More than half of AIDS-related deaths in Washington, D.C., not reported

More than half of the AIDS-related deaths that occurred in Washington, D.C., from 2000 to 2005 were missed by the city's system for reporting such deaths, according to an analysis by the district's Department of Health and CDC that was published recently in CDC's Morbidity and Mortality Weekly Report, the Washington Post reports.

The underreporting of AIDS-related deaths suggests that the epidemic "may be taking a far greater toll" on the district than health officials had originally thought, according to the Post.

For the analysis, city health officials worked with CDC to review all death certificates from 2000 to 2005 in an effort to identify deaths that appeared to be AIDS-related. They compared that number with the deaths that had been reported and discovered the discrepancy, the Post reports. According to the analysis, of the 2,460 deaths from AIDS-related illnesses that occurred between 2000 and 2005, 1,337 had not been reported because the city's system for tracking them was "inadequate," the Post reports. Officials launched the investigation because of health officials' increasing concern that they were undercounting the number of district residents living with HIV and those dying of AIDS-related causes, in part because they discovered boxes of unexamined paper records. Shannon Hader, senior deputy of the health department's HIV/AIDS Administration, said the analysis "tells us our surveillance system wasn't complete enough," adding, "We're clearly underreporting."

According to the Post, at least 12,500 district residents have developed AIDS -- one of the highest rates in the country -- and officials estimate that between 3% and 5% of people living in the city are HIV-positive. Hader said that in order to curb the spread of HIV in the district and ensure that HIV-positive people receive appropriate care, the department needs an "accurate count." In addition, the amount of federal HIV/AIDS funding the district receives is based on such estimates, Hader said, adding, "We want everything they owe us."

In response to the findings, Hader said the district has initiated several efforts to improve its reporting system, including a mass mailing in January to about 4,000 physicians and laboratories to try to increase the number of reported diagnoses. Officials also have begun routinely reviewing death records and have launched a campaign to try to identify more people for treatment.

"What we need to do is get more people who don't know they have HIV diagnosed and into care and treatment," Hader said, adding, "Every time you go into a health care provider, they should be offering to test you for HIV. We want to drive down the number of people living with HIV and [who] don't know about it" (Stein, Washington Post, 6/14).

The analysis is available online.