Capital tries to stem HIV/AIDS epidemic

By Christine Dell`amore Mar 23, 2006

WASHINGTON, DC, United States (UPI) -- In a city where new AIDS cases have reached 10 times the national average, government and community leaders here have taken promising steps to halt the disease, yet in many areas they continue to falter, a report card released today shows.

The DC Appleseed Center for Law and Justice graded the city in 12 areas originally targeted by their landmark August 2005 report, 'HIV/AIDS in the Nation`s Capital,' which illuminated a dearth of leadership and coordination in fighting HIV/AIDS.

'We want to applaud and celebrate where steps forward have occurred, but criticize and lament where steps have not been taken,' said Walter Smith, executive director of DC Appleseed, an independent non-profit. 'We`re talking about an issue that is of life-and-death consequence in the nation`s capital.'

The Washington AIDS Partnership, a local grant-making organization, commissioned the DC Appleseed report to address grave concerns about city leadership and a lack of overall data on the epidemic.

Since the document surfaced, a 'surge of constructive energy' has motivated reforms in the district, where one in 20 residents is infected with the virus, the report card states. The district is thought to have the highest rate of HIV/AIDS in the country: New AIDS cases hit 179.2 per 100,000 residents in 2004, vs. 15.0 cases per 100,000 nationwide.

The district government has also embraced the DC Appleseed report as a blueprint for change, and Mayor Anthony Williams has publicly committed to putting the recommendations in action.

Although the six-month report card did not assign an overall grade to the district`s efforts, the mixed grades reflect a city still struggling to come to grips with a public-health quagmire.

In the arena of leadership, city officials earned a relatively high grade -- B minus -- for working to make HIV/AIDS a top health priority. On Aug. 11, the day after the DC Appleseed report was released, Williams announced the formation of a task force that he would lead. The Administration for HIV Policy and Programs recruited 28 of the 'best and the brightest' among corporate, government, non-profit and community entities, and the group will be officially announced very soon, Marsha Martin, director of the AHPP, told UPI.

The report has been a 'rallying document' for the Washington community, said Martin, who was hired to head the agency a few weeks after its publication.

'Everybody would say unequivocally there is a renewed, reinvigorated energy of the government about HIV,' she added.

Martin also emphasized although the DC Appleseed report is a useful tool, it is not the only way to bring about change.

This new leadership in the HIV office is substantial, said Washington Councilmember Jim Graham, who was the executive director of Whitman Walker Clinic from 1984 to 1999. Whitman Walker is the largest provider of care and services for people living with AIDS in the district.

'If you don`t have confident people at the helm, you`re whistling in the wind,' he added.

Still, many of the leaders who rally against HIV do so in a hushed tone.

'With HIV, it can`t be done quietly,' said Josh Levinson, deputy director of DC Appleseed, who works with the HIV project. 'You have to be loud, you have to be vocal, because at the end of the day, this is about sex and drugs.'

Perhaps the most crucial issue in the report is data and surveillance, or how the city tracks infected people. DC Appleseed assigned an incomplete grade to this category, opting for a wait-and-see approach. Although the government attempts to collect data, their ability to do so is limited. For instance, AHPP`s Surveillance Division has a staff vacancy rate of more than 50 percent.

As a result, no one actually knows how many people are infected with the virus.

'Who would have thought 25 years into the epidemic, one of the biggest problems would be that we don`t know what the problem is?' Levinson said.

Martin cautioned that the lack of data means the rate of infection could turn out less dismal than imagined.

'We don`t have the survey capacity to really know how to discern what our epidemic looks like locally,' she said.

But that might change with the AHPP`s new partnership with the George Washington University School of Public Health and Health Services, which will oversee and improve the current surveillance program. The university also plans to recruit a Ph.D.-level epidemiologist to assist AHPP in collecting data.

The district`s management of grants to community-based organizations has also become more efficient, earning a grade of B.

Roberta Geidner-Antoniotti, the interim executive director of the Whitman Walker Clinic, said her organization has run more smoothly since timely deliverance of grants.

The district`s public school system got a B minus for adopting revised health education curricula, which includes HIV prevention material. Barbara Rockwood, the executive director for health, physical education and athletics for the system, refrained from describing the particulars of the new health education material, but it will likely appear in the classroom by 2007.

In addition, a separate resolution passed in September 2005 by the School Board will take a harder look at the efficacy of the HIV curriculum. However, the superintendent of schools, Clifford Janey, has not responded to the School Board`s request to present a plan for HIV education.

On the downside, the city`s track record on substance-abuse treatment has not improved, warranting a D plus. Recommendations by the mayor`s Interagency Taskforce on Substance Abuse, Prevention, Treatment and Control have gone largely unnoticed; their 2005 annual report stated the district 'is not making significant progress' toward its goal of reducing alcohol and drug abusers. Cutting drug use is a clear prevention strategy for contracting HIV.

The city has also failed to make condoms widely available. AHPP distributed only 290,000 condoms in 2004, falling short of its goal of 600,000. Condom distribution received a D grade from Appleseed.

The lack of condoms represents only one example of how much still needs to be done, said Channing Wickham, executive director of the Washington Aids Partnership.

'With numbers like 1 in 20, the issue is impossible to ignore, yet people have found a way to ignore it,' Wickham said.

Most community and government leaders agreed the key is visibility -- the more people place a spotlight the epidemic, the more action will occur.

'The Appleseed report put into words what most of us in the community level already knew. But we finally have the curtains drawn on this problem,' said Adam Tenner, director of Metro TeenAids, an organization supporting young people in the fight against HIV.

'Unlike a lot of reports that are left on the shelf when they`re written, we want to make the Appleseed report a living document,' Wickham said. 'This is a chance for a fresh start for a lot of people.'

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