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From NPR News this is ALL THINGS CONSIDERED. I'm Melissa Block.

MICHELE NORRIS, host:

And I'm Michele Norris. Higher than West Africa, on par with Uganda and parts of Kenya; those are words used to describe the HIV-AIDS rate in Washington, D.C., the nation's capital, now the highest in the US. A new report out today finds that three percent of DC residents have HIV or AIDS, that's a 22 percent increase since 2006.

Shannon Hader is the HIV-AIDS administration director for the District of Columbia, and she joins us now.

Ms. Hader, welcome to the program.

Ms. SHANNON HADER (HIV-AIDS Administration Director, District of Columbia): Hi. How are you?

NORRIS: Now, you led the team that produced this report. You've been looking at these numbers for a while. How surprised were you when you saw that final number, three percent?

Ms. HADER: Well, you know, I think taking the number of cases that have been diagnosed, number of people that we know are diagnosed and living with HIV and putting them together with our population data, our census data, I think that was dramatic for all of us. So I think when we saw the three percent number, it really complimented what we already knew. But the way we could take it home by looking at different populations, different geography, different age groups, I think really made it much more meaningful.

NORRIS: Why is the rate so high in DC?

Ms. HADER: How we came to this point is very multifactorial. But certainly, there are couple of things that are noticeable. Number one, I think there's been a perception in DC and in our nation overall, as if HIV has gone away. You know, it's - we have it under control and it's normal, just old-fashioned disease that this is as good as it gets.

And when we look at our numbers and we look at what happened here in the District, we say this is not as good as it gets. And things, I think, did get out of control because maybe people didn't put their - keep their eyes on the ball. I think there are a lot of folks that were stuck in a old-fashioned mindset of the epidemic we had in 1985, thinking that this was an epidemic that only affected men who had sex with men, or maybe only infected injection drug users.

And when we're able to take a look at the real numbers and see actually this disease crosses almost every ward in our city and almost every age group, and almost every race and gender group, that's really I think where hopefully a lot of folks are able to wake up and say, wow, this is not everybody else's disease. It's my disease, too, so how do we take control of it?

NORRIS: When you talk about perception, there's one stat from the findings, one statistic I want to ask you about. The city found that three in 10 people said that they had used a condom the last time they had sex. That's a lot of unprotected sex in this city, in a city that's long been in the bull's eye of the AIDS epidemic.

What's going on? Is that an example perhaps where people have let down their guard?

Ms. HADER: I think that's a great statistic to focus on. You know, we were able to launch today the first behavioral risk factors survey that really covers these wide questions along with the basic statistics. And that one number, you know, 70 percent of folks didn't use a condom the last time they had sex. You know, that number is probably pretty comparable across other areas in the United States.

But the impact of that, the impact of that choice here in the District, whereas you said it's been an epicenter for HIV for a while, is vastly different than it might be in North Dakota. So I think this is a part of putting information and actions together with the context so that people can maybe get a clearer picture for their own decisions and say, wow, maybe given the fact that HIV is such a normal disease here in the District, it's so common, that a 30 percent condom rate is just not the way to go.

NORRIS: If this is a, to some extent, a wakeup call, what does the city need to do that it hasn't been doing in the past? And what lesson should other cities take from this?

Ms. HADER: Well, I think what we've been trying to do with these data and the data from last year, is to recognize that we need a whole portfolio of activities that match the scale and complexity of our epidemic. So it's not enough just to give out a few condoms. We need a condom distribution program that we can scale up across our city in easily accessible venues. Just like it's not enough to just have a few good places to go to get HIV testing, we need the healthcare system to take this on so that routine, regular, voluntary HIV testing is part of your routine healthcare services.

And then I think the other part is empowering individuals and families and organizations to have enough information to really contribute and step up for themselves and the people they care about as well. So - to make decisions, to look at some of the hard choices in their relationships, hard decisions, as well as some of the easy decisions, which are like to support the people you love.

NORRIS: Shannon Hader, thank you very much for spending time with us.

Ms. HADER: Great. Thank you guys for getting out this important information.

NORRIS: Shannon Hader, she's the HIV-AIDS administration director for the District of Columbia.

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