The District of Columbia Department of Health’s HIV/AIDS, Hepatitis, STD and Tuberculosis Administration (HAHSTA) released its annual report Wednesday highlighting the progress that HIV/AIDS advocates say has been made over the past few years in terms of preventing the transmission of and treating patients diagnosed with HIV.
According to the 2013 report, which examines progress made from 2008 to 2012, the District has been successful in decreasing the number of new diagnoses made each year, dropping 42 percent overall, from 1,180 cases in 2008 to 680 newly diagnosed cases in 2012. At the same time, the number of newly diagnosed AIDS cases – meaning the latter stages of the disease, decreased 35 percent, from 567 in 2008 to 370 in 2012.
The number of deaths from HIV also decreased over the same time period, from 345 to 221. This could be related to other statistics showing that more patients who were diagnosed with HIV were linked to care within the first three months following their diagnosis. Whereas in 2008, only 57.3 percent of patients were linked to care within three months, by 2012, that number had increased to 85.7 percent.
The smallest gains came in the area of viral suppression, meaning that the patient has gone on antiretroviral medications to suppress the virus and prevent it from replicating. When a patient regularly adheres to an HIV-medication regimen, their viral load, or the amount of HIV copies per milliliter of blood has fallen below 50, essentially becoming “undetectable.” According to the report, in 2008, 57.4 percent of patients diagnosed with HIV achieved viral suppression, compared with 61 percent in 2012.
The District has also been quite successful in linking expectant mothers with care, with the Department of Health (DOH) receiving no reports of any babies born with HIV for both 2011 and 2012. In total, there are 148 cases of people living with perinatal HIV, meaning those who contracted it from an infected mother. Zero of those patients are white, and only 5 are Hispanic or “other.” Only 18 of the 148 are under the age of ten.
Dr. Raymond Martins, the chief medical officer for Whitman-Walker Health, the local community health center that specializes in both HIV/AIDS and LGBT culturally competent health care, said that the report, overall, is good news for the District, where 2.5 percent of the population is living with HIV. The World Health Organization (WHO) classifies it as a “severe epidemic” if more than 1 percent of the population is living with HIV.
“The report is outstandingly positive for the District,“ Martins said in an interview with Metro Weekly. “We are diagnosing more people before they get ill, and we have more people with a suppressed viral load.”
The bulk of those living with HIV are males, particularly black males, and those between the ages of 30 and 59, though infection rates have been rising among younger men.
Among all residents in the District, 3.9 percent of blacks have been diagnosed with HIV, 1.6 percent of Hispanics, and 1.2 percent of whites. Other groups, such as Asian/Pacific Islanders, Native Americans, and others, taken collectively fall just below the 1 percent “epidemic” level, at 0.9 percent. When gender is taken into account, those rates rise to 5.7 percent among black males, and register at 2.6 percent for Hispanic males, 2.4 percent for black females, and 2.3 percent for white males.
Within the city, the largest rates of people living with HIV are in Ward 8, which tops out at about 3,058 per 100,000 people, and Ward 6, where the level is 2,772 per 100,000 people. Following close behind are Wards 5 and 7, followed by Wards 1, 4, and 2. Ward 3 has the lowest incidence, at about 388 cases per 100,000 people. Among those newly diagnosed, Ward 8 leads, with about 914 cases per 100,000 people, followed by Wards, 5, 7, 1, 6 and 4. Ward 3 again rounds out the bottom, with only 101 new diagnoses per 100,000 people.
Martins said he has anecdotal evidence from his work at Whitman-Walker that younger patients are less likely to use condoms, partly because of less fear of contracting HIV. But he also noted that so-called “behavioral-based” approaches to combating HIV, such as promoting abstinence or lecturing people about wearing condoms, has largely been unsuccessful in reducing the incidence of HIV. The biggest aim, then, should be reducing the viral load of those infected by linking them to treatment sooner.
“We know reducing viral load is decreasing transmissions,” he said.
The biggest concern, insofar as being able to achieve viral suppression, Martins said, is that while a number will comply with the medication regimen, there are still a large number of others who don’t, largely because of three reasons: mental health issues, substance addiction, or “competing life priorities,” such as a case where a single mother diagnosed with HIV, for example, may forget to take a dose because of struggling with pressures from work and child-rearing. It is up to health providers, Martins said, to ensure patients diagnosed with HIV who may be struggling with mental health or addiction issues receive proper treatment in order to ensure they comply with the medication regimen in order to achieve suppression.
Asked about the use of pre-exposure prophylaxis (PrEP) to combat HIV transmission, Martins said that it is an option, but only in addition to efforts to reduce the viral load of the infected partner.
“The idea is to identify the people who are at the highest risk of infection and infecting others,” he said.
Anecdotally, Martins notes that there appears to have been a change in behaviors among at-risk populations. While 10 years ago, people would have engaged in less risky sexual behavior, and five years ago, infected people were more likely to serosort – meaning sleeping only with other people with HIV – now people seem to do less of both.
“Young gay men, in particular, are harder to get into care,” Martins said. “So in some cases, putting them on PrEP is a way to get them involved in care, to get them used to seeing a doctor on a regular basis, and monitoring their health.”
The report also examined the incidence of other STDs, documenting a small percentage increase in the number of people diagnosed with chlamydia and gonorrhea from 2010 to 2012, after decreasing from 2008 to 2010. The Department of Health attributes this rise to the availability of more sensitive testing, increased testing of youth, and increased screening of men involving swabs of the throat and rectum. Reported cases of syphilis largely remained stable from 2008 to 2012.
Wards 8, 7 and 5 led the way among diagnosed cases of chlamydia, ranging from about 1,268 to 2,225 cases per 100,000 people. Ward 3 had the least number, with only 110 cases per 100,000 people. A similar geographical distribution pattern emerged for gonorrhea, though Ward 1 had a higher incidence than the four wards with the lowest number of cases.
However, the rate of syphilis was much higher in Ward 2, checking in at 45 cases per 100,000 people, followed by Wards 6, 7 and 5 in the 30s, Ward 1 in the 20s, Wards 8 and 4 in the teens and Ward 3 rounding out the bottom with only 5 cases per 100,000.
The incidence of Hepatitis B was more prevalent in Wards 4, 5 and 1, while the incidence of Hepatitis C was more prevalent in 7, 8 and 5. For diagnosed cases of tuberculosis, Wards 4 and 1 led the way, boasting numbers almost double that of any other ward.