Fighting AIDS in the Nation’s Capital
Back then, city officials acknowledged that they didn't have a complete picture of the problem. But they estimated that as many as one in 20 residents were infected with the disease, rivaling rates in sub-Saharan Africa.
"We had an epidemic that wasn't being controlled by any stretch of the imagination," said
But today, even as the city's population has grown to 681,000, its infection rates have dropped dramatically. In 2016, 347 people in the nation's capital tested positive for HIV, down three-quarters from 2007.
D.C.'s success mirrors national trends; HIV rates are on the decline around the country. But the tools city officials used to tackle the epidemic are being held up as a model for the rest of the country, AIDS researchers say.
"There are things that D.C. has done that are unique and ahead of the curve," said
How did D.C. do it? A decade ago, city health officials stepped up AIDS awareness campaigns and pushed to get more residents tested. They created a "red carpet" program, immediately linking anyone who tested positive to care, whether or not they had health insurance. They stepped up condom distribution and began a robust needle exchange program. Since then, the city has almost eliminated new infections from IV drug use. Finally, in 2014, officials increased the use of PrEP, a drug that prevents the transmission of HIV.
The city's goal now: to end the epidemic by 2020. In December, Mayor
The plan sets specific targets to be met by 2020: 90 percent of the HIV positive people in the district will know their status; 90 percent of people diagnosed with HIV will be in treatment; 90 percent of residents who are in treatment will reach viral load suppression, which means they can't transmit the disease to others; and new HIV infection rates will be cut in half.
Today, the
"D.C. was a national embarrassment in terms of our HIV rates, really by almost any measure," said
Playing Catch-Up
A decade ago, D.C. had a lot of catching up to do. A 2005 report by the
The report was a shock to the system. And, driven by an unusual effort among public officials, private groups, churches and community activists, the city set out to change the way it dealt with AIDS.
In 2006, the district launched an ambitious campaign to get more people tested. Public health officials took to local radio stations, urging anyone who was sexually active, regardless of age, to get tested. They set up mobile units a few blocks from the
"This was visionary -- and the right thing to do," Millet said.
As more people in the district were tested for HIV, fewer people were diagnosed with HIV and full-blown AIDS, Millet said.
"If you catch people sooner in the infection and get them in care, they're likely to live a very long life and less likely to transmit it to others," Millet said.
With expanded, name-based testing, city officials were able to identify which ZIP codes were hardest hit, said
The approach was unusual, Jones said, and it allowed the city to direct resources to local AIDS groups that knew best how to serve the needs of those populations.
The city also worked with the police. In the past, police would flag anyone they pulled over who was carrying more than three condoms as a potential sex worker, said
City health workers convinced police that carrying large numbers of condoms was ultimately good for public health, he said. "I wanted to flood the city in rivers of latex."
The Nation's Capital
D.C.'s success is due to a number of factors: plentiful resources, strategic use of data to target at-risk populations, city council members who pushed for changes, and active community-based AIDS organizations, such as
The city also requires medical doctors, nurses and physician assistants to have three continuing medical education credits on HIV in order to be licensed, a requirement that Kharfen said doesn't exist in most other jurisdictions.
Another thing that helped: the city has above-average access to medical care, according to
Before the implementation of the Affordable Care Act, D.C. was one of the few jurisdictions that had expanded Medicaid to cover people living with HIV who were not disabled, Killelea said.
And beginning in 2006, anyone in the district who tested positive for HIV and earned less than
"That was very, very, very important," she said, because AIDS drugs can cost thousands of dollars a month.
In 2015, the district's new HIV diagnosis rate was far higher than any state's, according to
But when the district is counted as a metropolitan area encompassing parts of
Targeting the Fight
Black gay and bisexual men and straight black women remain hardest hit in the district.
Earlier this year,
AIDS experts worry that a proposal from the Trump administration could drastically reduce HIV/AIDS funding. That could spell chaos for a city that managed to beat back disaster, they say.
"If we were to slow down now, our epidemic could come roaring back," said Wickham of the
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