Ground Zero at AIDS 2012: HIV epidemic in Washington DC

The XIX International AIDS Conference (AIDS 2012) opened in Washington DC on 22nd July 2012, twenty two years after the 6th International AIDS Conference had taken place on the US soil in 1990 (San Francisco, USA). The US had imposed a travel ban on people living with HIV (PLHIV) in 1987, when the US Department of Health and Human Services added HIV to a list of communicable diseases prohibiting PLHIV from entering the country. When Barack Obama became President he lifted the travel restrictions on PLHIV in January 2010, allowing the conference to take place on US soil after twenty two years.

An estimated 1.1 million Americans are living with HIV. They are disproportionately African Americans, a group that makes up 12% of the US population but 44% of those living with HIV. According to UN statistics, Washington DC is the US state with the highest new HIV infection rate. At 3% it is considered an epidemic. In the Washington District of Columbia (DC) two or three people become infected every day.

Dr Gregory Pappas, senior director at the DC Health Department in charge of HIV and AIDS, said: “The picture in DC - we have a serious epidemic, but we’re making strides in combating the disease.”

Poverty and poor education are the main drivers of new infections in the United States. District of Columbia has a considerable number of LGBT community members, disenfranchised black and Hispanic people and poor people.

According to the latest study released by the D.C. Department of Health, the HIV infection rate for heterosexual African American women in the District’s poorest neighbourhoods nearly doubled in two years, from 6.3% to 12.1%. District health officials announced new recommendations for doctors and other healthcare providers to start treatment immediately for all people newly diagnosed with HIV instead of waiting for evidence that someone’s immune system has been severely damaged. They are also encouraging people to get tested and know their status in the hope this will encourage residents to seek treatment and reduce the chance of passing on the virus.

New HIV cases among people who inject drugs began declining in 2008 but fell more sharply in 2009. Officials said they have reallocated funds to three providers of clean needles to injecting drug users after the main provider shut its doors this year.

Pointing to other successes in the state, Dr Pappas said waiting time between diagnosis and care has been reduced on average from a year to three months. He also pointed to a successful pilot program, which allows residents to be tested free of cost at the Department of Motor Vehicles Office in a shopping centre in south east Washington.

Arguably, the number of new cases is the best measure of progress in fighting HIV. On that front, the news is encouraging. Newly diagnosed cases of HIV fell from 1,311 in 2007 to 755 in 2009. Although the DC Health Department reported last year the first ever decline in new AIDS cases, it found a decrease not only in the number of new full-blown AIDS cases but also the number of new HIV cases. Health officials suggested this could be the result of preventive measures gaining hold.

Unlike other cities in the US, where the people most at-risk population to HIV are concentrated among people who inject drugs or men who have sex with men, Washington DC has a very mixed epidemic with a huge burden falling on heterosexual African Americans.

Dr Pappas said the district is finding people with HIV earlier. Early treatment with antiretroviral drugs not only improves individual health but also can prevent the virus from being transmitted to others.

Another sign of progress is that no child in Washington DC has been born with HIV since 2009, and there has been a big drop in newly diagnosed HIV cases attributable to injecting-drug use due to the District’s needle-exchange program.

Washington DC has been a leader in HIV testing and education this year, but it has a long way to go before completely controlling its epidemic.

Ishdeep Kohli
(The author serves as the Vice President, Jodhpur National University; and also as the Executive Director of Swasthya India. She has written extensively on HIV and health issues)