Washington, D.C. Facing HIV/AIDS Epidemic
FARAI CHIDEYA, host:
This is NEWS & NOTES. I'm Farai Chideya.
In the nation's capital, a killer is on the loose. It's been operating in America for decades now. We're talking about AIDS. Tomorrow is World AIDS Day. Today, we'll discuss staggering new information on how prevalent AIDS is in Washington D.C., particularly among African-Americans. Overall, the rate of AIDS cases in Washington D.C. is about 10 times higher than in the United States. Dr. Shannon Hader is the director of the D.C. HIV/AIDS Administration. Welcome.
Dr. SHANNON HADER (Director, D.C. HIV/AIDS Administration): Thank you.
CHIDEYA: So, these are really some chocking numbers. Sixty percent of the city's residents are African-American, but 81 percent of new HIV cases in the city are among African-Americans. How many people are we really talking about?
Dr. HADER: Well, you know, we have about 12,500 people in the district right now living with HIV and AIDS, but about 80 percent of those are mainly African-American communities. So, we're talking a high number of people, not just a hundred or two hundred, but thousands.
CHIDEYA: What about the trend lines? Are you seeing these number of new infections increase?
Dr. HADER: Well, you know, certainly over the United States, the trend over the last decade has been increasing racial disparities and the HIV epidemic with more African-Americans affected. Here in the district, we have really good data for the last 2001 through 2006, and what we see is that we're not gaining much ground at this point in terms of reducing infections, although we seem to be holding a little bit even. And - but I think particularly among the women, the rates among women have been increasing over the last five or six years.
CHIDEYA: What percentage of women in the D.C. area are African-American who were infected?
Dr. HADER: Mm-hmm. Among all the women that we know are infected with HIV in the district, about 90 percent of them are African-American.
CHIDEYA: With these numbers, with the racial disparities, what is being done? What are the approaches that you and other government, public health officials, nonprofits are taking to really start addressing this?
Dr. HADER: Well, I think what we're doing and what we need to continue to do is an attack on all fronts. First step is, information is power. These data, these hard facts give us a good picture for everyone at the individual level, at the community level, at the government level, at the policy level, to really wake up if they haven't and see the nature of the epidemic we're dealing with. Second, it's about services and it's about taking action, both to protect yourself and protect others. We are ramping what was already sort of a groundbreaking HIV policy in the district, which is this know your status, HIV tests should be just the same as knowing about your other routine health indicators.
So, our goal is, by 2009, when you go to an emergency department, they should routinely offer you an HIV test. When you show up at your primary care doctor's office, you should get, just like you get the rest of the tests for your annual physical - you get your BMI for obesity, you get a blood pressure for hypertension, you get your blood sugar for diabetes - you should be getting your HIV status as well, without having to sort of beg for it or ask specifically. This has to be part and parcel about how we all approach our general health going forward.
CHIDEYA: There have been celebrity campaigns that say things like, it's good know, know your status, et cetera, et cetera, et cetera, but people are afraid. All of us have fears and some people may not want to know. What's the sense that you get of that?
Dr. HADER: Well, I think that that issue of stigma, fear, and silence is huge. And absolutely, that impacts people searching their test results, but it also impacts people taking preventive measures and taking care of measures to keep their health strong. I've been incredibly motivated by Mayor Fenty's leadership in saying, I'm making HIV/AIDS our number one health priority here in the district. And, in large part, a lot of that has to do with saying, come on, let's come together, let's break the stigma, break the fear, break the silence.
CHIDEYA: Who's really responsible for this - responsible may be the wrong word, but, I mean, Washington D.C. is a very interesting case of the overlap of the federal government and the local government. So, what responsibilities does it seem as if each has in dealing with this issue?
Dr. HADER: Well, you know what, we're all responsible and we have to use all the resources that are out there, whether they're district or federal, to get to the next level of our HIV response. Certainly, one of the specific relationship issues that's come out in D.C. has been this issue of Congress limiting our ability to spend our own district tax money on our own district programs and specifically, I'm talking about needle exchange programs.
Certainly, Congresswoman Eleanor Holmes Norton has been working as well as Mayor Fenty has been working to convince Congress to remove that restriction on our funds, and I'm confident that that's going to happen this year. So, that's something that's specific to the district that other jurisdictions don't have to deal with.
CHIDEYA: How much of needle exchange programs become more popular? They were extremely controversial when they were first proposed and first implemented.
Dr. HADER: Mm-hmm.
CHIDEYA: Is this now a fairly accepted form of a public health intervention?
Dr. HADER: Well, I think when it comes to comprehensive substance abuse, HIV prevention, we want a full toolkit available. Needle exchange is just one element in that full toolkit, and a lot of the wraparound services - including having on-demand treatment access for drug cessation, including having medical care available, including mental health services available, including having prevention information going out, those are all part of the toolkit. So, we don't want just one tool of the toolkit or just another tool in the toolkit, we want the whole thing at our disposal to really have a comprehensive program.
CHIDEYA: Well, Dr. Hader. Thanks for the information.
Dr. HADER: Well, thank you for helping share that information. I think this really important and I hope a lot of your audience doesn't just listen, but takes the topic home, starts breaking that silence and stigma, and have some dinner-table conversations.
CHIDEYA: Well, thanks again. Dr. Shannon Hader, she's the director D.C. HIV/AIDS Administration.
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