Although the D.C. government is making good progress toward its ambitious goal of reducing the overall number of new HIV infections in the city by 50 percent in 2020, some of those at most risk for HIV/AIDS, especially LGBT people of color, “have been overlooked” in the city’s fight against AIDS, according to one of two independent reports released last week.
The report making the latter assertion, “Reclaiming The Right To Live: Reducing HIV/AIDS Disparities for LGB/Trans People of Color,” was prepared by student attorneys enrolled in Georgetown University Law Center’s Community Justice Project-Health Justice Alliance.
The report says the research on which its findings are based was conducted in partnership with Casa Ruby, the D.C. LGBT community services center that works closely with the transgender community. Its focus was on the city’s HIV/AIDS prevention efforts “as they relate to the LGB/Trans community and communities of color,” according to the report.
“Despite efforts to combat the epidemic in the District and general success with decreasing the number of cases in the last decade, these communities are disproportionately high risk for HIV,” the report says. “So while the District has had general success in fighting and preventing the spread of HIV, the most vulnerable and historically marginalized groups have been overlooked,” it says.
The report provides a number of recommendations for improving the city’s outreach to trans women and LGB people of color, including suggestions for improving the city’s data collection, which it says lumps transgender people together with gays, lesbians, and bisexuals.
It points out that a recent report by the D.C. Trans Coalition found that a staggering 20 percent of transgender people reported they were living with HIV, with 75 percent of them being people of color. The report also notes that D.C. data show that black men who have sex with men contracted HIV in 2016 at a rate of one in four compared to white men who have sex with men, who had an infection rate of one in eight.
The second report, “Ending the HIV Epidemic in DC: 2017 Progress Report,” was prepared by the D.C. Appleseed Center for Law and Justice, a nonprofit group that has been monitoring the city’s AIDS programs since 2003.
The report points out that last year D.C. Appleseed entered into a partnership with Mayor Muriel Bowser, the city’s Department of Health and its HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA), and the nonprofit coalition Washington AIDS Partnership to develop a plan to achieve a 50 percent reduction in the number of new HIV cases in the city by 2020.
Known as the “90/90/90/50 Plan, the report and statements by Bowser at the time it was launched on World AIDS Day in 2016 say its overall aim is to bring an end to the AIDS epidemic in the District at the soonest possible time.
In addition to its goal of reducing the number of new HIV cases by 50 percent in 2020, the plan calls for achieving that goal by bringing about three other important objectives: Making sure that 90 percent of all city residents with HIV know of their HIV status; making sure that 90 percent of all city residents with HIV are in “sustained treatment;” and ensuring that 90 percent of those in treatment will reach full “viral suppression,” which means they will have an undetectable level of the virus in their body.
The DC Appleseed report, released Dec. 1 on World AIDS Day, says the city has made good progress in reaching those objectives based on the most recent data for the year 2016. It points out that the number of new HIV cases reported in D.C. for 2016 was 347, a 33 percent reduction from the 2013 figure of 520 new cases. It says the 50 percent reduction goal for 2020 would mean there would be 260 or fewer new cases that year.
The report, however, says the city’s main strategy for achieving the 2020 goals is based on two important clinical advances in recent years, one of which the Georgetown Law Center’s report says has been problematic for trans and LGB people of color.
The first strategy is known as “treatment as prevention,” which holds that people with HIV who achieve full viral suppression through anti-retroviral medication are far less likely if not completely shielded from transmitting the virus to someone else.
The second strategy, for which the Georgetown report and Casa Ruby Executive Director Ruby Corado have expressed some concern, is known as Pre-exposure Prophylaxis, or PrEP, which involves prescribing an anti-retroviral drug to HIV-negative people who are considered to be at high risk of HIV infection. Studies have shown that PrEP is highly effective in preventing HIV infection among those to strictly adhere to their drug regimen.
But the Georgetown Law Center report points out that LGB and trans people of color, among other groups, often do not have access to health insurance or medical care needed for the required monitoring of people on PrEP, including ongoing doctor’s visits and blood tests to prevent potentially harmful side effects of the PrEP drug.
“Pushing for PrEP as the be all and end all is not realistic for the population groups that we see all the time at Casa Ruby,” Corado told the Blade during the city’s World AIDS Day ceremony at the Reeves Center municipal building.
Corado said “culturally competent” programs to reach out to transgender women of color and others will be needed to make sure that those groups are helped by the city’s 90/90/90/50 Plan.
Walter Smith, executive director of D.C. Appleseed, told the Washington Blade on Tuesday that Appleseed and its report concur with the Georgetown Law Center report’s conclusions that certain longtime underserved population groups have not benefited from existing HIV prevention programs.
“Our take on this is the two reports are quite complimentary and supplementary to each other,” he said. “And I hope that as the mayor and the Department of Health move forward they will treat both of them seriously.”
Smith said that although D.C. Appleseed entered into a partnership with the city to develop the 90/90/90/50 Plan it remains an independent organization. He said the report it released on Dec. 1 and all future reports will be impartial in their assessment of the city’s AIDS programs and critical of those programs when information gathered indicates there are problems.
The Georgetown Law Center report can be viewed here.
The D.C. Appleseed report can be viewed here.