Could D.C. be the next place that declares a bold plan for ending the HIV epidemic in just a few years? New York Gov. Andrew Cuomo was the first governor to announce such an effort. Now it appears that Mayor Muriel Bowser wants to make this a priority in her first term. But while I applaud the mayor for taking on this ambitious (yet achievable) goal, she needs to make the community part of the process of conceiving, developing, and implementing this new plan.
Last week, Bowser announced the city’s new HIV surveillance report, which shows a decline in new HIV diagnoses for the sixth consecutive year and no cases of mother-to-child transmission. But, in many ways, the mayor buried the lead. In a press release about the report, she announced a new HIV plan for D.C. to mirror the new global targets set by UNAIDS, stating, “We are setting a bold goal of 90-90-90-50 by the year 2020: meaning 90 percent of D.C. residents with HIV will know their status, 90 percent of persons living with HIV will be in treatment, 90 percent of persons with HIV will achieve viral load suppression, and the District will see a 50 percent decrease in new HIV cases.”
This is a great goal for D.C. Currently about 2.5 percent of the city is HIV positive, a figure twice as high as the baseline definition of an epidemic. Among the city’s black population, that rate is nearly double the city’s overall rate: 3.9 percent of black Washingtonians are HIV positive, and 5.8 percent of black gay and bisexual men in D.C. have HIV.
So the mayor is well justified in increasing high-quality care for people with HIV and expanding prevention efforts in the most heavily affected communities. She announced that her administration is partnering with D.C. Appleseed, a local think tank, to develop the plan to achieve these goals. Appleseed has a long history of evaluating the city’s progress on reducing HIV infections and scaling up access to care; it makes sense to have the organization on board as a partner to help shape this plan.
However, in order for the plan to be successful, it will have to be developed by a broad range of stakeholders across D.C. from the very beginning. It should include a task force comprising a diverse range of stakeholders including people living with HIV and representatives from affected communities. It should also include medical providers, insurers, epidemiologists, social science researchers, service providers and advocates; it should not be created without a wide range of stakeholders being able to put their ideas forward, in a transparent process.
Treatment Action Group was one of the organizations that advocated for a plan in New York State before Cuomo adopted it. What made the New York plan so ambitious in its goals, and what will ultimately make it a success, is that stakeholders from all over the state sent in hundreds of policy recommendations that were debated by the governor’s appointed task force. Its meetings were open to the public and allowed public comment from stakeholders and experts who were not on the official task force.
For New York, it felt as if this was a plan the community could own and be proud of—a plan in whose ongoing work, implementation and evaluation the community could participate. My fear is that if the D.C. plan to end the HIV epidemic here is developed largely in secret with only select voices at the table, we’ll lose the richness of ideas from the people whose input matters most. Just as importantly, we could lose public confidence that we’re committed to ensuring not only that no more babies are born with HIV, but that no more (or very few) others contract the virus and that people currently living with the virus get the best care without fear, shame or stigma.
Kenyon Farrow is a local resident and U.S. and Global Health Policy Director for Treatment Action Group.