Study Calls HIV in D.C. a ‘Modern Epidemic’

Susan Levine, Washington Post, November 26, 2007

The first statistics ever amassed on HIV in the District, released today in a sweeping report, reveal “a modern epidemic” remarkable for its size, complexity and reach into all parts of the city.

The numbers most starkly illustrate HIV’s impact on the African American community. More than 80 percent of the 3,269 HIV cases identified between 2001 and 2006 were among black men, women and adolescents. Among women who tested positive, a rising percentage of local cases, nine of 10 were African American.

The 120-page report, which includes the city’s first AIDS update since 2000, shows how a condition once considered a gay disease has moved into the general population. HIV was spread through heterosexual contact in more than 37 percent of the District’s cases detected in that time period, in contrast to the 25 percent of cases attributable to men having sex with men.

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The new numbers are a statistical snapshot, not an estimate of the prevalence of infection in the District, which is nearly 60 percent black. Hader, an epidemiologist and public health physician who has worked on the disease in this country and internationally, said previous projections remain valid: One in 20 city residents is thought to have HIV and 1 in 50 residents to have AIDS, the advanced manifestation of the virus.

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District health officials have long been faulted for the lack of HIV information and lagging AIDS data. Not until forced by federal funding requirements did the health department start tracking HIV.

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HIV information is particularly valuable because it represents the most recent infections and can indicate changes in transmission patterns. It is mainly collected through the investigation of cases forwarded by laboratories and health-care providers.

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The District’s AIDS rate is the worst of any city in the country, nearly twice the rate in New York and more than four times the incidence in Detroit, and it has been climbing faster than that of many jurisdictions.

One explanation might be the high percentage of infected residents labeled “late testers,” people who learn they have AIDS within a year of the HIV diagnosis. Although the proportion of adults and adolescents screened for HIV is greater in the city than nationally, the finding raises questions about the strategy of the District’s “know your status” campaign.

People who learn of their infection late face serious consequences. By the time symptoms arise or infections occur, their immune systems have suffered considerable damage. They face increased medical costs and death rates.

More than two-thirds of local AIDS cases fell into this category during the past decade, according to the report, compared with 39 percent of cases in the United States. “I think that’s dramatic information for our care and treatment providers,” Hader said.

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But the data made public today expose an alarming dimension of pediatric HIV. Each of the three dozen District children to test positive in the past five years was infected during birth.

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