HIV/AIDS In US Capital Exceeds UN Epidemic Threshold

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Main Category: HIV / AIDS
Also Included In: Public Health
Article Date: 18 Mar 2009 - 2:00 PDT

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The health department of the government of Washington DC, the capital city of the United States, has issued a report that says 3 per cent of its residents over the age of 12 are infected with HIV/AIDS, a figure that most likely places DC above the threshold that the United Nations defines as an epidemic (1 per cent of the whole population of a specific geographic area).

The report, titled "District of Columbia HIV/AIDS Epidemiology Update 2008", is an update to the 2007 annual report on HIV/AIDS; before that there hadn't been one for over five years. The 2007 report was the first to publish statistics on HIV and described the District of Columbia (the formal way to refer to Washington, DC) as being in the middle of a "modern HIV/AIDS epidemic", modern because of its size and complexity.

The 2008 Update, released earlier this month but dated February 2009, reaffirms the depth and diversity of the epidemic and gives a snapshot of how severely it is affecting the people of DC, according to its preface. It is also the first report to cover the behaviour of heterosexual DC residents.

The report suggests that black men and people aged between 40 and 49 are the ones most affected by the HIV/AIDS epidemic in DC.

Among its major findings, the Update reports that studies of behaviour show that between one third and one half of residents may be unaware of their infection, and this suggests that the true infection rate is most likely to be higher than the 3 per cent of over-12s given in the official figures which are based on diagnosed and reported cases.

Across age groups, the current infection rates given in the report break down as follows:

• 0.1 per cent of 13 to 19 year olds.
• 1.1 per cent of 20 - 29 year olds.
• 3.4 per cent of 30 - 39 year olds.
• 7.2 per cent of 40 - 49 year olds.
• 5.2 per cent of 50 - 59 year olds.
• 1.3 per cent of those aged 60 and over.

Broken down by race and sex, the infection rate of HIV/AIDS in DC is:

• 0.2 per cent of white females.
• 0.7 per cent of Hispanic females.
• 2.6 per cent of black females.
• 2.6 per cent of white males.
• 3.0 per cent of Hispanic males.
• 6.5 per cent of black males.

As with all reports of this type, these figures are based on diagnosed reported cases compared to census data on the numbers of people in the various groups of the population. They do not take account for example, of whether some groups of a population are more likely to report symptoms and undergo diagnosis than others.

On a geographic basis, the report found high rates of HIV in nearly every neighbourhood of DC, and suggests that the reported figures are actually an understimate since 20 per cent of the cases reported don't have sufficient information to attribute to a specific ward.

The report does not give figures for what it describes as vulnerable groups, such as heterosexuals living in areas of high HIV/AIDS infection and high poverty, or men who have sex with men, or injected drug users. It mentions plans to have these in the next issue once smaller studies targeted at these specific groups are complete.

The Whitman-Walker clinic is one of Washington's biggest HIV centers. Their chief medical officer told the BBC that he thinks the real figure is much higher than the 3 per cent given in the report.

"When they've tested large groups of the District population it looks like the prevalence is actually about 5 per cent," said Dr Raymond Martins.

Martins said the apparent recent increase in these figures could be because Washington has a new director responsible for HIV/AIDS administration, and this has led to a "large push" in getting people tested and they are discovering a lot of people that didn't know they were infected.

Washington DC Mayor Adrian Fenty wrote in a letter at the front of the report that the city's government is following a three point plan to tackle the HIV/AIDS epidemic: Promote, Prevent, Protect. This includes increasing publicly supported testing, providing free condoms and needle exchanges to stem the spread, taking better care of the people who are already infected and reducing the number of babies born with HIV.

"District of Columbia HIV/AIDS Epidemiology Update 2008."
Government of the District of Columbia Department of Health, Washington DC, Published February 2009.

Click here to see full report (opens as PDF).

Sources: District of Columbia Department of Health, BBC.

Written by: Catharine Paddock, PhD
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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