The New York Times - November 27, 2007
Ian Urbina

"H.I.V./AIDS in the district has become a modern epidemic with complexities and challenges that continue to threaten the lives and well-being of far too many residents," said the report, which includes the first-ever study of statistics on H.I.V. in the city, along with updated data on AIDS cases. The H.I.V. data offers a vital snapshot of the most recent infections so health officials can study any changes in transmission patterns, the officials said.

The city's AIDS prevention office has been faulted in the past as not keeping proper data to track and fight the disease, and the director of the office is the 13th in just over two decades, a turnover rate that has hampered its focus, advocates for AIDS patients said.

The report said that from 2001 to 2006, 56 children, ages 13 or younger, were found to have either H.I.V. or AIDS, and almost all of them were infected at birth.

These cases, which account for 6 percent of all mother-to-child H.I.V. infections in the nation in the last five years, were especially alarming, city officials said, because they could have been avoided with routine H.I.V. testing during pregnancy, quick-results oral swabs during labor and "fast tracking" of the anti-retroviral drugs that can prevent transmission during delivery.

Although black residents account for 57 percent of the city's population of 500,000 or so, they account for 81 percent of new reports of H.I.V. cases and about 86 percent of people with AIDS.

The report also found that the disease spread through heterosexual contact in more than 37 percent of the cases detected from 2001 to last year, in contrast with the 25 percent of cases attributable to men having sex with men. Starting in 2004, the number of new H.I.V. cases among men and women ages 40 to 49 outpaced every other age group in the city.

While the report found 8,368 reported cases of people living with AIDS in the district at the end of last year, a 43 percent increase from 2001, it also found that the number of new H.I.V. cases began declining in 2003. City health officials say the drop in H.I.V. numbers was most likely a result of under-reporting or delayed reporting.

Dr. Shannon Hader, who became head of the city's H.I.V./AIDS Administration in October, said the city had begun confronting the problem. In the last year, Dr. Hader said, the city began providing voluntary screening to all incoming prison inmates, tripled the number of locations for free screening and initiated a free condom distribution program.

"We are also trying to raise awareness that there are programs in the city where people who are infected can get antiretroviral treatment, even if they do not have insurance and or cannot afford to pay for the treatment," she said.

City health officials said unprotected sex was the most common way H.I.V. is spread, followed by intravenous drug use. Since 2000, about 13 percent of all new H.I.V. cases in the city involved intravenous drug use, most likely the sharing of needles.

Washington is still the only city in the country barred by federal law from using local tax money to finance needle exchange programs. Congress controls the city's system of government, and for nearly a decade members of the House, citing concerns about worsening drug abuse, have inserted language into the bill approving the city's budget to prohibit financing such programs.

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