District of Columbia HIV/AIDS prevalence at 3%, report says

At least 3% of District of Columbia residents are living with HIV/AIDS, greater than the 1% level that constitutes a "generalized and severe" epidemic, according to a 2008 report to be released Monday by the city's HIV/AIDS Administration, the Washington Post reports.

The 2008 study, which updates 2007 data, is the most accurate count to date of the district's HIV/AIDS prevalence, the authors said. Tracking for the report occurred as the district made the switch from a code-based system to a name-based system. Surveillance teams interviewed medical workers to identify unreported HIV cases, questioned providers who did not provide consistent reports and searched databases for unreported cases. According to the Post, about 2,984 district residents per every 100,000 people older than age 12 -- or about 15,120 people total -- are HIV-positive. The report found a 22% increase in HIV/AIDS cases from the end of 2006, when the district reported 12,438 HIV cases. The report suggests that HIV/AIDS has reached an epidemic level in all but one of the city's wards and that the increase in prevalence has affected all genders and racial groups. The report also cautioned that "the true number of residents" living with HIV could be higher than official data indicate, according to the Post.

According to the study's findings, more than 4% of black district residents are living with HIV, as are 2% of Hispanics and 1.4% of whites. Of those living in the city who are HIV-positive, about 76% are black, 70% are men and 70% are age 40 or older, the report said. The report found that black men in the city have the largest HIV burden, with a prevalence of about 7%. In addition, about 3% of black women in the district are HIV-positive, partly because of an increase in heterosexual transmission in the city. According to the report, men having sex with men remains the leading cause of HIV transmission in the district, followed by heterosexual transmission and injection drug use. Among blacks, heterosexual sex was the leading cause of HIV transmission, accounting for 33% of cases. MSM accounted for the most HIV cases among white residents at 78% and also among Hispanics at 49%. The study also found that black women account for more than one-quarter of the district's HIV cases and that 58% contracted the disease through heterosexual contact. About 25% of black women contracted HIV through injection drug use, the study said.

According to the Post, the report also emphasizes the district's aging HIV-positive population, with data indicating that almost one in 10 residents between ages 40 to 49 has HIV. According to the report, "this growing population will have significant implications on the district's health care system" as the population begins to face conditions associated with both HIV and aging. However, the report also had "good news" with data indicating that more people are receiving earlier diagnoses for HIV, the Post reports. According to the Post, publicly supported HIV testing in the district has expanded by 70%, partly as a result of a routine testing policy implemented in 2006.

Shannon Hader, director of the district's HIV/AIDS administration and former head of CDC's work in Zimbabwe, said the city's HIV prevalence is "higher than West Africa" and "on par with Uganda and some parts of Kenya." Hader added that all modes of transmission are "on the rise, and we have to deal with them." Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, called the report's findings "very, very depressing news, especially considering HIV's profound impact on minority communities." Fauci added that the report is "just based on people who've gotten tested," the Post reports. Walter Smith, executive director of the DC Appleseed Center for Law and Justice, praised the study but also expressed disappointment that it did not include more data on new HIV cases. The report did not include this information because it could take five years to discern accurate data from the transition to the name-based tracking system from the code-based one, according to the CDC. Smith said that he is "not criticizing" officials for not including information about new cases but added that the city has "had more testing, more needle exchange programs." Smith said, "We don't have, at this moment, any understanding about what impact the new programs have had."

David Catania, chair of the D.C. Council's Committee on Health, said that the city has improved testing and monitoring efforts in the past two years but added that the HIV/AIDS administration still faces several difficulties arising from past challenges. Catania said, "For years prior to 2005, mayors and previous individuals allowed things to exist in an unacceptable way." He added that he does "blame this government for part of the epidemic we're confronting." District Mayor Adrian Fenty praised the city's recent efforts to address HIV/AIDS but also acknowledged that more action is needed to control the spread of the disease. "In order to solve an issue as complex as HIV and AIDS, you have to step up," he said, adding, "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." Some people also have questioned whether congressional control over the district has hindered the city's ability to address HIV among injection drug users. According to the Post, a nearly 10-year ban Congress imposed on the use of tax dollars to fund needle-exchange programs in the district was lifted last year.

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According to the Post, district health officials on Monday also released a companion study on heterosexual behavior conducted by George Washington University's School of Health and Health Services and funded by CDC. The study, titled "Heterosexual Relationships and HIV in Washington, D.C.," examines social networks that include people at a high risk of contracting HIV. The report also seeks to analyze individuals' choices and actions before they visit clinics or contract the disease.

The study involved 750 participants and targeted four areas of the district with high HIV prevalence and large low-income populations (Vargas/Fears, Washington Post, 3/15). According to the study's findings, among district residents who had connections to high risk networks, about three out of five were aware of their HIV status and about three in 10 had used a condom the last time they had sex (AP/Baltimore Sun, 3/15). The study also found that almost half of those who had connections to part of the city with high prevalence and poverty rates said they had overlapping sexual partners within the previous 12 months.

Rather than interviewing those who exhibit high-risk behavior themselves, the study focused on those who had connections to high-risk neighborhoods. According to the Post, this methodology reflects a shift in the direction of CDC, which developed the survey protocol. According to the Post, the two reports provide a "sobering assessment" of the HIV/AIDS burden in a city that has struggled to control the disease (Washington Post, 3/15).