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'Until recently, the District's AIDS office lacked a fully staffed surveillance unit to collect, analyze and distribute data.'

   Sun, March 15, 2009 - 9:47 AM
From the Washington Post -

At least 3 percent of District (Washington D.C.) residents have HIV or AIDS, a total that far surpasses the 1 percent threshold that constitutes a "generalized and severe" epidemic, according to a report scheduled to be released by health officials tomorrow.

That translates into 2,984 residents per every 100,000 over the age of 12 -- or 15,120 -- according to the 2008 epidemiology report by the District's HIV/AIDS office.

"Our rates are higher than West Africa," said Shannon L. Hader, director of the District's HIV/AIDS Administration, who once led the Federal Centers for Disease Control and Prevention's work in Zimbabwe. "They're on par with Uganda and some parts of Kenya."

In addition to the epidemiology report, the city is also releasing a study on heterosexual behavior tomorrow. That report, funded by the CDC, was conducted by the George Washington University School of Health and Health Services.

Among its findings: Almost half of those who had connections to the parts of the city with the highest AIDS prevalence and poverty rates said they had overlapping sexual partners within the past 12 months, three in five said they were aware of their own HIV status, and three in 10 said they had used a condom the last time they had sex.

So urgent is the concern that the HIV/AIDS Administration took the relatively rare step of couching the city's infections in a percentage, harkening to 1992, when San Francisco, around the height of its epidemic, announced that 4 percent of its population was HIV positive. But the report also cautions that "we know that the true number of residents currently infected and living with HIV is certainly higher."

The District's report found a 22 percent increase in HIV and AIDS cases from the 12,428 reported at the end of 2006, touching every race and sex across population and neighborhoods, with an epidemic level in all but one of the eight wards. Black men, with an infection rate of nearly 7 percent, carry the weight of the disease, according to the report, which also underscores that the District's HIV and AIDS population is aging. Almost 1 in 10 residents between the ages of 40 and 49 has the virus.

The report notes that "this growing population will have significant implications on the District's health care system" as residents face chronic medical problems associated with aging and fighting a disease that compromises the immune system.

Until recently, the District's AIDS office lacked a fully staffed surveillance unit to collect, analyze and distribute data. Inevitably, the office lost credibility, and although it has received millions in federal and local funds -- $95 million this year -- some care providers questioned whether resources were being properly allocated.

Critics also say congressional control over the District had restricted the AIDS office's ability to combat the virus among drug injection users by banning the use of local tax dollars for a needle exchange program. After almost a decade, the ban was lifted last year.

Heterosexual sex was the principal mode of transmission for blacks with the disease, 33 percent. Men having sex with men was the chief mode of transmission for white residents, 78 percent; and Latinos, 49 percent. Black women represent more than a quarter of HIV cases in the District, and most, about 58 percent, were infected through heterosexual sex. About a quarter of black women were infected through drug use.

There is good news in the AIDS office's report: More people are getting HIV diagnoses early, while they are still healthy, as a result of a policy of routine testing implemented by the city in mid-2006. Publicly supported HIV testing expanded by 70 percent.

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