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The Washington Blade
EDITORIAL: HIV wake-up call - The epidemic is out of control in D.C. and there's plenty of blame to go around
Victor Maldonado
March 20, 2009
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 the occasion.

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 that fact.

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.

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