Washington Blade - August 29, 2003
Laurel Faust

Other experts cited governmental failure, a high at-risk population and complacency as among the factors leading to the high number of AIDS cases in the city.

HAA issued a report in July authored by Guy Weston, director of data and research, which showed that D.C. has a rate of 119 AIDS diagnoses per 100,000 residents. Data from 2001, the first year the information was compiled, revealed 678 new AIDS diagnoses. This is a higher rate of incidence than New York, Baltimore and San Francisco, among other cities.

An AIDS diagnosis is a medical term used to describe the progression of HIV, the AIDS virus, in a person to such a degree that it compromises their immune system, as determined either from the presence of opportunistic infections or a low T-cell count. The percentage of new AIDS cases is, however, indirectly related to the number of new HIV infections in the District and surrounding area, AIDS activists said.

In response to Blade inquiries about the higher number of per capita AIDS cases, the District's HIV/AIDS Administration sent a three-page written response claiming the incidence rate is lower in larger cities because there are more people.

"Other cities known to have a large number of AIDS cases, such as New York, Los Angeles and Chicago, have much larger populations. These cities have populations of 9 million, 3.7 million and 2.9 million respectively. The large denominator thus brings the rate per 100,000 down," HAA stated in its response.

Joan Wright Andoh, HAA chief of HIV/AIDS surveillance, confirmed that statistic.

"Cities with larger denominators make the total numbers go down," she said.

Playing with numbers

Bob Summersgill, treasurer of the Gay & Lesbian Activists Alliance, said that this is another instance in which HAA "plays with numbers."

"It shouldn't affect the rate," he said. "The rate is a per capita thing."

When pressed about the numbers, Wright Andoh said that another report would be needed to explain why the rate of incidence is higher in D.C. than in other cities.

The HAA response also listed a high poverty rate, lower education levels, lack of health insurance, a high rate of IV-drug use and traditional sexual disease (gonorrhea, syphilis, chlamydia) as contributing factors to the high incidence level.

Summersgill said that while these factors are present, other cities face these problems as well. He blamed the high rate rather on a failed public health system and said that HAA is a major part of the failure.

"I don't think our problems are unique, but our government is barely functional," Summersgill said.

Brent Minor, chair of President Bush's HIV Advisory Committee, agreed to address the rising D.C. AIDS rate, but not in his official capacity. Minor said the District has traditionally taken a very piecemeal approach to prevention and that the new statistics should serve as a wake up call.

"We need to talk very bluntly and openly about HIV and how it is spread and who is at risk," said Minor, who also serves as chair of the Alexandria Commission on HIV/AIDS and is the former co-chair of the District's Ryan White Planning Council. "The more open and frank we are in our discussions of HIV, the more people will hear that message and will take it seriously. We're so timid about stepping on people's toes that we forget that we're stepping over dead bodies."

Tony Bullock, communications director for Mayor Anthony Williams, acknowledged the city's problems.

"Our health stats in the District of Columbia are abysmal, and we need to do something about it," Bullock said. "We've had the unfortunate distinction of having one of the highest incidence rates in the nation for many, many years."

Bullock noted the long-standing acrimony between gay activists and HAA. He said the mayor has confidence in Ron Lewis, who used to head HAA and now - as deputy director for the Department of Health - oversees the District's AIDS agency.

"The mayor has no specific information that would suggest we have a problem. If specific information is brought to his attention, he'll certainly look into it," Bullock said.

Bullock said that in January the mayor instructed the inspector general to look into the financial operations of HAA, but he didn't know if the matter had been resolved.

Attempts to reach Lewis or Weston by press time were unsuccessful.

Wright Andoh and others said that Washington has a large gay and African-American community, which contribute to the high incidence rate.

Eighty percent of AIDS diagnoses in the District are from among African Americans, who make up 61 percent of the city's population.

Bullock said the average life expectancy of a black male in the District is 56 years.

Ron Simmons, president of Us Helping Us, a community-based AIDS service organization committed to reducing HIV infection among African Americans, said that many bisexual black men don't know they are infected with the virus, and they go ahead to unwittingly infect their wives and girlfriends.

"So many women who end up infected are monogamous women. It's their partner that's infected," Simmons said.

He said that too many people are assuming they don't need to get tested and aren't at risk.

"That's not true," Simmons said. "They are at risk."

Young people aren't getting tested

Michael Cover, deputy executive of public affairs for the Whitman Walker Clinic, said another reason for the high rate of AIDS cases is that many people aren't getting tested for HIV until late in the progression of the illness. A person with HIV who doesn't get treated will eventually develop AIDS.

"Many are HIV-positive and don't know it," Cover said. "The reason they don't get tested is that they don't perceive themselves to be at risk."

Cover said young people especially are not getting tested.

"They didn't come to sexual maturity in the height of the crisis. So they've never lost friends to AIDS, and they've got friends who are HIV-positive who are taking pills and are healthy."

The AIDS cocktail drugs have been known to prolong the lives of persons infected with HIV.

A "Basic Statistics" report by the Centers for Disease Control states that half of all new HIV infections annually are thought to occur in young people under 25, and the majority of them are infected sexually.

HAA's written response to the Blade reported that youth aged 13-19 represented less than 1 percent of the reported AIDS cases, but the age group accounted for 43 percent of chlamydia cases and 25 percent of gonorrhea cases, which indicates that young people are practicing behaviors that can expose them to AIDS.

Cover said that the city has a "very poor public health system."

"HIV is as much a disease of poverty as it is of the immune system. When poor people don't have access to the health care system, and to prevention, care and treatment, we see a sharply rising epidemic," Cover said.

Bringing healthcare to the poor

Bullock said Williams is focusing on preventative health care through the D.C. Health Care Alliance, which he described as an "HMO for poor people." The Health Care Alliance is a no-cost program for low-income people who don't otherwise have health insurance.

Bullock said that it will serve, for instance, young people who have health questions and concerns but don't feel comfortable talking to their parents, teachers or friends.

"We need to do a better job of getting out good health information," Bullock said.

Bullock said Williams is working to remove the congressional ban on funding for a needle exchange program.

"They continue to ignore solid evidence that syringe exchange programs can work when properly implemented," Minor said of congressional Republicans who have blocked the program's implementation.

Summersgill said that there is no compulsory sex education in the schools, and that rather in its place are abstinence programs.

"Abstinence is a fine idea. It works to a point, but it doesn't work for people who are sexually active. We have to address that issue head on," Bullock said.

Minor said that urban settings tend to have higher infection rates, because there are more opportunities to find and use drugs and to have sex.

"There are more opportunities than if you're living in the sticks in Kansas," he said.

Simmons proposed that it may actually be a good thing that more AIDS cases are being diagnosed, because it could mean that more people are getting tested.

"I think the city is indeed successful and doing what it should be doing, and that's why we're finding more people infected," he said.

Simmons cited reports that state that one-third of those infected with HIV don't know their status. He said if this is true, it only makes sense that the number of AIDS diagnoses would increase.

Cover said the private sector, individuals, nonprofits, and all levels of government need to work together to improve the quality of health care and access to care and treatment.

MORE INFO

Whitman-Walker Clinic

1407 S St., NW

Washington D.C. 20009

202-797-3500

www.wwc.org

Centers for Disease Control

1600 Clifton Road

Atlanta, GA 30333

404-639-3311

www.cdc.gov

D.C. HIV/AIDS Administration

717 14th St., NW, 10th Floor

Washington D.C. 20002

202-727-2500

Us Helping Us

811 L St., SE

202-546-8200

www.ushelpingus.com

030829
WB030813

Always watch for outdated information. This article first appeared in 2003. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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