How Does D.C.’s HIV Rate Compare to Other Cities?
Thanks to the Washington Post’s preview yesterday of the city’s latest HIV/AIDS numbers, we know know that, with 3 percent of the population diagnosed, D.C.’s rates are “higher than West Africa” and “on par with Uganda and some parts of Kenya.”
Those comparisons came from Dr. Shannon Hader, head of the city’s HIV/AIDS Administration and a former public health officer who did extensive work in Africa. But LL and LL’s boss had the thought: Is this just another example of the District suffering in an apples-to-oranges comparison—you know, where the District is compared to a state or country encompassing both urban, rural, and suburban areas rather than to its peer cities?
So after today’s press conference on the numbers, LL asked Hader to put the numbers in context of American cities: “Our rates are twice as high as New York City and five times as high as Detroit,” she said, adding she wasn’t aware of a city with a higher infection rate.
Hader added this thought: “What I’m most concerned with is…southern cities are starting to have the same complexity of epidemic that we have, where you have every risk factor contributing. I hope that in a sense we can be a cautionary tale to some of our other southern urban centers who if they don’t take the opportunity to know they’re data and intervene now, they could evolve to matching us, and we don’t want anyone to evolve further.”
Hader and her boss, health director Dr. Pierre Vigilance, both made the point that D.C. in recent years has developed one of the most comprehensive testing regimes in the country. Vigilance, in his slight British accent, pointed to a “surveillance bias,” where “doing a better job of testing people means more people actually get tested and more people get results. And you may find that there are more people with disease than you knew beforehand.”
The unspoken subtext, of course, is that if New York or Detroit or Uganda or Kenya tested as thoroughly and reported their data as thoroughly as the District does, the District might not look so bad.
In any case, the four folks behind the mic at this morning’s presser—Hader, Vigilance, Mayor Adrian M. Fenty, and Councilmember David A. Catania—urged District residents to get tested regularly for HIV.
So LL asked each of them when their last test was. Said Hader, “I’ve been tested as recently as I access heath care, so i guess I’m a few months behind in my annual checkup.” Vigilance said, “I was tested last year and need to get tested again this year.” Fenty said he’d been tested “within the last year,” and Catania said, “It has been some time,” citing his now seven-year-long committed relationship as reason for his delinquency. (For the record, LL was tested when he had a checkup in fall 2007.)
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3:45 pm
How is it sensible for all District residents to get tested regularly for HIV? Shouldn’t testing be limited to people who have multiple partners or are with a new partner, people who work with human fluids/waste, intravenous drug users, and other at-risk types? Saying that everyone should get tested is about as advisable as telling all men, regardless of age, to undergo annual prostate exams.
Or maybe LL was hoping that D.C. leaders could serve as good examples, even if some of them getting regular HIV tests (Fenty’s married and faithful, right?) is sort of moot?
4:09 pm
Your original question is a good one, but the response you got doesn’t answer it. You can’t just compare to another city because DC is unlike any other city.
Most cities include larger suburban areas outside city limits that would be the equivalent of Montgomery County, PG County, and Northern Virginia, which would obviously dramatically change the statistics in DC.
If you look just at Manhattan for example, it’s a different picture:
http://www.nyc.gov/html/doh/html/ah/ah.shtml
1 in 25 men living in Manhattan (4%)
1 in 5 black men age 40-49 in Manhattan (20%)
I couldn’t find the source data for this NYC analysis to do a more apples-to-apples comparison with the numbers reported for DC.
But what is clear, is that demographics probably have a LOT more to do with infection rates than DC’s particular policies and programs.
9:27 am
NPR this morning said DC ranked fifth among US cities in AIDS rate (as opposed to HIV, which the reporter said there wasn’t complete data for), behind San Francisco, New York, Miami, and Ft. Lauderdale.
10:14 am
I think that it should be mandatory that if a person test posititve for HIV that we have a website that the person’s name gets placed on. If you contracted a disease 15 years ago, the doctor made you contact all of the partners and if they refuse to get treated, the Health Department would come to their perspective jobs, your house, ect until they found you. This is not rocket science, stop spending money to travel to other countries that have nothing to do with the District of Columbia and get some funding for this initative.
10:30 am
Ummm… Babs… I hope you are joking. If for some reason you aren’t, then I think you should consider, ever so briefly, the consequences of a law like that (which would be totally unconstitutional anyway, and about as popular as prohibition).
Thought process of individual considering HIV test:
1) If I test positive, I will be on a public list
2) Therefore everyone will know I have HIV and I could be discriminated against
3) DECISION: I’m NOT going to get tested, ever.
Result: Nobody ever gets tested; HIV rates skyrocket.
I suppose your next move would be to require mandatory HIV testing every three months, followed by concentration camps and/or santioriums for people with HIV, herpes, or a history of shingles outbreaks.
10:48 am
Obviously from the looks of things, people are not getting tested, forget worrying about war or being attacked in the US, we are already at war, it is called AIDS. Yes, I do think that we should go back to the Health Department’s way of enforcement and treatment.
11:11 am
Part of the appeal of comprehensive HIV/AIDS testing is to reduce the stigma attached to going into the clinic. Anyone can contract HIV, not just drug users and people who have had multiple partners in the past year. How many people who claim to be “married and faithful” aren’t?
11:40 am
So everyone should waste time and public dollars to get tested for a disease that–barring infidelity, risky sexual behavior, drug use, or a handful of other behaviors–is difficult to contract in order to reduce the stigma for people who are at risk? I don’t follow.
Re: How many people who claim to be “married and faithful” aren’t?
I have no idea, but I agree that the liars should go out and get tested. And I agree that the same would be in the best interests of people in the body modification community, and people who like to hook up, and people who use drugs, and people who have practiced first aid on someone else.
But the case for routine, universal HIV testing without regard for individual circumstances doesn’t hold up.
3:29 pm
It is obvious by Mike’s comments that he has no idea what he is talking about. You can’t get HIV from giving first aid to someone. You can get HIV from having a husband or wife, who you think is being faithful, go out and hook up or do IV drugs and come back and have unsafe sex with you. The costs of an HIV test today are minimal, especially compared with the cost of someone not finding out and spreading the disease.
3:49 pm
@JohnD “First aid” may have been too ambiguous (though I didn’t think so)–I was referring to car accidents, stabbings, shootings, bicycle accidents, or any situation where a stranger may conduct first aid and come into contact with another person’s blood before EMS workers arrive. I used it as an example (one of many) where getting an HIV test would be a wise decision.
And sure, if you’re married/dating/partnered with/to someone who might be using IV drugs without your knowledge, go get that HIV test. But I don’t think everyone should get regular testing regardless of circumstance.