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GlobalPost's John Donnelly and a team of reporters investigate what experts are calling a 'turning point' in the global fight to reduce HIV infection rates. Successes in southern African countries have produced valuable lessons on effective approaches to fight AIDS, lessons that need to be learned in US cities where infection rates remain persistently high — particularly among African-Americans. Meanwhile a political confrontation looms in Washington over critical funding which could threaten gains already made.
Part Two: Washington's HIV infection rates are comparable to many African countries, which have provided critical insight into the epidemic.
WASHINGTON – If the nation’s capital were a nation in Africa, it would rank 23rd out of 54 countries in percentage of people with HIV — a higher rate than the Democratic Republic of Congo, Ghana, Rwanda, Ethiopia and 28 other African countries.
Just a few years ago, AIDS in Washington had become such a dangerous threat that federal officials in the DC offices of the US global AIDS effort used to say with somber cynicism that Washington itself should be part of the extraordinary global push.
DC, they said, should have been the 16th PEPFAR country — PEPFAR — standing for President’s Emergency Plan for AIDS Relief, which was started by President George W. Bush in 2003 to fight AIDS in 15 countries where the problem was among the worst in the world.
Indeed, Washington is among the worst. Statistically, it has a higher HIV rate — 3 percent of all adults ages 15 to 49 are HIV positive — than five PEPFAR countries today, according to United Nations statistics.
But Washington, which will be host to the International AIDS Conference next month, attracting attention to the homegrown epidemic from more than 20,000 participants, is finally getting a handle on how to fight AIDS effectively.
“Weβve made this investment to Africa for a reason. We wanted to save lives.”~Toni Young, director of the Community Education Group
The reason is surprising: It has learned from the fight against AIDS in Africa.
From PBS NewsHour: What DC is learning from Africa in the fight against AIDS
That congressionally funded effort has come back to benefit the neighborhoods around Capitol Hill as several PEPFAR veterans returned home to take jobs in the District’s AIDS office. They brought with them proven strategies and tactics tested in Africa, which gave them newfound confidence that they could turn around a lackluster fight against the epidemic in not just any American city, but the city with the worst epidemic in the nation.
District leaders often reject any comparison involving AIDS between Washington and an African country because it implies that largely African-American communities here are on par with the developing world. But several leaders of the District’s AIDS fight say the link is apt in this specific instance because the African experience has informed DC’s response.
“I think under the surface [Africa's lessons] are something people don’t like to talk about. But … it is just such a model that has allowed us to get where we are,” said A. Toni Young, director of the Community Education Group, which oversees several AIDS prevention projects. “…We’ve made this investment to Africa for a reason. We wanted to save lives. We learned from Africa about treatment and treatment adherence."
The turning point came with a simple decision: Learn the epidemic. For years, the District had failed to do in-depth surveillance of the AIDS epidemic and had perceived it to a problem largely limited to the gay community and injectable drug users. But new data uncovered a new reality: AIDS was centered in the African-American community, infiltrating the general population of heterosexual couples. Nearly 7 percent of all African-American men in the District are HIV positive.
That knowledge changed everything. It meant that the focus should expand more broadly to the entire city but focused specifically on African Americans, encouraging more to get tested for HIV and starting major outreach efforts to let people know about the risk all around them.
On a recent day not far from Capitol Hill and the White House, about a dozen HIV outreach workers toting bright yellow duffle bags stuffed with condoms and prevention information stood outside of the Anacostia Metro station, waiting for the next wave of passengers to arrive.
When hundreds of commuters emerged from the subway, the outreach team fanned out to meet them, handing out free condoms and sharing facts and common misperceptions about AIDS. The process repeated itself about every 10 minutes with arrival of each new Metro train. After a couple of hours they had handed out hundreds of packs of condoms – and had persuaded 21 people to take an HIV test with an oral swab in a Chevy van parked nearby.
“You have to know your status, man. I’d rather be safe than sorry,” said Alvern Harris, 25, as he waited for his results. “What we do is a reflection to the younger generation. If we don’t, they won’t, and that’s another generation’s curse, another generation dying.”
This type of outreach mirrored programs in many African capitals, where young people, funded by the US government, routinely reach out to their peers in the street to engage them in discussion about AIDS and to pass on knowledge of how to protect themselves. The African efforts also included innovative ways to test people for HIV, including going door-to-door and setting up testing days in community centers and churches, tactics also started or being considered in Washington. But the first step — getting the data — was the most critical one.
“PEPFAR set up a very structured model for evaluating programs and outcomes around the work being done in Africa to address the HIV epidemic,” said Tiffany West, who directs HIV surveillance for the D Department of Public Health. “[DC government] was really good at bringing some of those international best practices into the domestic realm.”
More from GlobalPost: Female condoms: Pricey but cheaper than the alternative
Even with these lessons, the Anacostia neighborhood and others like it in the Bronx, New Orleans, Los Angeles and elsewhere still struggle against high HIV infection rates. This is somewhat due to the belated response in recent years to the growing domestic epidemic in African-American communities as well as the inherent difficulties in treating drug addicts and alcoholics, who with high frequency stop taking treatment.
Anacostia is located in DC’s Ward Eight, right in the backyard of the White House and Congress, and the African-American men and women who live here are disproportionately affected, Black men in DC accounted for nearly three quarters of cases among men, and black women accounted for about 90 percent of cases among women. The disparity is not exclusive to DC. According to a report by the CDC in 2007, in the United States, the prevalence rate for blacks was almost eight times as high as that of whites.
One of the outreach workers, Erika Williams, 41, said the high rates among African-Americans was one of the reasons she wanted to educate fellow blacks about the danger.
“My friend passed away from HIV,” she said, adding, “What she had offered to her then is so much different now. It might have made a huge difference in her life.”
Global AIDS strategy comes home
The turnaround in DC started with the hiring of Marsha Martin in 2005, a former special assistant to the Secretary of Health and Human Services who traveled around the world to learn about other approaches, and continued with AIDS experts who had worked in Africa. The DC effort is now led by George Pappas.
“PEPFAR brought [countries in Africa and Asia] a scientific intervention, fully based on data and now you could say we are re-importing that idea,” Martin said. “We are coming back full-circle to strengthen our response.”