At Least 3 Percent of D.C.
Residents Have HIV or AIDS, City Study Finds; Rate Up 22% From
Jose Antonio Vargas and Darryl Fears
Washington Post Staff Writers
Sunday, March 15, 2009
At least 3 percent of District residents have HIV or AIDS, a
total that far surpasses the 1 percent threshold that
constitutes a "generalized and severe" epidemic, according to a
report scheduled to be released by health officials tomorrow.
That translates into 2,984 residents per every 100,000 over the
age of 12 -- or 15,120 -- according to the 2008 epidemiology
report by the District's HIV/AIDS office.
"Our rates are higher than West Africa," said Shannon L. Hader,
director of the District's HIV/AIDS Administration, who once led
the Federal Centers for Disease Control and Prevention's work in
Zimbabwe. "They're on par with Uganda and some parts of Kenya."
"We have every mode of transmission" -- men having sex with men,
heterosexual and injected drug use -- "going up, all on the
rise, and we have to deal with them," Hader said.
In addition to the epidemiology report, the city is also
releasing a study on heterosexual behavior tomorrow. That
report, funded by the CDC, was conducted by the George
Washington University School of Health and Health Services.
Among its findings: Almost half of those who had connections to
the parts of the city with the highest AIDS prevalence and
poverty rates said they had overlapping sexual partners within
the past 12 months, three in five said they were aware of their
own HIV status, and three in 10 said they had used a condom the
last time they had sex.
Together, the reports offer a sobering assessment in a city that
for years has stumbled in combating HIV and AIDS and is just
beginning to regain its footing. A more accurate accounting of
the crisis offers a chance to contain what is largely a
So urgent is the concern that the HIV/AIDS Administration took
the relatively rare step of couching the city's infections in a
percentage, harkening to 1992, when San Francisco, around the
height of its epidemic, announced that 4 percent of its
population was HIV positive. But the report also cautions that
"we know that the true number of residents currently infected
and living with HIV is certainly higher."
The District's report found a 22 percent increase in HIV and
AIDS cases from the 12,428 reported at the end of 2006, touching
every race and sex across population and neighborhoods, with an
epidemic level in all but one of the eight wards. Black men,
with an infection rate of nearly 7 percent, carry the weight of
the disease, according to the report, which also underscores
that the District's HIV and AIDS population is aging. Almost 1
in 10 residents between the ages of 40 and 49 has the virus.
The report notes that "this growing population will have
significant implications on the District's health care system"
as residents face chronic medical problems associated with aging
and fighting a disease that compromises the immune system.
Men having sex with men has remained the disease's leading mode
of transmission. Heterosexual transmission and injection drug
use closely follow, the report says. Three percent of black
women carry the virus, partly a result of the increase in
"This is very, very depressing news, especially considering
HIV's profound impact on minority communities," said Anthony
Fauci, director of the National Institutes of Health's program
on infectious diseases. "And remember: The city's numbers are
just based on people who've gotten tested."
Ron Simmons, who is black, gay and HIV positive, said he's not
shocked by the study's findings. "You have a high incidence of
HIV among African Americans, and a lot of African Americans live
in the city," said Simmons, who is a member of a black gay
support group. "D.C. also has a high number of gay men, and HIV
is high among gay black men."
Charlene Cotton, a D.C. resident who got an HIV positive
diagnosis five years ago, said breaking the taboo on discussing
HIV is the key to moving forward. "You need to start at home and
talk about it," Cotton said. "It's so hush-hush."
Mayor Adrian M. Fenty (D) said he is aware that some advocates
have called on elected officials and others to more aggressively
and publicly address the crisis. He praised the city's recent
efforts, however, and expressed his frustration about the
"In order to solve an issue as complex as HIV and AIDS, you have
to step up," he said. "It's the mayor and certainly other
elected officials. But it's also the community. You have this
problem affecting us, and you tell people how serious it is and
it literally goes in one ear and out the other."
David Catania (I-At Large), chairman of the D.C. Council's
health committee, said that although the District's testing and
monitoring have improved in the past two years, the AIDS office
is still playing catch-up. The city was in the forefront of the
crisis when it created the office in 1986, but it fell far
behind. Hader took control in 2007. She is its 12th director and
the third in five years.
"Frankly, there can be no excuse for the state of the HIV/AIDS
Administration that I found in 2005," Catania said. "I cannot
speak to why it was not a priority previously. For years prior
to 2005, mayors and previous individuals allowed things to exist
in an unacceptable way. And I do blame this government for part
of the epidemic we're confronting."
Until recently, the District's AIDS office lacked a fully
staffed surveillance unit to collect, analyze and distribute
data. Inevitably, the office lost credibility, and although it
has received millions in federal and local funds -- $95 million
this year -- some care providers questioned whether resources
were being properly allocated.
Critics also say congressional control over the District had
restricted the AIDS office's ability to combat the virus among
drug injection users by banning the use of local tax dollars for
a needle exchange program. After almost a decade, the ban was
lifted last year.
The study is the most precise count to date, according to the
authors. The document is an update of a breakthrough 2007
report, which brought into clearer focus a picture of a city in
the grip of a complex and "modern epidemic" that had traveled
from a mostly gay population to the general one and
disproportionately hit blacks.
For years, District HIV/AIDS workers depended on estimates that
put the rate at 1 of 20 living with HIV and 1 of 50 living with
The current study notes that its tracking occurred as the city
made a switch from a code-based counting system to a name-based
one. The surveillance unit interviewed medical providers to find
unreported cases, pressed providers who did not consistently
report to the administration and searched databases for
More than 4 percent of blacks in the city are known to have HIV,
along with almost 2 percent of Latinos and 1.4 percent of
whites. More than three-quarters -- 76 percent -- of the HIV
infected are black, 70 percent are men and 70 percent are age 40
Heterosexual sex was the principal mode of transmission for
blacks with the disease, 33 percent. Men having sex with men was
the chief mode of transmission for white residents, 78 percent;
and Latinos, 49 percent. Black women represent more than a
quarter of HIV cases in the District, and most, about 58
percent, were infected through heterosexual sex. About a quarter
of black women were infected through drug use.
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The companion study, "Heterosexual Relationships and HIV in
Washington, D.C.," is a detailed look at those whose social
networks include individuals at high risk of infection and aims
to analyze people's choices and actions before they set foot in
a clinic or get HIV.
The 750-participant study targeted four areas in wards 1, 2, 5,
6, 7 and 8 with both high rates of AIDS and poverty. Salaries of
a majority of participants -- 60 percent -- were under $10,000
yearly; a similar percentage had never been married; and 43
percent were unemployed.
The survey's methodology -- interviewing those with connections
to high-risk networks rather than those who exhibit high-risk
behavior themselves -- highlights a shift in the direction by
the CDC, which developed the survey protocol.
There is good news in the AIDS office's report: More people are
getting HIV diagnoses early, while they are still healthy, as a
result of a policy of routine testing implemented by the city in
mid-2006. Publicly supported HIV testing expanded by 70 percent.
Walter Smith, executive director of the DC Appleseed Center for
Law and Justice, praised the study but also lamented that it did
not offer more current data on new infections. The report said
that detailed information on new HIV cases is not included
because the transition from the code-based tracking system to a
name-based one takes five years to be mature, according to the
"I'm not criticizing them for that," he said. "But we've had
more testing, more needle exchange programs. We don't have, at
this moment, any understanding about what impact the new
programs have had."
Staff writers Jon Cohen and Jennifer Agiesta contributed to this