Washington Blade - November 30, 2007
Lou Chibbaro Jr

Men accounted for more than twice the number of new HIV infections than women in Washington between 2001 and 2006, and men who have sex with men - both white and black - had the highest HIV infection rates among the city's male population, according to the report.

The 120-page report shows that HIV was transmitted through men who have sex with men, referred to by AIDS researchers as MSM, in 25.8 percent of the HIV cases reported between that five-year period.

MSM transmission accounted for 71.3 percent of the HIV cases among white men during that time period, the report shows. MSM transmission comprised 33.4 percent of the HIV cases among black men, a figure higher than the 28.8 percent of black male HIV cases transmitted by heterosexual sex, according to the report.

By contrast, the report found that the virus was transmitted through heterosexual sex in 37.4 percent of all new infections of men and women combined in Washington that were reported during the same period.

The fact that the heterosexual figure was higher than the 25.8 percent transmission figure for men who have sex with men prompted Dr. Shannon Hader, the newly appointed director of HAA, to declare that it "blows the stereotype out of the water" that AIDS is a gay disease.

Hader and other city officials, including Mayor Adrian Fenty, expressed alarm in yet another finding of the report - that more than 80 percent of the 3,269 new HIV cases reported in Washington between 2001 and 2006 were among blacks, including large numbers of black women.

"This report gives us critical statistics on HIV and AIDS in our city and we must take advantage of this information with the sense of urgency that this epidemic deserves," Fenty said on Monday, when the report was released.

"Today, the District plans to build on our past efforts to aggressively work to reverse some of the trends that have plagued our community," the mayor said.

Among other things, Fenty said his administration would continue to push for more HIV testing throughout the city, double the number of free condoms distributed to community-based HIV prevention groups, and "revamp prevention strategies" to better target high-risk groups.

In a finding that is likely to raise questions among some AIDS activists, the report shows the number of new HIV cases in D.C. peaked in 2002 and dropped each year after that. The report shows there were 687 new HIV cases in 2002, 615 in 2003, 541 in 2004, 483 in 2005 and 403 in 2006.

Despite the drop in reported cases, the report says the figures for each of those years, when compared to other major cities by the number of cases per 100,000 residents, are higher than the HIV rates in other major U.S. cities, including New York, Philadelphia and Baltimore.

Hader said she believes the declining number cases in Washington after 2002 represent an under counting of cases rather than an actual reduction in cases.

The report notes that while the city kept track of the number of full-blown AIDS cases since the early 1980s, 2001 was the first year it began keeping records of HIV cases. The HIV cases were obtained through coded numbers rather than by names through what was called a Unique Identifier System, the report states.

The U.S. Centers for Disease Control & Prevention has called the Unique Identifier System flawed, saying it made it difficult to yield accurate HIV counts. In November 2006, under new CDC rules, D.C. joined most states in dropping the Unique Identifier System and started using a confidential names reporting system for counting new HIV cases.

The newly released D.C. AIDS report states that HAA researchers never methodically "evaluated" the accuracy of the Unique Identifier System. While HAA took steps to check for duplication of cases, it could not be certain that the counting process is 100 percent accurate, the report says.

All of the HIV cases in the report released this week were obtained through the Unique Identifier System, the report says.

The report provides these additional findings concerning HIV cases identified in D.C. between 2001 and 2006:

* Males comprised 2,114, or 64.7 percent of the cases; females comprised 1,155, or 35.3 percent, of the cases.

* The racial/ethnic breakdown of the cases consisted of: 359, or 11.0 percent white; 2,649, or 81.0 percent black; 132, or 4.0, Hispanic; 9, or 0.3 percent Asian; and 120, or 3.7 percent "other."

* The "mode of transmission" breakdown consisted of: MSM, 842, or 25.8 percent; Intravenous Drug Users (IDU), 432, or 13.2 percent; MSM/IDU, 61, or 1.9 percent; heterosexual contact, 1,222, or 37.4 percent; mode of transmission unknown, 712, or 21.8 percent.

* Among white men: 239, or 71.3 percent, MSM; 9, or 2.7 percent, IDU; 8, or 2.4 percent, MSM/IDU; 20, or 6.0 percent, heterosexual; 59, or 17.6 percent, mode of transmission unknown.

* Among black men: 530, or 33.4 percent, MSM; 228, or 14.4 percent, IDU; 51, or 3.2 percent, MSM/IDU; 457, or 28.8 percent, heterosexual; 322, or 20.3 percent, mode of transmission unknown.

* A copy of the report, District of Columbia Annual HIV/AIDS Epidemiology Report 2007, can be accessed through the D.C. Department of Health web site, www.doh.dc.gov.

Clinton calls for æbold leadership'

In a related development, local supporters of Democratic presidential candidate Hillary Clinton said a plan to fight AIDS in the U.S. and internationally that Clinton unveiled this week would help D.C. address many of the issues raised in the D.C. AIDS report.

The Clinton plan calls for doubling the HIV/AIDS research budget at the National Institutes of Health to $5.2 billion annually. The plan also calls for ending the Bush administration's abstinence-only prevention policy and instead proposes to fund "evidence-based HIV/AIDS prevention programs including, but not limited to, abstinence education as part of a comprehensive prevention policy."

Clinton's plan proposes to more aggressively address the higher incidence of HIV/AIDS in the African-American community by working with community groups and by increasing funding for the government's Minority AIDS Initiative and minority-run community based groups.

"The troubling news that the CDC may increase its estimate of annual HIV infection in the U.S. and the new report showing that the HIV/AIDS crisis has reached epidemic proportions in Washington, particularly among African Americans, demonstrate the need for bold leadership to fight this disease," Clinton said in a statement released to the Blade. "My plan will make progress in combatting this epidemic by making increased investments for research, prevention and education, and access to treatment and other services.

"This is especially important for groups that have seen HIV infection rates rise over the past several years, including African Americans and gay men."

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