Washington Blade - March 13, 2009
Amy Cavanaugh

A report from the Centers for Disease Control & Prev-ention says Washington has the highest HIV death rate in the country, though the city's infection rate improved slightly from 2006. The report, released last month, also says 871 new cases of HIV were reported in D.C. in 2007, the most recently completed calendar year the report considered.

Justin Goforth, head of the Whitman-Walker Clinic's medical adherence unit, said the new data show that "here in D.C., we have an epidemic that's out of control."

The report's sobering findings were expected to be affirmed next week when the D.C. 2008 HIV/AIDS Epidemi-ological Report is released.

Daniel O'Neill, who heads a new HIV Prevention Working Group at the D.C. Center for gay, bisexual and transgender people, said he was given an early look at the 2008 D.C. data, and that it's "very grim" for men who have sex with men.

He was recently appointed to the D.C. HIV Prevention Community Planning Group, a part of the D.C. Department of Health HIV/AIDS Administration.

O'Neill said the D.C. report shows HIV infection rates in D.C. were twice as high as New York for 2008. That finding, if true, would represent a major shift from the 2007 CDC numbers, which showed D.C. with a lower infection rate than New York. The local report also reportedly says that 3 percent of D.C. residents over age 13 were diagnosed as HIV positive in 2007, 25 percent of known infections in the District are comprised of men who have sex with men, and 6.5 percent of black men in D.C. and 2.6 percent of white men in D.C. are diagnosed as HIV positive.

The statistics follow last month's release of the CDC's report, titled "Cases of HIV Infection and AIDS in the United States and Dependent Areas 2007." The report includes cases of HIV infection and AIDS reported to the CDC through June 2008.

According to the report, there was a 26 percent increase from 2004 to 2007 in estimated annual HIV/AIDS diagnoses among men who have sex with men. The report says the increase "may represent an increase in HIV incidence" among men who have sex with men, but could "also be affected by increases in testing."

Among other notable figures in the CDC report are that as of 2005, D.C. has the highest HIV death rate per 100,000 people: 37.1. The next closest was Florida at 9.8. The nation as a whole averages 4.2.

Nationally, the report shows that from 2004 to 2007, HIV diagnoses increased 15 percent in the 34 states that have long-term, name-based HIV reporting. The increase could be due to changes in state reporting regulations, more people getting tested for HIV, instability in the data or an actual increase in the number of new HIV infections. But the report also notes that the annual number of HIV/AIDS diagnoses remained stable from 2004 through 2006, and the 15 percent increase in annual HIV/AIDS diagnoses from 2006 to 2007 accounts for the majority of the increase seen from 2004 to 2007.

The report also breaks down HIV infection rates by metropolitan area. D.C.'s 2007 rate was 34.5 per 100,000 people, which represented a slight improvement over its 2006 rate of 35.8.

The report's data for cumulative AIDS cases show that through 2007, D.C. was tracking 18,196 AIDS cases and knew of 8,895 people living with full-blown AIDS. The number of total AIDS cases in the U.S. was 1,030,832.

HIV/AIDS experts in D.C. described the numbers as appallingly high, yet unsurprising.

Goforth said he was looking forward to seeing the new D.C. data and comparing it against the CDC data.

"What you're going to see out of the D.C. numbers is that the epidemic is absolutely growing," he said. "One in 20 adults in D.C. is [said to be] infected with HIV, but I believe that the new number will be higher than that."

Chip Lewis, a Whitman-Walker Clinic spokesperson, noted that in 2008, the Clinic confirmed 541 new HIV diagnoses, which represented about 1 percent of all new HIV cases in the United States. He said most of those cases occurred in gay and bisexual men in their late teens and early 20s and those in their late 30s and early 40s.

Adam Tenner, executive director of Metro Teen AIDS, called the raw numbers in the CDC report "astounding," but noted that it's tricky to make direct comparisons for D.C. against state data.

"No state is as concentrated as we are [in terms of population]," he said. "Most states have some rural areas, so it's really apples and oranges to compare the data."

He said that Metro Teen AIDS provides services that would help the numbers diminish over time. "We feel like the investment in HIV protection for young people à will yield longer term reduced HIV infections," Tenner said. "When we give young people the knowledge, information and skills, we give them not just the preparation to remain safe during adolescence, but the preparation for a lifetime of decision making. That's the goal. We have failed young people in D.C. by not adequately educating them about the dangers of HIV."

Carl Schmid, federal affairs director at the AIDS Institute, said the new data show that "we need to do more and our country needs to do more."

"We need to do more, we need to focus more on the prevention, we need leadership," he said. "We need a national AIDS strategy with goals, timetables and resources to make sure we are meeting these goals."

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