D.C. HIV/AIDS Rate Higher Than West Africa

According to a new report issued by Washington, D.C., officials, the HIV rate in the nation's capital is the highest in the country. Nearly 3 percent of the city's residents are living with HIV/AIDS, a rate higher than in West Africa. Cornelius Baker, formerly of Washington's renowned Whitman-Walker clinic, and Patricia Nalls, of The Women's Collective, discuss the epidemic.

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MICHEL MARTIN, host:

I'm Michel Martin and this is TELL ME MORE from NPR News.

Coming up popular historian Thomas Cahill who spends most of his time thinking about the past so he can write such bestsellers as "The Mysteries Of The Middle Ages". So how did he come to be friend and write about an inmate on death row in Texas? We will find out in just a few minutes.

But first, an alarming fact: Washington D.C. has one of the highest of rates of HIV infection in the country, if not the highest. According to a report released Monday by district officials, nearly three percent of residents in the nation's capital are living with HIV or AIDS. That surpasses the one percent mark that's considered the threshold for an epidemic.

And adding to the grim numbers, the study found that every form of transmission is on the rise, with minorities and women at an especially high risk. Joining me to talk about this now: Cornelius Baker from the Center on AIDS and Community Health at the Academy for Educational Development, and Patricia Nalls, Founder and Executive Director of The Women's Collective. Since 1992 the D.C. non profit has been providing services to women living with HIV and leading prevention efforts geared towards women and their families. Welcome to you both, thank you both so much for stopping in.

Mr. CORNELIUS BAKER (Executive Director, Whitman-Walker Clinic): Thank you for having us.

Ms. PATRICIA NALLS (Founder and Director, The Women's Collective): Thank you for having me.

MARTIN: Cornelius, I want to start with you because you have been combating HIV and AIDS in D.C. and on a national level for nearly two decades. You used to be director of the renowned Whiteman-Walker Clinic in D.C. You've seen many reports on HIV and AIDS over the years and you've seen this report. This has to be frustrating, but is it surprising?

Mr. CORNELIUS: It's not surprising. As now you must know from years at Whitman-Walker Clinic, we were using the statistic that one in 20 adults in Washington D.C. was HIV positive. And that was just data that we were seeing from our own clinic and where we were coming out with our all estimates of the epidemic. And now of course, this D.C. report does confirm what we've known for a while. And what it tells us is that the action that was needed then is even more urgently needed now.

MARTIN: And what was the action needed then that's still needed now?

Mr. CORNELIUS: Well, certainly we need to have a full scale plan in the district, and that we need leadership - from the mayor to every single citizen - really committed to what we're going to do to combat this in the district. We also need resources. You know, so long, agencies in this city have struggled -from paycheck to paycheck - just to keep their services going and that's no way to fight an epidemic. And we need a constant reminder. There need to be pubic education in our schools, on our streets, in our churches, everywhere. And, every single citizen needs to get an HIV test. Those…

MARTIN: Everybody.

Mr. CORNELIUS: …everybody. Everybody. You just cannot presume. We're in a full fledged epidemic in this city. And you cannot presume that you are negative.

MARTIN: Patricia, you founded The Women's Collective in response to a lack of services for women and their families. This report confirmed that women and girls are still at a very high risk and the risk is growing. I think a lot of people are used to thinking about women and girls at risk in developing countries like Africa, where people say, well, you know, cultural factors -women aren't as able to negotiate their sexual relationships and things of that sort. People talked about you know labor market patterns, oh well, a lot of men need to leave home to earn a living and they, you know, transmitting the disease that way. But what about here, in the nation's capital, why are women and girls have such great risk?

Ms. NALLS: Well, women and girls are at risk for several reasons. One prevention messages are not addressing women's needs. And women - you are not seeing women in the face of the campaigns and the messages that's out there. When the tools that are put out there, are not a tool that women can use. It's condoms, it's male condoms. So when you are out in the streets you are getting a male condom. Now women can't use a male condom. There is such a thing as female condoms but they costs three dollars as compared to 10 cents for a male condom. So it's not affordable or accessible to women. Then we have to look at the violence against women. We have to start looking at violence against women as a part of HIV and AIDS.

MARTIN: What do you mean by that. Many women - even the report that came out -almost 50 percent of women in the report are experiencing domestic violence, sexual violence. And it's even higher, those are just people who are saying… I know from what the women we serve, it's more than 50 percent. So we have to start looking at these two issues together and not separate. And there are many, many issues. Many of the women are not… Many of the women are not, you know, going out to get tested because they have so many things on their plates to deal with - they're single head of household. They are dealing with domestic violence, sexual violence, substance use; they're dealing with cancers, losing their kids to violence in street, hunger, homelessness…

MARTIN: So they're not making their own self a priority?

Ms. NALLS: No. And they don't want to deal - for finding out another thing to deal with. You know, reality is I have to deal with something else. And that issue of time, you know, there all kinds of, you know… So we have to kind of look at all of those things. The messages it's not addressing women. And we saw in the report that women - that came out that - 40 to 50-year-old - when you look at them, the messages, you're not seen women in that age group in the pictures that you see - if you do see the messages out there and if you do see women in the campaigns.

MARTIN: If you're just joining us, you're listening to TELL ME MORE from NPR News. I'm speaking with long time HIV/AIDS advocates Patricia Nalls and Cornelius Baker about new data about Washington D.C.'s HIV and AIDS rate. District officials tell us that it's now at epidemic level. I want to talk about prevention messages. There is a whole generation of young people that came of age after this epidemic was known as HIV/AIDS. And so I just think a lot of people don't understand how it is that people could still not understand that they are at risk. It's like the all thing about, you know, smoking. There's before the Surgeon General's Report that said, you know, like this stuff will kill you and then there is after the Surgeon General's point…

So people say, before you can say - well I really didn't know this was the culture, this was just what we did. Now you have to know. So Cornelius I guess a lot of people just don't understand how is it possible that people could still not know that they are at risk and that they have to protect themselves.

Mr. BAKER: Well, I think there are a couple of things. I mean, I think, you know, if we look at smoking, we should recognize that still one quarter of American public does smoke. And so it's not surprising that when you look at HIV, and you look at several factors, that people are still at risk. I mean, one element is that people aren't always quite sure what to do? There is a generalized risk out there but they don't know how it pertains to them. Especially young people in our culture, really don't understand the fundamentals of sex or of their bodies and sexual healthiness.

And you look at a culture that is very squeamish about it and also inconsistent. It praises life, it praises youth, and it sells sex, but yet doesn't give young people the tools to have life, to have healthy bodies and to have healthy sexuality. And you look at even just this week, the Pope, you know, condemning condoms, basically. And so at least young people in particular - very confused. We also live in a pill society, where there is a pill that cures almost everything. Well there is not a pill that cures HIV.

But for a long time, I think, that if you were an 18-year old, 19-year old right now, all you have heard is there are these drugs for HIV and it makes you okay. It makes you better, it doesn't makes you okay. And so I think that we have to think about the cultural context in which younger people are now living this epidemic.

MARTIN: And also, Patricia, you made this interesting point that older women, 40 and 50-year old women, are now at far greater risk and that the numbers of infected people in this age group, in this demographic, are rising rapidly. And yet, what you're saying - you're saying that when people go around talking about education, it's just they just they don't talk to these women. They act like they don't exist. That the ads still have like young men, particularly young white men in them.

Ms. NALLS: Precisely. Precisely. And you know, when we talk about, you know, asking a partner to put on a condom, we have to think about for women, what does that entail?

MARTIN: What's the script?

Ms. NALLS: And that can induce violence. And we have to talk about that.

MARTIN: Can we talk about, just in the couple of minutes that we have left, what would you like to happen now? What should people learn from this? What should people be doing?

Ms. NALLS: Well for one thing, I think our government need to call this a state of emergency. Because the District of Columbia, we - for years we have been asking our government to say the words. Our District of Columbia is in a state of emergency. Before this report came out, a group of us, met with our district government and asked that we say these words and we're still not willing to say these words. I think we need to say them. We are in a state of emergency and we need to act as though we are. And we, you know…

MARTIN: One we were facing if we were facing a horrendous storm, someone would get up and say, you know what? We are facing a terrible storm, we need to protect ourselves. And you're saying that this is the situation.

Ms. NALLS: This is where we are at. And this three percent is only the people that we know are positive.

MARTIN: Cornelius we have only a minute left, what do the people need to be doing now?

Mr. BAKER: Well all sectors.

MARTIN: All government officials, citizens.

Mr. BAKER: We certainly we all need to recognize this for what it is, and we need to take urgent action. And I think the things that I mentioned earlier, in getting tested, but I think that also one of the things we need to make sure that we do is we look at the district as an opportunity. That we say that here is a place that we know what is happening, lets do something about it. For young black gay men, for young black women, all across the country, this is happening. It's not just a district, it's Oakland, it's New York, it's Atlanta, it's Birmingham. And we need to take action now or this picture is going to look like this, not only here, but it's going to look like this across the country.

MARTIN: Is this a specifically black issue?

Mr. BAKER: It is becoming an increasingly black issue as well as a gay issue, still. And we know that there are factors in the black community that are not well understood, and we need research to tell us why this is happening?

MARTIN: Cornelius Baker, a senior communications director of the center on Aids and Community Health at the Academy for Educational Development. He is a long time HIV/AIDS activist and the District's former director of the Whitman-Walker clinic which many people will know. Patricia Nalls is founder and executive director of The Women's Collective here in Washington D.C., also a long time HIV/AIDS activist. The Women's Collective was founded to offer services to women who were underserved. They were both kind enough to join us here in our studio in Washington. Thank you both so much.

Mr. BAKER: Thank you

Ms. NALLS: Thank you

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