MICHELE NORRIS, host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris. Washington, D.C. is a center of wealth and power. But beyond all those majestic monuments, the nation's capitol is in the grip of a major public health crisis. D.C.'s annual rate for new AIDS cases is ten times higher than the national average. More than New York, Philadelphia, San Francisco, and any other major urban center.
In a city of just over half a million residents, one in 50 people is living with AIDS. An estimated one in 20 district residents is HIV positive. To understand what those numbers mean, think about a movie theatre, the kind you find at the Cineplex, with 20 seats per row. Now, imagine that one person in every single one of those rows could have HIV. One in 20.
And what's particularly troubling, thousands of people don't know they're infected or that they in turn, could infect someone else. On a busy street corner in Washington, D.C., outreach workers are handing out fliers and fistfuls of free condoms and encouraging people to take an HIV test.
(Soundbite of D.C. street)
Ms. JUANICE PRINGLE (ph) (The Women's Collective): Here you go. Hi, we giving away free HIV testing on our van over here. (unintelligible)
Ms. ANGIE VENEVEL (ph) (The Women's Collective): Free of charge, like I said, free. And our van is right at the corner of 17. You interested in going to get tested today?
NORRIS: Juanice Pringle and Angie Venevel are wearing bright purple aprons and open smiles as they walk near 7th and T streets. It's a busy intersection in a so-called transitional neighborhood. Here you see college students from nearby Howard University, urban hipsters who are renovating area row houses, and on almost every corner, you spot groups, mainly men, just hanging out.
Ms. JUNE PALADOR (The Women's Collective): We have proven to be a lot of trafficking of drugs and that kind of thing in this block. So you may notice a lot of people are around. It's not that they're (unintelligible) but I guess they're doing their business.
NORRIS: What kind of test are you offering?
Ms. PALADOR: HIV.
NORRIS: Rapid test?
Ms. PALADOR: Yes, the HIV Oraquick Advance.
NORRIS: That's June Palador. She's part of a group called The Women's Collective, a nonprofit that supports those with HIV, while, at the same time, trying to stop the spread of the disease. The confidential test provides preliminary results in about 20 minutes.
A 54-year-old man accepts the invitation for a free HIV test. He's sporting cornrows and starched blue jeans. He climbs inside the mobile testing van, sits down and begins a pretest interview.
Ms. PALADOR: If there's any questions that you would like to ask, feel free to interrupt me.
Unidentified Man: Well, I like, well, I'd like to make a statement. I should have gone ahead and done this a long time ago.
Ms. PALADOR: Oh, good for you.
Unidentified Man: And I'm just doing it today because I met you all here. And, no, I'm not afraid. I'd like to know what my status is. I assume that I'm healthy, but you can never know.
NORRIS: It's cramped inside. The van is divided into three testing units and the man in cornrows has his knees up near his chest, as counselor June Palador assess his risk factors.
Ms. PALADOR: Have you had a sexual relationship with a person with HIV/AIDS?
Unidentified Man: Not that I know of.
Ms. PALADOR: Have you ever had a sexual relationship with a man who had sex with men?
Unidentified Man: No.
Ms. PALADOR: Have you ever had sex while intoxicated?
Unidentified Man: Yes, I tried to at one time.
Ms. PALADOR: Have you ever had sex under the influence of non-injecting drugs?
Unidentified Man: Yes.
Ms. PALADOR: Have you ever exchanged money or drugs for sex?
Unidentified Man: No, no.
Ms. PALADOR: Can you identify high-risk behavior?
Unidentified Man: Yeah, just being black is high risk out here.
NORRIS: That may not have been the answer the counselor was looking for, but that 54-year-old man was not too far off the mark, not in Washington, D.C. While AIDS and HIV first surfaced among a small population of gay men, it's now reached deep within the city's black population, particularly women. Black or Latino women make up 85 percent of all new AIDS cases.
Cornelius Baker has monitored the evolution of AIDS in Washington for decades. He's the former executive director of the Whitman Walker Clinic, the city's largest medical center for people living with AIDS and HIV. He says other cities have similar problems and similar demographics, but a number of societal and political factors have set D.C. apart.
Mr. CORNELIUS BAKER (Former Executive Director, Whitman Walker Clinic): We have a smaller population, but we also have a large gay community, where we know that the infection rate has been historically high. We also have a majority black population. And the black community is being ravaged by this epidemic. And then you add other factors. You add a very poor healthcare infrastructure. So people haven't always gotten the best primary care that they need. You have a high rate of drug addiction.
NORRIS: And in some cases, people trading sex for drugs.
Mr. BAKER: And people are trading sex for drugs, sex for money. Remember this is a city that ten years ago was bankrupt and had high rates of poverty, unemployment. And we still have lingering effects of that.
NORRIS: And D.C. also has a very high rate of incarceration.
Mr. BAKER: That's correct.
NORRIS: Is that a factor as well?
Mr. BAKER: That's, absolutely. I mean, when we look at what is the single most common factor that is present when a black woman is infected with HIV by her partner, he was incarcerated. And so we know that jails are now also a breeding ground for HIV.
NORRIS: On top of all that, Baker says the city's primarily black leadership has been slow to acknowledge that the black community has moved directly into the bull's eye of the epidemic. He says that applies to politicians and to the churches, as well.
Mr. BAKER: In Washington, D.C., a city that, remember, has struggled to come into its own, politically, to step out of the shadows of Congress, certainly the black community is often struggling for its pride. And the last thing that these communities want to be told is that they are the reason that we have such a horrible HIV epidemic. And that is again, their fault.
NORRIS: So a city that was once the site of riots, that was once labeled the murder capital of America, is not eager to embrace this new problem.
Mr. BAKER: It's not. And so what it breeds is a denial and we know what denial breeds. Denial breeds ignorance. And then ignorance breeds disease.
NORRIS: Last summer, a non-profit law and justice center published a scathing report about the district's handling of AIDS. If found the city's response was understaffed, under-funded and, particularly, ineffective at reaching those at greatest risk. Since then, the district has hired a new director for HIV and AIDS programs.
Dr. Marsha Martin took over in September with an ambitious agenda, but without a big increase in funding to support it. In the last five years, district and federal funding for HIV and AIDS programs has increased, but it has not grown in proportion to the steady rise in AIDS and HIV cases. We sat down with Dr. Marsha Martin in her office recently. Beyond money, she told us that one of her challenges is to make AIDS a higher priority.
Dr. MARSHA MARTIN (Director, HIV & AIDS Programs): Unfortunately, ten years ago, when people weren't doing so well, you know when people were dying from HIV, people had a far greater awareness. But it's now no longer so much in the public eye and as a result of that people aren't paying so much attention. And people are being diagnosed every day.
NORRIS: Why aren't you doing more to put it in the public eye? Why is it that I can drive from one end of town to the other and not see a billboard or barely see a bus placard unless it is sponsored by one of the drug companies?
Dr. MARTIN: That's exactly the same question I asked myself when I came into this job. And that's one of the things that we're working on which is to change this city's relationship to this epidemic. And so we have to revisit where our resources are and to determine whether we can do that big public education, public awareness program.
NORRIS: Do you presently have a public awareness program?
Dr. MARTIN: We don't have one right now but we have a task force that the mayor's office is in the final stages of vetting that will be including some of the significant individuals that can help us with that campaign.
NORRIS: Now that's curious. The city is in the wake of an epidemic but doesn't have a public awareness campaign. That doesn't make sense.
Dr. MARTIN: Well what doesn't make sense about it, and I agree with you, what doesn't make sense is, when it's off the radar screen because people are doing better, people think it's not so necessary to remind people. And as a result of that there are fewer dollars both public and private that are going to public education, public campaigns. And so we have to own in the District of Columbia our own problem so that people will know we are doing something about it.
NORRIS: Martin says the city needs to step up funding and move into battle mode. Her wish list is long. She wants to make condoms available in all public places that serve alcohol. She'd like to expand the needle exchange program, target prevention messages at sexually active teens and college students, and offer HIV testing in more doctors' offices and emergency rooms, as other cities are doing. Most of all, she wants to expand testing for people behind bars, where there's a high concentration of HIV.
Dr. MARTIN: That's probably the highest rate of HIV anywhere in Washington D.C.
NORRIS: They do testing of inmates during the intake process. Why isn't testing done at the point of discharge, since the status may have changed during the course of incarceration?
Ms. MARTIN: Well, and that's a very good point, and in fact we were just at a meeting with HIV prevention directors from all over the country at the Centers for Disease Control last week, where we have learned that in fact in several states and jurisdictions there is something called automatic testing going on, where you are automatically tested when you enter, and you are automatically tested when you are discharged. We, right now, have a voluntary system. We are going to move toward automatic. And my recommendation is that it's automatic upon entry and it's automatic upon discharge.
And I would also like to add that we are also looking to work with the federal government, as well as our community partners, to have all the residents of the District of Columbia tested for HIV.
NORRIS: Every single one?
Ms. MARTIN: Everybody know their status. If we have 1 in 20 living with HIV, that means it could be any of us.
NORRIS: What's the likelihood that that's going to happen within the next five years?
Ms. MARTIN: Oh, no question. It's going to happen. No question.
NORRIS: That there will be a program so that every single resident of the District of Columbia will take a test?
Ms. MARTIN: Absolutely. Everybody needs to know their status.
NORRIS: Back at the intersection of 7th and T, Martin's idea for a universal testing campaign was met with skepticism from a woman who had just taken a test herself.
Unidentified Woman: If she can do it, more power to her. I'm sure that a lot of people be very pleased about that, you know what I mean. But I don't see that happening here.
NORRIS: On this day, the Women's Collective vans met two hours at 7th and T and tested seven people in all, including a mother with a toddler on her lap, a woman who recently discovered her husband was secretly gay, and that 54-year old man. All were black, and all seven received negative results. The fellow wearing cornrows and blue jeans said he was relieved by his outcome, but nonetheless, he was shaken by what he heard.
Unidentified Man: I'm upset. I'm a whole lot upset because I didn't realize how prevalent the HIV is here in the District of Columbia. You can't copulate with a girl out here any more. It's too dangerous.
NORRIS: I'd like to hear your theory. How did we get to this point?
Unidentified Man: Ignorance. Basically, ignorance.
NORRIS: So while the city comes up its new battle plan for HIV, an army of advocates is fighting ignorance one person, one condom, one confidential test at a time.
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