June 23, 2011 at 2:30 pm EDT | by Gregory Pappas
Fighting for an HIV-free future

Thirty years ago this month, the first case of AIDS was reported in the United States. Since 1981, more than 1 million people in the U.S. have been infected and nearly 600,000 have died. In the District of Columbia, 20,000 people have been infected since the beginning of the epidemic and more than 10,000 lost their lives.

While we have made tremendous strides in 30 years and advances in medical treatment mean that a person living with HIV can live a standard life span, we know that we still have more work to do to stop new infections and ensure those living with HIV have access to treatment.

The District of Columbia has a generalized epidemic with 16,721 of our residents diagnosed and living with HIV. Our epidemic has all three modes of transmission – heterosexual contact, men who have sex with men and injection drug use – at high levels impacting all population groups, ages, races/ethnicities and 7 out of 8 of our wards.

While the D.C. metropolitan area may have this large and complex epidemic in most of our city, we are not alone as sections of other cities – Atlanta, Chicago, Miami – have trends similar to ours, and we have the opportunity to learn from each other on how best to address this disease.

In the District, our core strategy to reduce HIV is routine testing, timely linkage to and retention in care and treatment and prevention to change behavior to healthy and safe sexual activity.

As we mark National HIV Testing Day, D.C. has been a national leader in HIV testing. We have nearly tripled our publicly supported tests from 43,000 in 2007 to 110,000 in 2010. We have engaged our medical community to incorporate routine testing as well as innovative testing at our DMV office. D.C. recommends an annual test for all adults and adolescents and twice a year for gay and bisexual men.

It is treatment that is the critical component of our strategy and Mayor Gray has made Treatment on Demand the cornerstone of our plan to fight HIV in D.C. We know that treatment works to control HIV. We know that the combination of an HIV diagnosis and treatment change people’s behavior to stop further infections. And now we know that new science is showing treatment itself reduces the chance of spreading the virus. In other words, treatment is prevention.

We are diagnosing people earlier in their disease and getting them entered into treatment. More than 75 percent of persons in D.C. entered into care and treatment within three months of their HIV diagnosis. Earlier diagnosis and treatment has led to a 30 percent decrease in the number of new AIDS cases from 2005 to 2009. And we have seen a decrease in the number of deaths among persons with HIV/AIDS by more than half from 326 in 2005 to 153 in 2009.

When Mayor Gray assumed office in January 2011, I was determined to assemble the experts, the providers on the frontline, the persons living with HIV and other stakeholders to assess our course in responding to the epidemic and develop new recommendations to improve our efforts. Mayor Gray appointed and co-chairs the Mayor’s Commission on HIV to build on our work and provide a fresh set of eyes to improve care for people living with HIV and ending the epidemic in our city.

Our work and the Commission’s recommendations will be in the spotlight of the world when Washington, D.C., hosts the International AIDS Conference AIDS2012 in July next year. This is the first time in 20 years that the conference will be in the U.S.  We intend to showcase the success of our programs, rooted in our data-driven and scientific-based approaches.

We are at an exciting crossroads in the domestic epidemic. We have a national strategy for the first time in 30 years. We are in a new era of collaboration and innovation. We must not let the old silo approach derail the opportunity to change the course of the HIV epidemic. We owe it to the pioneers over the past 30 years who lost their lives fighting and to our contemporaries to ensure that the next generation is HIV free.

Gregory Pappas, MD, Ph.D., is
senior deputy director of the
 HIV/AIDS, Hepatitis, STD and TB Administration for the D.C. Department of Health.

  • This is supposed to be an opinion piece. I read it as being a general report on HIV/AIDS not all that unlike the multitude of others I’ve read recently. I assumed the writer would offer an “opinion”, i.e. something fresh, novel, a new way of viewing events and actions – anything to generate discussion and a back-and-forth. Did I miss something?

  • An ‘HIV-free future’ will not arrive without a comprehensive, and city-wide approach with effective and measurable goals and set and stated accountability to achieve those goals.
    Close to 900 District residents living with HIV & AIDS currently sit on a growing housing wait list. According to the National AIDS Housing Coalition, “Major studies have proven that providing housing for poor people living with HIV & AIDS dramatically improves health outcomes.” However, structural interventions including housing are completely ignored when developing effective prevention and care strategies. This blatant disregard extends to the approximately 27,000 households waiting for low-income housing in the city.
    Despite growing STD and HIV infections among the District’s youth, city officials are stubbornly reluctant to implement comprehensive sex & sexuality education in all school aged settings. Again, studies show these programs, when properly presented by adequately trained and willing educators, lower new infections and early births, and lessen the violence aimed at queer and questioning youth. Perhaps not implementing a life-protecting and life-saving measure among the ‘next’ population is a political decision, which also begs the question: Why are we allowing politicians to make smart public health decisions?
    I challenge Dr. Pappas, Mayor Gray and his ‘Commission’ appointees to make the fundamental changes necessary to heal the societal wounds that consistently fuel the HIV & AIDS epidemic in the District. If we are not acknowledging the roles that poverty, education, joblessness, homophobia, and sexual violence play in cementing those health disparities – particularly among people of color – we will continue this perpetual march.
    The city’s leaders are in full party planning mode as we prepare our best linens and silver for our global guests arriving to break bread at next summer’s International AIDS Conference. As a District resident living with HIV, I plan to join thousands of others in making sure that we are the ultimate party crashers, not relenting until measurable change hits our streets – not just rhetoric.

    Larry Bryant
    Co-Chair, DC Fights Back

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