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Washington D.C.: IAC Host and HIV Battleground

Posted by Lucile Scott , July 20, 2012

Washington D.C.: IAC Host and HIV Battleground

Washington D.C. is more than just a host of this year’s International AIDS Conference. It’s an epicenter and key battleground in the global fight against AIDS. At 2.7% citywide, D.C. has the highest HIV rate of any U.S. city— high enough to put HIV in the city at epidemic levels. And recent studies show that in certain low income pockets, that rate rises to as high as 8%. The seriousness of D.C.’s epidemic— not just the fact that it’s our nation’s capitol— contributed to the International AIDS Society’s decision to dub it the first U.S. conference host city in 22 years. “We try and select cities where we can use the conference as a tool to try to engage awareness in the local population,” said Chris Beyrer, professor of epidemiology at Johns Hopkins University and member of governing council of the IAS. And those alarming rates, along with the city’s role out in recent years of comprehensive testing, treatment access and needle exchange programs to combat them, will be spotlighted at the IAC, shedding light on factors both driving and effectively fighting the U.S. epidemic.

Doctor Gregory Pappas, Director of the D.C. Department of Health, contends that while D.C.’s reported rates are higher than other U.S. metropolises, D.C., because it is a district and not actually a city, is an unusually geographically concentrated urban center, and its epidemic does not actually look that much different than in sections of other large city’s where the factors driving the D.C. epidemic also converge. “We are 600,000 people within a metropolitan area of five million people,” he says of the D.C. metropolitan area which includes larges sections and Maryland and Virginia. “And we happen to be a cutout where there are a lot of gay people and a lot of disenfranchised black and Hispanic people—poor people. Poverty and poor education are the main drivers of new infections in the United States.”

A study released in June reported that HIV rates in low income African American women in some of the city’s poorest neighborhoods had doubled in just two years, from 6.3 to 12.1%, sparking much conversation about HIV in the city. Tiffany West, Bureau Chief of the Strategic Information Bureau at the D.C. Department of Health responded to questions about what is fueling the increase by saying that she is not convinced the numbers reflect an actual increase of HIV rates in that population, but instead a shift in the sample population mid study, and the fact that D.C.’s extensive testing campaign has paid off and made more people willing to get tested and aware of their status. “I think that we need to do further studies to see if the rate is actually going up in those areas,” says West. However, the city’s DOH consistently touts how clean their data is, calling question either to West’s statement or to all the numbers reported from the data set, many of which show progress. Farah Nageer-Kanthor, Director of Programs at The Women’s Collective, a D.C. AIDS services organization, says that regardless of the exact numbers, the data “tells us that the disease is hitting women hard—and poor women are being further victimized, marginalized, and impoverished at the hands of the disease.”

In 2006, D.C. became one of the first cities in the nation to comply with the CDC’s recommendation that HIV testing be made routine, instead of exceptionalized. “People thought opt-out routine testing wasn’t possible, but D.C. started a huge social marketing campaign and engaged hospitals and providers to scale up testing,” says West. “That push, paired with programs linking all people who test positive to care, has resulted in some real HIV progress in the city.” Indeed, the newly released numbers also show that the percentage of people getting linked to care within three months of their diagnosis has increased from 58 to 76 in two years, causing new AIDS diagnosis in the city to drop significantly. And because of increased testing, fewer positive people remain unaware of their status, and even though the numbers getting tested continue to mount, new diagnosis have dropped 50%. The city also began public funding of needle exchanges in 2007, which West largely credits for a 60% drop in new diagnosis in injection drug users. She says of Congress reinstating a federal ban on funding syringe exchanges this year, “I would hope that politicians would focus on science and look at data of what has happened in D.C. since implementation of needle exchange funding and do the right thing.”

Of course the city still has a long way to go to end AIDS and plenty of barriers remain— chief among them, stigma and the city government’s failure to address the social and economic issues fueling the epidemic, causing it to have a HOPWA housing waiting list with 1,000 names. “While awareness about HIV has increased in the District over the last few years due to health department and other types of campaigns, I don’t think that stigma associated to the disease has reduced as a result,” says Nageer-Kanthor. “We have newly diagnosed young women who fear coming into our office or who avoid seeking needed medical care because they don’t want anyone to find out that they are HIV positive.” West concurs that stigma remains one of the largest barriers to care and testing in the city, adding that the DOH has new stigma fighting campaigns in the work, including one targeting faith-based organizations, slated for a fall release.

Nageer-Kanthor adds that in addition to stigma, lack of stable housing and access to mental health care prevents many of the women, girls and families they work with from getting the continuing care they need. “It is interesting to note that 30% of HIV positive women suffer from post traumatic stress disorder—a rate 5 to 6 times higher than the PTSD rate among the general population of women,” she says. “At the service level we see that we can’t address HIV for a woman without addressing her need for safe, long-term housing, mental health counseling, and trauma and coping support.” West says many of the health services now relying on Ryan White funding will soon be covered under the Affordable Care Act, hopefully freeing up the money to do just that and improve comprehensive support services for HIV positive people across the district.

The D.C. Health Department will be front and center next week discussing these campaigns, successes and ongoing barriers. Says Nageer-Kanthor of what she hopes to see highlighted, “D.C., as the nation’s capital, is primed to be a leader in addressing the intimate relationship between HIV and poverty,” which she adds is absolutely essential, “if we as a city, society, and country are to turn the tide against the epidemic.

Follow the Update blog on Twitter @housingworks#WeCanEndAIDS.

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