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D.C. sets ambitious new goals for curbing HIV epidemic over next decade

A pharmacist pours Truvada pills (brand name of PrEP), which can prevent HIV infection.
A pharmacist pours Truvada pills (brand name of PrEP), which can prevent HIV infection. (Justin Sullivan/Getty Images)
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The D.C. Health Department has announced ambitious new goals for further reducing the spread of HIV in the District over the next decade.

After some success in meeting HIV-reduction goals for 2020 that were set in 2015, D.C. Mayor Muriel E. Bowser is asking the public health system to reach still-higher targets.

Bowser (D) took office in 2015 with the goal of combating a virus that had ravaged parts of D.C. for decades. She set metrics for 2020 that she labeled “90/90/90/50” — calling for 90 percent of residents with HIV to know they have the virus, 90 percent of patients to be receiving treatment, 90 percent to achieve viral suppression so they cannot transmit the virus to others, and 50 percent fewer people to be diagnosed per year.

In 2019, the city met or nearly met all three of the 90 percent thresholds. New infections dropped from nearly 400 in 2015 to 282, the lowest number since the mid-1980s but still well above the goal of 200 cases in 2020.

Data for this year will not be available until sometime in 2021.

D.C. is close to ending the HIV epidemic, but covid-19 may get in the way

Bowser’s new plan, released Friday, raises the bar, calling for 95 percent of patients to know they have the virus by 2030 and 95 percent to achieve viral suppression, as well as for 95 percent of patients to begin treatment the day they test positive.

The plan aims for fewer than 130 new infections in 2030, a number that the D.C. Health Department said would mean “D.C. has maximized all the ways to end the epidemic.”

Nina Yamanis, a professor of public health at American University, said she believes the District’s plan includes reasonable steps to meet those targets, including a data-driven focus on improving testing and treatment access in census tracts that have poorer HIV-related outcomes.

Yamanis praised the collaboration between the city government and leaders in the transgender community to promote the drug PrEP, which can effectively prevent HIV infection but which some transgender women are hesitant to use for fear it will disrupt the hormones they take.

But Yamanis said the District’s efforts to convince more at-risk residents, including Black and Latino gay and bisexual men, to start taking PrEP have become more difficult because of the coronavirus pandemic.

“I think their ability to meet these goals is dependent on the consequences of the pandemic: how long is this going to last; are people going to be able to access health services again in person? I’m sure that is having a huge impact on HIV care,” Yamanis said.

She laughed when asked whether the city might see fewer new cases of HIV this year because people who are social distancing might have fewer sexual partners.

“Sometimes in times of stress and crisis, people have more sex,” she said. “It’s a way to cope.”

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