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Efforts to slash HIV infections in D.C. stall, while other STD cases are rising

A worker with the Women's Collective tests a woman for HIV in a mobile testing van near the Benning Road Metro in Washington, D.C., in December 2016. (Nikki Kahn/The Washington Post)

The District’s efforts to curb the spread of HIV stalled last year, while diagnoses of other sexually transmitted diseases surged to record highs, according to a new public health report.

About 400 people received HIV diagnoses during Mayor Muriel E. Bowser’s first year in office in 2015. As part of a broader strategy to end the spread of the disease in the nation’s capital, Bowser set a goal of cutting that number in half by 2020.

The latest city data shows the challenges ahead. In 2017, 368 District residents received HIV diagnoses — just one fewer diagnosis than the previous year. Health officials say long-term trends still show a stable decline in new infections.

“I describe this sort of as a pause when you had so many years of continual decreases,” said Michael Kharfen, who leads STD prevention at the D.C. Department of Health. “But this does raise a flag for us that what we’ve been doing has been working, but now we have to step it up.”

New HIV infections rose last year among gay and bisexual men and Latinos. Young people accounted for 41 percent of new infections, the highest proportion in a decade.

In all, 150 people ages 13 to 29 received HIV diagnoses last year, up from 134 in 2016.

City health officials are taking new steps to promote an HIV prevention drug among young people. Pre-exposure prophylaxis, a daily pill commonly known as PrEP, reduces the risk of infection by more than 90 percent.

Why D.C. wants black women to use an anti-HIV drug popular with gay men

The District already has been pushing the drug for gay men and black women — the two groups most likely to contract HIV — and says it helped about 1,700 residents get on the drug in 2017. The Food and Drug Administration recently approved PrEP, marketed as Truvada, for teenagers as young as 15.

During the upcoming school year, the city’s confidential STD screening programs at high schools is expected to provide information about the drug to students. The Department of Health has also set aside $300,000 to help young people pay for PrEP, which is covered by health insurance, but it could be difficult to acquire.

“They may be under their parents’ insurance plans and for them, it would be revealing either their sexual identity or revealing about their sexuality or their sex life,” said Kharfen, referencing how many young people at-risk of contracting the drug are gay, bisexual or transgender.

Although HIV infections are leveling out, curable STDs are on the rise.

The city reported 10,157 cases of chlamydia last year, a 35 percent increase since 2013. And there were 5,070 cases of gonorrhea, marking a 56 percent spike in the same period.

Those findings mirror national studies that found that sexually transmitted diseases hit record highs as local STD clinics have closed.

But in the District, health officials think the higher numbers are a result of better screening.

D.C. sees signs of success in record high STD reports from 2016

Kharfen said that the push for more people to use PrEP has resulted in more testing, and that the rise in STDs is also driven by some people infected multiple times in one year.

“We need to change some of our conversation with young people around their sexual health choices,” he said.

That doesn’t mean being a scold.

“I believe people should have the kind of sex they want, and it should be emotionally and physically safe,” he said. “We take a sex-positive approach.”