In the wake of a critical report on the District's response to HIV/AIDS, the director of the city's HIV/AIDS Administration was fired and Mayor Anthony A. Williams last week appointed a new one. The report, "HIV/AIDS in the Nation's Capital: Improving the District of Columbia's Response to a Public Health Crisis," was issued by the DC Appleseed Center. A small portion of the 130-page report is excerpted below. The full report can be found on the DC Appleseed Web site, www.dcappleseed.org.

The District of Columbia's response to the Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) epidemic lags far behind that of many other cities across the nation . . . .

Even though many individuals, government officials, and nonprofit organizations have devoted considerable time and resources to addressing HIV/AIDS in the District, the disease continues to devastate District residents.

The District's annual rate of new AIDS cases is over 10 times the national average and is believed now to be the highest of any major U.S. city. Through the end of 2003, approximately 16,500 District residents had been diagnosed with AIDS, resulting in over 7,000 deaths. Today, over 9,000 District residents are living with AIDS . . . .

Unfortunately, even these numbers fail to capture the extent of the epidemic because they do not include HIV-positive people in the District who have not developed AIDS.

Given that the District's incidence of AIDS is among the highest in the country, the District likely has one of the highest rates of new HIV infections. While the precise number of District residents infected with HIV is unknown, District public health officials estimate that 1 out of every 20 District residents is infected. Even more alarming is the fact that thousands of these individuals do not know that they are infected or that they may infect others . . . .

Unfortunately, as this report explains, there are no simple answers . . . .

But several things are clear:

* the District is not systematically collecting and analyzing data about the epidemic in a way that would allow it to plan prevention and care effectively;

* the District is not sufficiently coordinating and supervising the government agencies and private organizations that provide services for individuals living with HIV/AIDS;

* the District's general prevention efforts need improvement; and the District's HIV/AIDS services are insufficient for certain populations, including youth in the public schools, drug users, and the incarcerated . . . .

The main recommendations . . . are as follows:

The District's HIV/AIDS Administration (HAA) should collect and publicly release comprehensive HIV and AIDS data . . .

The District should improve coordination and supervision of funding for HIV/AIDS services . . .

HAA should improve the management of its grants to private HIV/AIDS service providers . . .

HIV testing and counseling should be offered as a routine part of all medical care . . .

HAA should significantly expand condom distribution efforts . . .

HAA should coordinate with agencies serving HIV-positive individuals who also have other serious illnesses . . .

D.C. Public Schools should develop and apply standards for HIV prevention education . . .

The District should expand substance abuse treatment opportunities and improve existing syringe exchange programs . . .

The Department of Corrections (DOC) should expand substance abuse treatment programs for the incarcerated . . .

DOC should ensure that HIV-positive inmates receive a 30-day supply of HIV medication when released from custody . . .

As Mayor Williams recently noted, the District has devoted significant resources to fighting HIV/AIDS -- far more, in fact, than the District has devoted to many other public health issues. Yet the District's annual AIDS incidence continues to rise and is one of the highest in the nation . . . .

[T]he authors of this report have asked key stakeholders in the District's system of HIV/AIDS care and prevention how the HIV/AIDS epidemic has reached such massive proportions in the nation's capital. The answer to this question was often the same: lack of effective, consistent leadership. This lack of leadership is evident in the following:

* the true extent of the HIV/AIDS epidemic in the District is unknown;

* HIV/AIDS services in the District are not coordinated to the degree necessary to be effective;

* funding for HIV/AIDS prevention and care in the District is not being distributed in a timely manner or being used as effectively and efficiently as possible; and

* the District does not effectively target services where they could make a significant difference -- among students, drug users, and prisoners.