Agency for HIV/AIDS. The disease is penetrating different parts of communities than it did in its early years. The number of cases reported among intravenous drug users in the Washington area now rivals that among gay men. African Americans accounted for four of every five cases reported last year, compared with 50 percent before 1990. And cases among women have more than doubled from 8 percent before 1990 to 20 percent last year. The impediments to effective prevention efforts have been both bureaucratic and political. For one thing, the District has been slow to spend its subsidies from the CDC. Last year, the city failed to distribute on time more than $1 million of its $4.6 million allotment of federal AIDS prevention funds, primarily because the District has been sluggish in awarding contracts to community groups that carry out the work. As a result, "a social marketing" campaign, one of the most innovative strategies the District has devised in recent years, is beginning this summer more than a year behind schedule. Through the $190,000 campaign, a public relations firm has been hired to hand out posters and postcards with safer-sex messages in bars that are popular among African American and Latino gay men. "Assuming these interventions matter, if you delay getting that money onto the street, it means people are getting infected," said Jeff Levi, a consultant and former deputy director of the White House Office of AIDS Policy.
© 1997 The Washington Post Company
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