Washington has been called the Murder Capital and the AIDS Capital. However, the District of Columbia overcame the first label. Now, some AIDS experts say that it is beginning to shake off the second one, too.
“I want to dispel an urban legend that D.C. is the worst in the world,” Gregory Pappas, M.D., Ph.D., senior deputy director of the HIV/AIDS, Hepatitis, STD and Tuberculosis Administration of the D.C. Dept. of Health, told delegates at the International AIDS Conference, which ended over the weekend at the Washington Convention Center.
“About 50 percent of people who are HIV positive live in 12 cities, and D.C. is one of those cities,” Pappas explained. “We’re comparable to the other 12 cities. We’re not the best; we’re not the worst.”
Tiffany West-Ojo, chief of strategic information at the health department, said that 3 percent of Washington residents are living with HIV. African Americans account for more than three-fourths of new infections with bisexual and gay men and women leading the way.
“We’re seeing steady declines in death rates, and we’re beginning to see declines in new infections, which we’re very happy about,” Dr. Pappas said. “One of the drivers is our very successful needle infection exchange program.”
Behind the Numbers
Carl W. Diffenbach, M.D., director D.C. Developmental Center for AIDS Research, said the quantity and quality of research being conducted in Washington is another measure of progress.
A. Toni Young, founder and executive director of the Community Education Group in Washington, D.C., acknowledged the importance of the increased focus on HIV/AIDS data. “It’s not that there was a limited amount,” Young said. “There was none.”
“You can’t know what you’re looking for if you can’t count it.”
Young praised researchers for involving residents and teaching them how to use the data to help eradicate the epidemic. She also discussed the importance of community, public and private sector partnerships. It hasn’t been easy, and there’s still a long way to go, Young and other panelists admitted.
”Sometimes we fight like cats and dogs,” Young said. “We had to make HIV more of a priority in the District of Columbia.”
Titanic on the Potomac
“We turned the tide in the epidemic in the District together,” she said, echoing the theme of the AIDS conference. Young likened their work to turning around the Titanic on the Potomac River. “That’s how awful it was.”
The panel was one of several filling an inch-thick program book that also included pre-conferences, panel discussions, scientific sessions, seminars, meet-ups, dance, theater, art and film screenings. Many D.C. residents came to the Global Village on the lower level of the convention center to attend some of these events.
“Welcome to Washington, D.C., my hometown and a place that’s fighting the good fight,” Young told a portion of the 30,000 attendees at her session. This is the first time that the conference has been held in the United States since the 1990 gathering in San Francisco.
The conference, which is held every two years, was able to return after the Obama and Bush administrations worked with Congress to lift the ban preventing people living with HIV from entering the country.
An End in Sight
During the opening plenary, Phill Wilson, founder, president and CEO of the Black AIDS Institute, noted that this was the “first International AIDS Conference where we know that we can end AIDS.”
Wilson, the first African American to give an opening address at the gathering, acknowledged funding and other challenges still ahead, but welcomed good news about HIV/AIDS, particularly on the medical front.
Studies released at the conference on antiretroviral therapy (ART) fueled hope for a cure. One indicated the potential ability to control the infection with early treatment. In a smaller study, researchers found no traces of the virus after administering chemotherapy and stem-cell transplants to two patients on ART.
For the first time, the Federal Drug Administration approved a drug to minimize HIV risk in uninfected people. The antiretroviral drug, Truvada made by Gilead Sciences, is designed for HIV-negative people who are at high risk, such as men and women who have infected partners. Known as PrEP or Pre-Exposure Prophylaxis, it was approved just before the conference as a daily oral medication to be used along with other prevention methods, including condoms.
Access to Health Care
Despite Wilson’s enthusiasm about new medication and research, he’s concerned about access to health care. “We have a system that can work very well for some of us,” Wilson said. “But for many of us, the system is terribly, terribly broken.”
“We do a terrible job of moving people from testing to going on antiretrovirals,” Wilson said. “In the richest nation on the planet, barely a quarter of the people with HIV are in fully effective treatment.”
“That is bad for them, and it is bad for everyone else, because when they are not on treatment, they are much, much more likely to spread the virus.”
Wilson praised Toni Young’s organization, the Community Education Group, for ensuring that D.C. residents who test positive for HIV don’t fall through the cracks — a major problem around the world.
He said that 95 percent of CEG’s clients who are HIV positive linked or relinked to treatment. They are counseled immediately after testing and escorted directly to treatment if necessary. CEG also provides financial incentives to ensure compliance; information about insurance and Medicaid; and text messages to follow-up with people.
Wilson also singled out Harlem United, which began as a small organization and is not a federally qualified health center with 3,000 patients. “AIDS organizations need to retool themselves,” said Wilson, noting that groups must go beyond behavioral interventions and push for biomedial tools and health care.
Sandra Snakigagga, a 23-year-old Ugandan woman who lives in London, is astonished that so many people go without treatment in Washington, the center for the Western world and throughout a developed super-power like the United States.
She views health care as a basic right and is glad that she has easy access to coverage in England. She helps to educate young people about HIV/AIDS through a non-profit organization called Body and Soul.
AIDS activists celebrate the U.S. Supreme Court’s decision to uphold the Patient Protection and Affordable Care Act. Under President Obama’s plan, more people will be able to connect with doctors on a regularly basis with increased insurance coverage and clinics. Young people, whose rates of HIV infection are high, can stay on their parents’ insurance plans until they are 26. Insurance plans won’t be able to reject patients with pre-existing conditions or because they’ve reached certain limits.
“Under the Affordable Care Act, everyone will have a way to pay for life-saving treatment,” Wilson said. “We must fully implement the Affordable Care Act. This will deliver health care to more than 30 million who are uninsured.”
The Pain of Stigma
Stigma was a key topic before and during the conference as experts examined the problem locally and internationally. A researcher cited his findings on stigma in Ethiopia, a homeland that he shares with many D.C. residents. Similar to the situation elsewhere, his findings indicated that stigma caused many HIV-positive Ethiopians to isolate themselves from family and friends, forego jobs and promotions, or even commit suicide.
It’s important that people with HIV are able to live with dignity and respect, said Dr. Mohammad N. Akhter, director of the D.C. health department.
During an interfaith pre-conference at Howard University, hundreds of religious leaders pledged to help reduce HIV-related stigma. The two-day event, “Taking Action for Health, Dignity and Justice,” included leaders from Christian, Islamic, Jewish faiths. It was sponsored by the Ecumenical Advocacy Alliance in partnership with the Balm in Gilead, which has been at the forefront of working with black congregations.
Wilson, who is openly gay and HIV positive, encouraged others to come out of hiding and share their status.
“I’m alive today because I have the love and support of family and friends.”