HIV/AIDS Epidemic in Washington, DC
Disease Touches Nearly Every Population and Age Group
Nov 5, 2009
Confirming what local AIDS activists already know, the District of Columbia government in March 2009 released data that paint a grim picture of HIV/AIDS in the U.S. capital. Overall, 15,120 residents of the city are known to have HIV or AIDS, equivalent to 3 percent of the population over age 12.
The U.S. Centers for Disease Control says an area has a “generalized and severe” AIDS epidemic when 1 percent of the local population is infected. Every age group in the District 20 years or older has HIV prevalence above this level.
Moreover, the 3 percent figure takes into account only those residents who have been tested. The real prevalence is probably much worse, according to Dr. Shannon L. Hader, the city’s HIV/AIDS administrator.
Posters placed around the city last summer by the AIDS Healthcare Foundation proclaimed that “AIDS is DC’s Katrina.”
Older Black Men Bear Highest Burden
The District of Columbia HIV/AIDS Epidemiology Update 2008 found high rates of HIV in nearly all the city’s neighborhoods. The highest concentrations are in the poorest wards in the central and eastern parts of the city. Only affluent, largely white Ward 3 on the city’s western edge has been spared.
In the 1980s, AIDS in the District of Columbia, as elsewhere in the country, was mainly a disease of gay white males. But that is no longer true. Today, African Americans, including men and women of all sexual orientations, bear the highest burden of HIV in the District.
Over 4 percent of black DC residents have the virus, followed by Latinos (1.9 percent) and whites (1.4 percent). Black men are the most heavily affected, with an infection rate of 6.5 percent. Figures in the report are current as of the end of 2007.
Heterosexual sex is the primary mode of HIV transmission in the city’s black population, followed by MSM (men who have sex with men) and injection drug use. Among whites, three-quarters of reported infections are through MSM.
As in other U.S. cities, AIDS in the District is predominantly a male disease. But 28 percent of District residents with HIV are women, and 91 percent of DC women with HIV are black.
The District’s AIDS population is aging. Seventy percent of DC residents with HIV/AIDS are older than 40. The highest prevalence is among people 40–49 years old, 7.2 percent of whom are infected, more than double the citywide rate. The infection rate among people in their fifties is also high, at 5.2 percent.
The report notes that early diagnosis and treatment are allowing District residents with AIDS to live longer. But it warns that an aging AIDS population will have a significant impact on the city’s health care system.
Congress Seeks to Block Needle Exchange
The District has made some progress in HIV prevention in recent years. In 2006, Washington became the first city in the country to implement a policy of routine HIV testing. Expanded testing has helped many District residents learn of their infection early, when treatment can prevent HIV from progressing to AIDS.
The number of young people tested for HIV doubled between 2007 and 2008. The District also has a school-based screening program for sexually transmitted diseases that can facilitate the transmission of HIV.
For the past two years DC has had an active needle-exchange program aimed at preventing HIV infection among injection drug users. The U.S. Congress, which largely controls the purse strings in DC, long barred the DC government from using local funds for needle exchange. When Congress lifted the ban in 2007, the city moved quickly to provide clean needles to addicts. Injection drug users account for 18 percent of people with HIV or AIDS in the city.
As of late 2009, however, Congress is threatening to again limit the District’s needle-exchange programs. Rep. Jack Kingston, Republican of Georgia, has introduced an amendment to the District’s federal appropriation for 2010 that would effectively cripple the program’s ability to reach addicts across the city.
AIDS Funding Scandal
While the District has made strides in prevention, it has done less well when it comes to caring for AIDS patients in the city’s poorest wards.
Widespread anger greeted news reports, in October 2009, that the city paid millions of dollars to AIDS nonprofit groups that in many cases delivered poor-quality services, or no services at all. Many of the groups found to have deficiencies were supposed to be providing housing to people sick with AIDS. Some patients found themselves without food, electricity, or heat.
The city immediately announced an investigation of its AIDS funding practices and vowed to root out waste and abuse among those receiving grants.
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