Washington Blade - March 20, 2009
JUST THIS WEEK, the D.C. Department of Health HIV/AIDS
Administration released estimates on the number of District
residents living with HIV. The numbers are jaw-dropping.
According to HAA, 15,120 District residents, or 3 percent of the
population, are HIV positive.
To place that number in context, if D.C. were an independent
nation, its HIV infection rate would be higher than that of many
African countries. There is a natural inclination to ask how the
capitol city of the United States developed epidemic levels of
HIV comparable to those of a developing country.
The answer is simple: leadership. The lack of it and need for it
have fanned the flames of this crisis. And it is through
leadership that we will develop the public awareness necessary to
slow, and, I hope, eliminate the spread of HIV.
First, it's important to note that the new HIV numbers are high
because of the District's overall effort to enhance public health
data collection and analysis. Four years ago, 40,000 residents
were tested for HIV; by 2007 the number of residents tested had
increased to 70,000. This increase in testing is to be applauded,
but testing only 14 percent of District residents does not give a
full measure of the epidemic in our city.
The truth is that because of the lack of widespread testing, the
prevalence of HIV/AIDS among District residents is probably
higher than 3 percent. Greater efforts are needed to track the
spread of the disease. But tracking and reporting only tell us
how a disease spreads. To understand the why behind the epidemic,
we have to look at the leadership surrounding the issue.
One clear reason for why D.C. suffers a 3 percent HIV rate is the
Bush administration's de-prioritization of domestic HIV
prevention services over the past eight years. While Bush
authorized up to $48 billion to combat global HIV/AIDS, his
administration flat-funded domestic HIV prevention programs and
provided only a marginal funding increase to treatment programs
for Americans living with HIV/AIDS. The Bush administration's
decision to prioritize the global AIDS crisis over the domestic
epidemic is an important reason why we are now seeing a rise in
local HIV infection rates.
ANOTHER FACTOR IS the lack of leadership shown by Mayor Adrian
Fenty's office. Certainly this week's news conference touting the
HAA survey is one example of mayoral leadership, but considering
the public health implications of HIV/AIDS, it is inexcusable
that Fenty has not taken a more active role in drawing public
attention to the issue.
As a 30-something African-American male, Fenty is in a unique
position to communicate with the community hardest hit by
HIV/AIDS: young black men. Yet the mayor has often not risen to
In Uganda, a country widely seen as having effectively battled
back against the spread of HIV/AIDS, the president took a very
public role in promoting widespread testing and treatment of
Ugandans with HIV. This brand of proactive leadership has been
absent in the District.
Finally, there is the lack of leadership within the gay
community. Since the mid-90s, advancements in anti-retroviral
drugs have extended the life of those living with HIV to the
point that the disease is now treated as a chronic illness rather
than a death sentence. During that same time the attention of
national LGBT organizations has shifted away from HIV and onto
issues of civil rights. Have we, as a community, chosen to sweep
the issue of HIV/AIDS under the carpet in an attempt to garner
public support for LGBT civil rights? Yes, and we must recognize
We need to begin talking amongst ourselves again about the need
to always practice safe sex and educating young gay men about the
risks of HIV. While life spans have been extended, the costs of
HIV infection, both financial and emotional, are still too high.
FORTUNATELY FOR AMERICANS worried about the explosion of HIV
rates in their communities, a new and different leadership
appears on the horizon. The Obama administration has already
committed itself to prioritizing domestic HIV/AIDS efforts, and
in a summary of its 2010 budget promised to increase "resources
to detect, prevent, and treat HIV/AIDS domestically, especially
in underserved populations."
Furthermore, Obama has named Jeff Crowley as the next director of
the White House Office of National AIDS Policy. Crowley, one of
the nation's leading public health policy experts, will be
responsible for coordinating the government's continuing efforts
to reduce the number of HIV infections across the United States
and develop a national AIDS strategy to help guide the federal
government in efforts to contain the domestic spread of HIV/AIDS.
Obama's promise of leadership on issues of HIV/AIDS still needs
to be fulfilled and while we must be vigilant about holding the
new administration to its word, we cannot abrogate our own
responsibility for action. Each of us - the individual, the
director of an organization, the mayor of a city, the governor of
a state, the president of the United States - must show the
courage of our convictions on this issue and lead by example if
we ever hope to one day eliminate the threat of HIV/AIDS.