DC leads the way in AIDS prevention

Pew Trusts - Ten years ago, Washington, D.C., was on the verge of a public health disaster: It had the highest reported rates of HIV in the country. And in a city of 588,000, 1,333 people tested positive for HIV in 2007 alone. By the time they were tested, most had full-blown AIDS.

Back then, city officials acknowledged that they didn’t have a complete picture of the problem. But they estimated that as many as one in 20 residents were infected with the disease, rivaling rates in sub-Saharan Africa.

“We had an epidemic that wasn’t being controlled by any stretch of the imagination,” said Marsha Martin, who was then the city’s director of HIV/AIDS programs.

But today, even as the city’s population has grown to 681,000, its infection rates have dropped dramatically. In 2016, 347 people in the nation’s capital tested positive for HIV, down three-quarters from 2007.

D.C.’s success mirrors national trends; HIV rates are on the decline around the country. But the tools city officials used to tackle the epidemic are being held up as a model for the rest of the country, AIDS researchers say.

“There are things that D.C. has done that are unique and ahead of the curve,” said Greg Millet, a vice president at amfAR, the Foundation for AIDS Research. “All of this is part of a good news story for what’s happening in the rest of the country.”

How did D.C. do it? A decade ago, city health officials stepped up AIDS awareness campaigns and pushed to get more residents tested. They created a “red carpet” program, immediately linking anyone who tested positive to care, whether or not they had health insurance. They stepped up condom distribution and began a robust needle exchange program. Since then, the city has almost eliminated new infections from IV drug use. Finally, in 2014, officials increased the use of PrEP, a drug that prevents the transmission of HIV.

The city’s goal now: to end the epidemic by 2020. In December, Mayor Muriel Bowser announced the city’s aggressive “90-90-90-50” plan, based on UNAIDS goals and the Obama administration’s National HIV/AIDS Strategy.

The plan sets specific targets to be met by 2020: 90 percent of the HIV positive people in the district will know their status; 90 percent of people diagnosed with HIV will be in treatment; 90 percent of residents who are in treatment will reach viral load suppression, which means they can’t transmit the disease to others; and new HIV infection rates will be cut in half.

Today, the D.C. Department of Health estimates that 86 percent of people with HIV know their status; 76 percent are in treatment; 82 percent are virally suppressed.