Getting to an AIDS Free DC

The latest epidemiology report from the DC Department of Health shows that things are looking up in the battle against the spread of HIV. So what will it take to have an AIDS free generation in the District?

There was a time when the District’s HIV infection rates were comparable to those of Western African countries. Hundreds of people were being diagnosed annually, turmoil in the HIV administration presented mixed messages and efforts to combat these rates seemed to be relatively ineffective. Over the past six years, however, a positive trend has been setting in and the city is seeing a strong, consistent decline in HIV infection rates. Are we closer to being AIDS free in DC?  

Lower infection rates

According to the 2013 Annual Epidemiology and Surveillance Report published in November, newly diagnosed HIV cases have been reduced from 1,180 in 2008 to 680 in 2012. The primary mode of transmission for new infections is men who have sex with men (MSM) among black males (25%) followed by heterosexual sex among black females (18%).  But the number of cases of MSM transmission overall has dropped by 29% over the past four years.  The virus still disproportionately affects African-Americans and the highest levels of diagnosed HIV cases are in Wards 5,6,7, and 8. Sadly, that statistic has remained consistent over many years.

Although technically the District is still classified as having an HIV epidemic, the good news is that residents continue to live longer with the virus and avoid progressing to AIDS. Living HIV cases in DC has risen from 13,862 in 2008 to 16,072 in 2012. The number of newly diagnosed AIDS cases has fallen from 564 in 2008 to 370 in 2012.  The leading modes of transmission among new AIDS cases are heterosexual sex followed by MSM. These numbers are promising in a city where HIV is one of the top five public health concerns. Why are things improving? Better treatments such as Truvada (aka PrEP), expansion of Medicaid, rapid diagnosis and treatment, and more access to health care in general can be attributed to the decline in infection rates and AIDS diagnoses. 

What’s working?

Take a look around the city. Safe sex messages are everywhere. There are ads on buses and Metro cars.  Many hospitals and clinics offer free condoms at practically every desk. Female condoms are more available at local pharmacies too. In 2008, the Department of Health’s Office of HIV/AIDS, Hepatitis, Sexually Transmitted Diseases Administration (HAHSTA) partnered with Octane Public Relations and Advertising to launch a social marketing campaign aimed at raising public awareness about HIV in the city. The District took a bold step towards promoting protection, safe sex practices and the importance of getting tested. Social marketing campaigns are now reaching more residents. 

How well are they working? A recent report entitled DC Takes On HIV: Public Awareness, Resident Engagement and a Call to Action highlighted how many residents recall seeing campaigns around the city and remember what the campaigns were about. Among the residents that were surveyed, 44% recalled the DC Takes On HIV campaign and 39% recalled the Ask for the Test campaign. In addition, 54% of DC residents said that the message of getting tested was clearly received while 44% said that protect yourself was a message they inferred. 

Hepatitis C- the new HIV

Another virus has been concerning health officials, health educators and physicians for some time now. Hepatitis C, a virus that attacks the liver, has been dubbed the new HIV because it is widespread. It is also similar to HIV in that it can be transmitted through intravenous drug injection, through sex with an infected person, and needle sticks, although the latter two circumstances are rare. Many people who are infected are unaware of their infection because typically the Hepatitis C virus (HCV) presents no symptoms. However, if left untreated, HCV can lead to cirrhosis or liver cancer. 

Nearly 16,000 residents tested positive for the Hepatitis C virus between 2008 and 2012.  Black males ages 50-59 comprise the majority of the newly diagnosed cases within that time frame. Ward 7 has the highest concentration of HCV cases followed closely by Wards 8 and Ward 5. 

The upside is that more people are getting tested for the virus and that can help health officials identify patterns.  But since this is a virus can be present in a person’s system for many years, there is more work to be done to get people tested. People with a history of intravenous drug use and baby boomers (people born between 1945 and 1965) are highly encouraged to get tested. 

Next steps

Lower infection rates are encouraging but the District is far from being out of the woods when it comes to HIV. In her World AIDS Day statement, Mayor-elect Muriel Bowser stressed the importance of increasing access to care for low-income and underserved residents, preventative education, and providing quality treatment. 

Harm reduction programs that include needle exchange and education have been proven to lower the rates of new HIV infection.  Restrictive federal bans have made things much more difficult to keep such programs going.  George Kerr, Executive Director of START at Westminster, says needle exchange cannot be discounted.  “As activists and community leaders, we need to work harder to increase harm reduction programs. This included needle exchange program, condom distribution and PrEP education. It is time to lift the federal ban on needle exchange.”

The District has taken many important steps to decreasing HIV infection rates.  But there is still more scientific research to be performed, and more creative solutions yet to be unveiled that will improve the quality of life for residents.  If the upward current trends continue, an AIDS free DC can be a truth instead of just an idea. 

Candace Y.A. Montague is the health reporter for Capital Community News.

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