The recent report from the D.C. Appleseed Center for Law and Justice that at least one in 20 District residents is infected with HIV criticized city leadership for mismanaging the epidemic. Within a week, the city took a decisive, public step: It fired HIV/AIDS Administration Director Lydia L. Watts.
Whether D.C. Health Director Gregg A. Pane's decision to fire Watts was a good one depends on whom you ask -- a nonprofit group might have said yes while an HIV-positive person expressed dismay. But reaction to the firing quickly gave way to rumors of Watts's replacement -- and a discussion of the kinds of qualities someone would need to handle the complicated mix of politics, public health know-how, managerial acumen and compassion for infected citizens that the position demands.
"It's a tough job, but I also think that right now the position has to be seen as a real opportunity," said J. Channing Wickham, executive director of the Washington AIDS Partnership, which financially supports nonprofit groups working on AIDS and commissioned the "HIV/AIDS in the Nation's Capital" study. Pane and Mayor Anthony A. Williams (D) said they mostly agree with its findings, and Williams plans to chair a new citywide AIDS task force.
Among findings were that teenagers and schoolchildren had little HIV prevention education and that the city lacked epidemiological studies that would better target funding and services to those in most need.
The 170-page report also makes such recommendations as hiring more staff to collect data and creating a citywide strategy for routine testing. To make other improvements, the new administrator would have to reach across agencies and work with the school system and the Department of Corrections, using the recent findings as a guide, Wickham said.
The $81 million HIV/AIDS Administration, a division of the Department of Health, dates to 1984 when a single nurse dedicated herself to fighting AIDS in the District. A few years later, the effort grew into an established division. The administration has gone through 13 leadership changes, including interim directors, up to the most recent firing. Its recent challenges include staff vacancies and late reimbursements to nonprofit groups, an issue that led to a change in the number of days for reimbursement from 120 to 30, after the D.C. Council became involved.
While Pane notes that the city health system has problems, the administrator's job is also difficult because emotions around the epidemic run high, said Adam Tenner, executive director of Metro TeenAIDS. Many of the advocates working on the issue have lost friends and loved ones to the virus.
"At the end of the day, community activists and advocates want to do their job, to stop new infections and help people living with HIV," Tenner said. He wants to see a leader with vision, "someone who can create a real sense of collaboration with the community."
Northwest resident Danielle Pleasant, 39, who is HIV-positive, wants a leader who can manage the bureaucracy as well as be a public face for fighting the disease.
"I think the hardest piece of the job is the state that the agency is in right now," Pleasant said. "But I know that is not something that can't be overcome."