By Susan J. Blumenthal, M.D., M.P.A., Raaj Mehta, and Stephanie Safdi*
Today, on National HIV Testing Day, we are reminded of the fact that one quarter of the million Americans who are living with HIV/AIDS are unaware of their status. Over the last five years, the United States has made important steps forward in addressing this epidemic abroad, investing more than $15 billion in the fight against global HIV/AIDS through the President's Emergency Plan for AIDS Relief (PEPFAR) which has become a cornerstone of its health diplomacy efforts. While the Congress is currently debating whether to increase funding for this initiative, it is also important for policymakers to intensify the fight against HIV/AIDS at home. They need look no further than beyond the walls of the Capitol to the District of Columbia, to witness a full-fledged domestic AIDS epidemic underway.
It is no secret that our nation's Capital has the highest rates of infection in the United States, comparable to several sub-Saharan African countries. 1 in 20 D.C. residents are HIV positive. The virus has also hit certain populations much harder than others. African Americans in the District, for example, account for about 80% of new HIV cases, although they comprise 55% of the population. Moreover, injection drug usage and men who have sex with men account for a substantial proportion of new cases reported in D.C. A report released from CDC today shows that nationally, HIV has risen 12% among young homosexual men. Furthermore, heterosexual contact has become the leading mode of transmission in the District, causing almost 40% of the city's new infections in the last five years.
The District of Columbia's Department of Health (DOH) and several non-profit organizations have been working to stem the tide of the epidemic. Thanks to Mayor Fenty's action since his election in 2006, the first major epidemiological report with comprehensive statistics on HIV in D.C. was published on November 26, 2007, uncovering the alarmingly high prevalence of the disease within the District. Since then, the D.C. Department of Health launched an investigation to reexamine past medical records of District residents and discovered hundreds of unreported AIDS fatalities over the last six years. As federal funding is based on reported infection statistics, the Department of Health has promised to continue strengthening public health surveillance systems to counter underreporting and bring more resources to the District's fight against the disease. Furthermore, because of the tireless advocacy work of organizations including amfAR, The Foundation for AIDS Research, D.C. was recently granted a significant victory when legislation passed permitting the city to use its own tax revenues to fund lifesaving needle exchange programs for the first time in ten years.
Still, one of the greatest dangers D.C. and our country faces is succumbing to "AIDS fatigue." Infection rates have remained quite high in the United States over the last ten years. Over 40,000 new cases are reported annually and recent articles suggest that this figure may in fact be as much as 25-50% higher. Complacency does not save lives and will not lower these numbers; more commitment, funding and science-based policies will. The federal government has a responsibility to the people of the nation's Capital as it does to improving the health of people in other parts of the world.
To help fight the epidemic in D.C. and nationally, the stagnant domestic HIV prevention budget must be increased. With more resources, cities like D.C. would be able to effectively implement the mission of today's National HIV Testing Day and better pursue more aggressive screening, which is a key pillar of early detection and effective treatment of the disease. Since 2006, the CDC has recommended routine HIV testing programs in health care settings based on an opt-out strategy in which patients provide oral consent for screening as part of routinely obtained general medical consent. With more funding, the D.C. Department of Health could encourage the widespread adoption of these strategies and streamline screening for the disease among its at-risk population.
However, testing alone is not enough to curb the spread of the virus -- it is only one part of a full arsenal of interventions. Testing should be incorporated into a system that includes prevention, treatment, and care and addresses critical issues including poverty reduction, eliminating health disparities, and improving access to health care, which will help stop new infections from happening in the first place. Furthermore, science-based public policies such as comprehensive sex education and promoting condom usage are critical components as well.
Washington D.C., as does the rest of our country, has much more work left to do when it comes to the battle against HIV/AIDS. Cities, states, and the federal government all have a responsibility to improve HIV prevention efforts in our own hometowns, but every individual also has a responsibility to know his or her status and get screened as well as to take steps to prevent the disease. Approximately half of Americans report ever having been tested for HIV, and just 21% say they were tested last year.
With the latest advancements, testing can be quick, easy, and confidential, so what better day to get screened for HIV/AIDS than today? See www.hivtest.org to find a site near you.
Susan J. Blumenthal, M.D., M.P.A. is the Director of the Health and Medicine Program at the Center for the Study of the Presidency in Washington D.C. She is also a Clinical Professor at Georgetown and Tufts University Schools of Medicine. For more than 20 years, Dr. Blumenthal served in health leadership positions in the Federal government, including as Assistant Surgeon General of the United States and the first Deputy Assistant Secretary of Women's Health in the U.S. Department of Health and Human Services, as Chief of the Behavioral Medicine and Basic Prevention Research Branch at the National Institutes of Health, and as a White House Advisor on health issues. Dr. Blumenthal has received numerous awards including honorary doctorates for her important contributions to improving health in the United States and globally. Her work has included a focus on HIV/AIDS since the beginning of the epidemic in the early 1980s.
Raaj Mehta is a junior at Princeton University and an intern in the Health and Medicine Progam at the Center for the Study of the Presidency in Washington D.C.
Stephanie Safdi, M.Phil, is a research assistant at the Center for the Study of the Presidency in Washington D.C. She graduated summa cum laude from Harvard University and earned her Masters Degree from Cambridge University on a Harvard-Cambridge Scholarship. Ms. Safdi served as a research fellow at the Harvard Initiative for Global Health and is the recent recipient of a Fulbright Fellowship.