By Alessandra Fodera (NHS ’16)
Despite a marked decline in the mortality and incidence rates of HIV/AIDS in DC, factors such as high prevalence rates, decreased HIV/AIDS attention and knowledge in the public, and disparities in the populations most affected by the disease, have contributed to the continuation of AIDS in the District of Columbia.
The rate of HIV and AIDS in Washington D.C. is six times higher than the national average, and in multiple countries in Africa, and is considered an epidemic by the World Health Organization. In addition to the devastating affects HIV and AIDS have on the health of the District’s residents, the possible economic effects are too severe to be overlooked.
The prevalence of HIV and AIDS in the District of Columbia poses the city’s largest social, economic, and health threat. When evaluating the impact of HIV and AIDS on an area, the three most important statistics to examine are the number of newly diagnosed cases of HIV and AIDS, the percent of the population that is living with HIV and AIDS, and the number of deaths from HIV and AIDS per year. When combined and examined in conjunction with breakdowns by sex and race, these three statistics present an accurate picture of the prevalence and consequences of HIV and AIDS in a given area.
The World Health Organization defines HIV epidemics as situations in which the frequency of HIV cases exceeds 1.0% of the total population. The overall percent of the population of the United States afflicted with HIV and AIDS is just under 0.4%. Despite the low national average, the percent of the population of the District of Columbia living with AIDS is a staggering 2.4%. This percentage is nearly twice as high as the percentage in the Democratic Republic of Congo and higher than the percent of people living with HIV and AIDS in fifteen African countries.
Additionally, the HIV and AIDS epidemic in the District of Columbia has disproportionately affected the African American community and the poorest sections of the city. Of the 4,919 newly diagnosed cases of HIV in Washington D.C. between 2007 and 2011, 77.4% of those diagnosed were Black. Of the 251 HIV related deaths in the District in 2011, 232, or 92.4%, were of Black men and women. Finally, the number per 100,000 persons living with HIV and AIDS and the number per 100,000 of new diagnoses of HIV between 2007 and 2011 were highest in Wards 5, 6, 7, and 8. These wards have higher levels of poverty than all of the other Wards in the District. However, there are very few services and programs targeting this population.
In a survey on HIV and AIDS conducted in 2011by the Henry J. Kaiser Family Foundation, just 7% of Americans were found to list HIV and AIDS as a top national health problem. The report also found a decline in the number of people who has seen, heard, or read about the HIV and AIDS epidemic in the last year, from seven out of ten persons in 2004 to just four out of ten today. But most importantly the report delineated the issue of a lack of leadership in the fight against HIV and AIDS.
There are two major counterarguments to this view. Firstly, HIV/AIDS has become less of a problem in DC due to increased testing. Organizations such as the AIDS Healthcare Foundation (AHF) offer free HIV testing at various locations. “Come Together DC–Get Screened for HIV,” a campaign in DC that began in 2006, aimed to increase HIV testing, thus increasing people’s awareness of their status. Previously, patients had to personally ask their doctor to be tested during a visit. After this campaign was implemented, new protocol has patients automatically tested at any clinical visit; a patient has to specifically “opt out” of testing. The Fifth Vital Sign model, implemented for primary health care visits, requires rapid HIV testing for all patients; the rapid test is performed along with other vital tests (heart rate, blood pressure, weight, pulse-ox). Because of these programs, more people are tested everyday. With increased testing, patients are diagnosed and receive treatment sooner.
Although testing has increased, HIV/AIDS in DC is still extremely high and has not decreased enough to not still be considered a major epidemic with many programs and initiatives to still be implemented. Also, although the previously mentioned protocol stated that patients should be automatically tested, this chart displays that this is not fully implemented. The statistic of 56.3% should be considered malpractice; only 56.3% of patients were offered an HIV test at any healthcare visit. Approximately 1/3rd of the people in the city who have HIV aren’t aware of it. To miss this opportunity to reach this group of people is almost criminal, especially when the care provider only has to do a rapid swab test to patients that are already visiting. Also, Georgetown Hospital does not have a rapid HIV testing option. With Georgetown Hospital being closest to Ward 3, which has a higher risk of HIV than the national average, not having a testing location here potentially misses numerous testing opportunities.
HIV/AIDS has become less of a problem, with incidence rates decreased, in DC because numerous resources have been allocated to treatment. Figure 3 in the 2011 annual report displays a decrease in incidence and deaths and an increase in living HIV cases. This proves that treatment plans are working and people are living longer healthier lives. The 2013 New Annual Report depicts the progress DC has made. DC has focused on increased testing and access to care. HIV incidence has decreased 46% from 2007 to 2011, while AIDS incidence has decreased 47% from 2007 to 2011. More people are being diagnosed and started on treatment sooner. Of patients diagnosed in 2011 with HIV, 80% accessed care for the disease within three months; when comparing this to those in 2005, 30% more people in 2011 got care. This proves that more people are accessing treatment. Other programs have been implemented and have been successful in targeting specific modes of transmission. A 10-fold increase of condoms were distributed in 2012 than distribution in 2007. Needle-exchange programs and increased health education in schools have been implemented.
Resources are allocated according to people’s perceptions about risk of contracting HIV/AIDS. However, there are very few services that target black men in the city. Meanwhile, there are more services for white men and African American women. There are very few preventative services for African American men, even though new infections among men are significantly higher than women. DC needs to figure out how to reach this population without marginalizing them. Until then, they are inaccurately allocating many resources and failing to zoom in on the real risk population. Figure 4 depicts that in DC, the highest incidence is in the black and poverty-stricken population. The quality of service in some parts of DC is extremely low. There are numerous differences between the black and white populations in accessing care, with some not receiving sufficient care and others not tested early enough.
Additionally, increasing prevalence requires more resources to be spent to treat people with the disease. With prevalence high and more people living with HIV/AIDS, more money and resources need to be allocated to treating patients for longer periods of time than before. Although our goal was always to have people who have contracting the disease to live longer, we might not be prepared for the amount of resources necessary to do this.
The HIV and AIDS epidemic has disproportionality affected Washington D.C. as a whole. HIV and AIDS is a complicated issue, affecting many different demographics is many different ways. Increased resources need to be allocated towards HIV/AIDS treatment, awareness, and outreach programs to truly combat this epidemic. The defeat of HIV and AIDS lies within our grasp, but without sustained, aggressive measures against it this disease will persist.
 District of Columbia Department of Health HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA). (2012). Annual Epidemiology & Surveillance Report. 8 Washington, DC: U.S. Available online at doh.dc.gov
 HAHSTA,2012. 8
 “HIV in the United States: At A Glance.”HIV/AIDS. Centers for Disease Control and Prevention, 7 Nov. 2013. Web. 15 Nov. 2013. <http://www.cdc.gov/hiv/statistics/basics/at
 HAHSTA, 2012. 8
 “Democratic Republic of the Congo.”AIDS info. UNAIDS, n.d. Web. 17 Nov. 2013. http://www.unaids.org/en/regionscountries/countries/democraticrepublicofthecongo
 HAHSTA, 2012. 62
 HAHSTA, 2012. 28
 HAHSTA, 2012. 13, 8
 DC Fiscal Policy Institute. (2011, September 22). ACS Poverty Analysis. Retrieved from http://www.dcfpi.org/wp-content/uploads/2011/09/9-22-11-ACS-Poverty-Analysis.pdf
 “HIV/AIDS at 30: A Public Opinion Perspective” The Henry J. Kaiser Family Foundation.” HIV and AIDS. The Henry J. Kaiser Foundation, n.d. Web. 1 Feb. 2014. <http://kff.org/hivaids/report/hivaids-at-30-a-public-opinion-perspective/>.
 Greenberg, Alan E., Shannon L. Hader, and Henry Masur. “Fighting HIV/AIDS In Washington, D.C.” Health Affairs. N.p., n.d. Web. 01 Feb. 2014. <http://content.healthaffairs.org/content/28/6/1677.full>.
 “Heterosexual Relationships and HIV in Washington, DC.” Http://doh.dc.gov. Department of Health, 2010. Web. 30 Jan. 2014. <http://doh.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/HET_BEH_STUDY.PDF>.
District of Columbia Department of Health HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA). (2011). Annual Epidemiology & Surveillance Report. Washington, DC: U.S. Available online at doh.dc.gov
 “New Annual Report Shows Continued Progress on Decreasing HIV/AIDS, STDs, Hepatitis and TB in the District.” Doh.dc.gov. Department of Health, 24 Sept. 2013. Web. 01 Feb. 2014. <http://doh.dc.gov/release/new-annual-report-shows-continued-progress-decreasing-hivaids-stds-hepatitis-and-tb-district>.
 HAHSTA (2011).