Report Points Out Flaws in Washington, D.C., Response to HIV/AIDS Epidemic; Mayor Agrees With Critique, Promises Reform
Although Washington, D.C., likely has the highest rate of new AIDS cases of any major U.S. city, the city's response to the HIV/AIDS epidemic has been inadequate and poorly coordinated, according to a 170-page report released on Tuesday by the DC Appleseed Center, the Washington Post reports. According to the report, which is based on information gathered since early 2004 at the request of the Washington AIDS Partnership and with the support of Mayor Anthony Williams, an estimated one in every 20 D.C. residents is HIV-positive, making HIV/AIDS "one of the most severe health problems facing the district, both in terms of disability and lives lost" (Levine, Washington Post, 8/10). There are four main problems with D.C.'s response to the HIV/AIDS epidemic: city officials are not systematically collecting and analyzing data about the epidemic; the city is not properly coordinating and supervising the organizations that provide services for people living with HIV/AIDS; the district's prevention efforts are poor; and the city's HIV/AIDS services are insufficient for certain populations, such as young people or other people at high risk of contracting HIV, according to the report ("HIV/AIDS in the Nation's Capital," 8/10). As a result, the report urges D.C. officials to "speak frequently, strongly and clearly" about HIV/AIDS and take "committed and strategic steps" toward improving HIV/AIDS surveillance, funding levels, prevention efforts and treatment for HIV-positive people (Washington Post, 8/10). Moreover, "addressing the epidemic must move front and center as a priority of district government," the report says ("HIV/AIDS in the Nation's Capital," 8/10).
During 2003, there were 170.6 new AIDS diagnoses for every 100,000 D.C. residents in 2003, up from 119 new AIDS cases per 100,000 residents in 2001, the report says (Washington Post, 8/10). However, those figures do not "capture the extent of the epidemic" because they do not include HIV-positive people who have not developed AIDS, according to the report. The report's authors urge the city's HIV/AIDS Administration to collect and disseminate comprehensive data on the epidemic. "Not having access to these crucial data handicaps policymakers who are responsible for HIV/AIDS prevention and care programs," and "[m]illions of dollars are being distributed for services and interventions based on outdated and incomplete data," the report says ("HIV/AIDS in the Nation's Capital," 8/10).
Other Report Recommendations
The report had the following additional recommendations.
- The city should immediately create an executive-level commission to determine how to better address the city's HIV/AIDS epidemic (Washington Post, 8/10);
- The city should develop a centralized application process for enrollment and eligibility verification for publicly funded HIV/AIDS treatment programs;
- HAA should improve the city's grant management process and use funding more efficiently;
- The Department of Health should promote routine HIV testing by all health care providers;
- HAA should broaden its condom distribution;
- HAA should coordinate with agencies providing services for HIV-positive people with other illnesses;
- The city's public school system should implement comprehensive standards regarding HIV prevention education;
- The city should improve access to substance abuse treatment programs;
- The Department of Corrections should widen its substance abuse treatment programs as an HIV prevention strategy; and
- DOC should use federal funds to increase the medication supply provided to HIV-positive inmates when they are discharged ("HIV/AIDS in the Nation's Capital," 8/10).
Reaction, Next Steps
Following the release of the report, Williams said he agrees with the findings and plans to create and chair a city task force to improve the city's HIV/AIDS response, the Post reports. He said the task force would be based on a similar city effort to improve the city's libraries. Although there had been some suggestion that the city create an external commission to address HIV/AIDS, Williams rejected that idea, saying, "People elected me as mayor to fix the problems I identify." Health Director Gregg Pane, speaking at the mayor's weekly news briefing, said the city health department already is working on implementing some of the recommendations outlined in the report, specifically filling vacant positions, devising a state health plan to address HIV/AIDS and encouraging dialogue within the community on HIV/AIDS-related issues. "We know what needs to be done," Pane said, adding, "What I need to do are the right things right now." Washington AIDS Partnership Executive Director J. Channing Wickham said he was pleased with the city's response to the report but added, "Now is really where the hard work starts" (Weiss/Labbe, Washington Post, 8/11). D.C. Appleseed Executive Director Walter Smith said the organization plans to follow up with city officials in six months, adding, "We think the resources are there to get the job done" (Washington Post, 8/10). According to the Post, the Washington AIDS Partnership plans to give D.C. Appleseed funding to monitor progress on the report's recommendations (Washington Post, 8/11).
Philippe Chiliade, medical director for the Whitman-Walker Clinic, answered questions about HIV/AIDS in Washington, D.C. in a washingtonpost.com online chat on Monday (Washingtonpost.com, 8/10). A transcript of the chat is available online.