Washington Blade - March 20, 2009
Lou Chibbaro Jr.

Similar to past reports on AIDS in D.C., the latest report shows that men who have sex with men, referred to in epidemiological studies as MSM, accounted for the largest number of people living with the disease: 36.9 percent.

Those that contracted HIV/AIDS through heterosexual contact comprised 28.1 percent of the living cases, and those contracting the disease through injection drug use accounted for 18.2 percent of people living in the city with HIV/AIDS by the end of 2007, the report shows.

Dr. Shannon Hader, director of the HIV/AIDS Administration, attributed a significant percentage of the overall increase in reported cases to a dramatic increase in the number of people in the city being tested for HIV.

Mayor Adrian Fenty joined Hader and Dr. Pierre Vigilance, director of the city's Department of Health, at a news conference Monday to announce the report's findings. The mayor noted that 70,000 people were tested for HIV in D.C. in 2007, a 70 percent increase over the 40,000 people tested four years earlier.

"Knowing your status and doing something about it has been the thrust of this administration" in tackling AIDS, Fenty said.

Hader said it's essential that people know their HIV status, so that people who test positive can obtain treatment and remain healthy. She also noted the city's testing program aims to prevent the spread of HIV by encouraging people who test positive not to engage in risky behavior.

The newly released report found that 15,120 D.C. residents - about 3 percent of the population over age 12 - had HIV or AIDS as of Dec. 31, 2007. Hader said the figure placed D.C. alongside African countries such as Uganda in terms of HIV/AIDS prevalence.

The finding placed the city's total AIDS numbers as the highest in the nation based on the number of cases per 100,000 people.

The report's findings also highlighted the disparities in the number of HIV/AIDS cases among different population groups.

Similar to past years, blacks in the city continued as the most severely affected group, with 4 percent of black residents over the age of 12 infected with HIV. The report showed that 1.9 percent of Latinos and 1.4 percent of whites are infected with HIV in Washington.

"Black males had the highest burden of disease with 6.5 percent of all black males in the District living with HIV/AIDS," the report says.

According to the report, while the total number of HIV/AIDS cases increased by 22 percent between 2006 and 2007, the number of cases among men who have sex with men increased by 35 percent during that same period. The number of cases attributed to heterosexual transmission increased by 16 percent and the cases linked to injection drug use increased by 8 percent in 2007.

"The HIV/AIDS Administration attributes most of the MSM increase to better case reporting and not to a trend in increasing MSM cases at this time," the report says.

Hader said that despite the city's stepped-up testing program, epidemiologists believe large numbers of people who are infected with HIV in the city most likely have yet to be tested. She noted the severity of the epidemic in the District is thus probably greater than what current figures show.

'We have a lot of work to do'

HAA released a second report Monday titled Heterosexual Relationships & HIV in Washington, D.C., which shows, among other things, that a significant number of heterosexual couples are having sex outside of a committed relationship.

The report is based on a study conducted for HAA by George Washington University's School of Public Health & Health Services.

It found that 46 percent of all study participants believed their last sexual partner was having sex with someone outside the relationship. It also found that 45 percent of the participants reported that they had sex outside their relationship.

In a finding that Fenty called highly troubling, more than 70 percent of the study participants did not know their last sex partner's HIV status and more than 70 percent reported they did not use condoms.

"You see why the city is experiencing such a problem," the mayor said at Monday's news conference.

"We know we have a lot of work to do as a government to educate and to get the information out and as a community to step up and realize how dangerous we are with our sexual behavior," he said.

D.C. Council member David Catania (I-At Large), who also spoke at the news conference, praised Fenty, Hader and Vigilance for making important progress over the past two years in the city's fight against AIDS.

Catania said many of the current problems related to AIDS are due to the "dysfunctional" HAA that existed under previous mayoral administrations.

"How did we get here? We had a very different situation," he said. "The city took six months to pay non-profit groups for [AIDS-related] services."

He also said that the AIDS office appeared incapable of filling job vacancies at HAA, including vacancies for important positions needed to gather epidemiological data. He described the earlier situation as "a mess."

Catania, who as chair of the Council's Committee on Health has been credited with playing a key role in prodding the city into improving the AIDS office, said he agreed with Fenty's call for citizens to take personal responsibility for protecting themselves against HIV.

"In the end," he said, "we cannot protect you if you don't protect yourselves."

New campaign, more condoms

Fenty and Hader said HAA would further increase the number of condoms it distributes throughout the city and would put in place AIDS prevention campaigns to reach high-risk population groups.

The main report released Monday - the District of Columbia HIV/AIDS Epidemiology Update 2008 - says that while men who have sex with men make up the largest number of people living with HIV/AIDS in the city, the number of people contracting the disease through heterosexual sex has surpassed the number of MSM cases among people newly diagnosed with the disease.

"The leading mode of transmission reported among newly diagnosed AIDS cases for each year since 2003 has been heterosexual sex with the exception of 2007, where the leading mode of transmission reported [for newly diagnosed cases] was MSM sexual contact," the report says.

"This exception is attributable mostly to improved reporting of MSM cases and not necessarily to a change in trends at this time," the report says. "The shift experienced in the District from MSM to heterosexuals as the leading mode of transmission is mostly observed among blacks and Hispanics, with newly reported AIDS cases among whites remaining largely attributable to MSM sexual contact."

Ron Simmons, executive director of the local AIDS service group Us Helping Us, said, "the good news to me is that putting the effort into more HIV testing has paid off."

But he said the bad news is that far more cases have been identified and a lot more people will need treatment and services. He also said the finding reiterating past studies showing that black men - including black gay men - have the highest HIV/AIDS prevalence sometimes leads to a misperception related to black gays and HIV.

He noted that a 2005 study conducted by the U.S. Centers for Disease Control & Prevention found that although the HIV rate for black men who have sex with men is far higher than their white counterparts, the degree of high-risk sexual behavior engaged in by both groups was essentially the same.

"This shows that there has to have been some other reason for these higher numbers among black gay men that we're still not sure about," he said.

One possible reason, Simmons said, is that the baseline figure for HIV positive black gay men was significantly higher than white gay men going back to the 1990s, and that the probability of transmission within this group is higher because far more people are already infected.

"Our solutions and strategies here in the District will have to take into consideration something other than just risky behavior," he said, when addressing the epidemic in the black gay population.

Dr. Raymond Martins, chief medical officer for the Whitman-Walker Clinic, said the trend of straight transmission cases surpassing gay transmission cases indicates that more emphasis on risky sexual behaviors will be needed to address the risk for the straight population as well as for gay men.

"Not only did the city's report show that a large percentage of people who consider themselves in a monogamous relationship know that their partner was unfaithful, but that a large percentage of those same people had been unfaithful to their partner," Martins said.

"We definitely need to end the stigma around even discussion of HIV and sexual behaviors to fight the epidemic," he said.

Martins also pointed to Whitman-Walker's own data for 2008 - which are more recent that the data released in this week's reports - showing 541 new HIV diagnoses.

"That's 1 percent of all new HIV infections in the United States just at our facilities," he said. "The majority of those cases were in gay and bisexual men, particularly men in their late teens and early 20s and those in their late 30s and early 40s," he said.

"Clearly, we need to reach out to not only young people who have no memory of the horrors of the early HIV/AIDS epidemic but also to older people who may be burned out on the same prevention messages they've heard for the last 28 years," he said.

The new HIV/AIDS epidemiology and heterosexual relationships reports can be viewed online at www.doh.dc.gov/hiv.

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