Not long ago, in 2009, Washington, DC, had the highest rate of HIV infections in the country. Headlines read that the rates were “higher than countries in West Africa.” Over 15,000 residents had the virus, and the bureau in charge of getting it under control was in a constant state of disharmony. Talk about the worst of times!
Fast forward nine years later and HIV in DC presents differently. It is no longer the scarlet letter on our chest but more like a manageable health condition that officials are working diligently and creatively to tame. Some of the same roadblocks remain, however.
The latest statistics on HIV, AIDS, tuberculosis, hepatitis and sexually transmitted infections were made public last month. It’s clearly not 2009 anymore but there’s still a lot of work to be done.
Numbers Reflect a Few Growing Pains
DC has 13,003 residents living with HIV. The number of newly diagnosed HIV cases overall has remained steady at 368. That number was over 1,300 in 2007. The number of new infections has been on a steady decline since 2013, and the number of people who remain virally suppressed has increased.
The face of HIV in DC, however, remains African-American. Heterosexual black women and black men who have sex with men still lead in new infections. New HIV infections among young people ages 13-29 are on the rise, from 134 in 2016 to 150 in 2017.
Michael Kharfen, senior deputy director of DC Health’s office on HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA), acknowledges the ups and downs in the current trends. “There’s some encouraging news around in terms of persons who have the virus and are receiving treatment and achieve viral suppression. We are getting people into treatment and getting them to viral suppression quicker. Those are really encouraging trends. And then we have some trends that motivate us. We need to step up and intensify the work that we’re doing.”
One trend that hasn’t broken is the infection rates in Wards 5, 7 and 8. The rates of newly infected persons and persons living with HIV remained high in these wards between 2016 and 2017. Efforts to lower the rates and prevent new infections are still going strong from local nonprofits such as Whitman-Walker’s Max Robinson Center (Ward 8) and The Women’s Collective (Ward 7).
Other factors that could influence infection rates are poverty and homelessness. Poverty has been linked to greater HIV risk but it is not an absolute. The median family income in Ward 7 is $31,273, while in Ward 8 it’s $24,096. Both incomes are well below the federal poverty level. DC still has some of the highest rates of homelessness in the nation. People who are unstably housed are not only at a higher risk for contracting HIV but are also less likely to seek or remain in treatment. The city’s fiscal year 2019 budget has been predicted to fall short of the need for housing.
Rise in Young People
Getting the message across to people under the age of 30 about risky behavior and HIV is complex. DC Health and local nonprofit organizations collaborate to find creative ways to keep young people in the conversation. In spite of those efforts, HIV rates have risen among youth. DC Health’s long-range plan for addressing this issue includes providing better coordinated services and resources to help youth make healthy decisions.
Kharfen explains that there are several approaches to the situation. “Young people use condoms more than adults do. And yet still they’re getting chlamydia and gonorrhea and some are getting HIV. We’re taking a multi-strategy approach here. One is we’re changing the conversation about young people and sex to build a community of trusted adults that young people can talk to. There’s also invincibility – it’s not going to happen to them – and inevitability – it’s going to happen so they might as well just get it. Those are two powerful factors. Education is important but we need to be open to them in conversation. We need to get them to a place where they can talk to an adult and get access to sexual health services so that they can manage it.”
The youth prevention arm of Whitman-Walker is known as Real Talk DC (RTDC). Located at Eastern Market, RTDC hosts youth-focused activities to encourage stigma-free conversation about sex and health. Amie Krautwurst, senior manager of wellness programs at Whitman-Walker Health, states that Real Talk is revving up the efforts to combat rising rates. “Whitman-Walker’s Real Talk DC team plans to redouble prevention efforts among youth in the coming year by increasing peer-to-peer street outreach, educating young people on pre-exposure prophylaxis (PrEP) and continuing to provide a safe space for young people to learn about their health through initiatives like ‘Sex, Milk and Cookies’ – where young people are invited to discuss topics around sex like the pros and cons of open relationships.”
The newest campaign from DC Health is Sexual+Being. It is a website designed to help increase positive talk about sexuality and making life choices, while promoting healthcare access and connecting people with information on prevention services. Information about PrEP, post-exposure prophylaxis (PEP), U Equals U – a campaign to promote viral suppression as a means of prevention – and hepatitis C are available on the user-friendly site. In addition, there is information on where to get condoms and HIV testing.
Positive discussions can lead to diminished stigma and, hopefully, a healthier DC.
For more information about HIV in the District or to read the 2018 epidemiology and surveillance report, visit https://dchealth.dc.gov/service/hivaids .
Candace Y.A. Montague is the health reporter for Capital Community News. Follow her on Twitter @urbanbushwoman9.