"Our rates are higher than West Africa....They’re on par with Uganda and some parts of Kenya."

—Dr. Shannon Hader, city AIDS czar, March 16

Prior to this year, Mayor Adrian M. Fenty had called HIV and AIDS in the city is his No. 1 public health priority. But while he made key changes in the background—appointing Hader, for one, and placing a new emphasis on testing—Mr. Meaningless Press Conference has rarely done high-profile AIDS-awareness events. He even forgot to mention the epidemic in his yearly State of the District address. That behavior's been put in sharper focus by the release of new testing results in March, which came packaged in the Washington Post with the above quote. The juxtaposition of the national capital with the Third World prompted an avalanche of hand-wringing and attention to the issue, not that that worked out for Fenty. As the year ended, he saw his valuable behind-the-scenes work go almost wholly unheeded as the Post set its sights on the city's AIDS epidemic (and a Pulitzer Prize). A series of articles by reporter Debbie Cenziper uncovered shocking instances of mismanagement and poor spending—virtually all of which predated the Fenty administration.

Photo by Darrow Montgomery

More from LL's Quotes of 2009

A little more than a week ago, news broke that at least three percent of District residents have AIDS or HIV. This provoked Shannon L. Hader, director of the city's HIV/AIDS Administration to now-famously compare D.C. to West Africa. When pressed by Loose Lips at a press conference, Hader stated that our rates of infection were twice as high as New York City and five times that of Detroit.

As LL pointed out, the bigwigs at the press conference—Mayor Adrian Fenty, Councilmember David Catania, et al.—defensively argued that the part of the reason for the high infection rates is that the city is just testing more people. Case in point: testing is now routine at the D.C. Jail.

But this epidemic is not a new epidemic. In fact, it's been called an epidemic too many times to count. Perhaps the reason this story didn't provoke serious outrage and more press conferences and men in white coats discussing infection trend patterns is that this is an old story.

"This is the number one [public health] priority of this government," Fenty told the Washington Post. That quote was from an April 5, 2007, story headlined: "Fenty Renews Fight Against HIV-AIDS; Mayor Promises Strong Effort, Plans To Pick New Agency Chief." In the story's first graph, the mayor "pledged" to "put an end to this crisis."

While Fenty has recently received high marks from local watchdogs DC Appleseed, you don't get to a more than three percent infection rate by accident. Along the way, there have been screw-ups, questions about funding, and more than enough declarations to do better. A quick Nexis search reveals just a little bit in how we got to this point:

• A Jan. 4, 2007, Post story reports that the city's AIDS/HIV Administration chief was stepping down after 16 months. The city would be forced to find a new chief—its third in two years—to head up the agency. The Post wrote: "The HIV-AIDS administration has had almost a dozen directors in its 21-year history. [Marsha Martin]'s predecessor, who held the job just 11 months, was fired after D.C. Appleseed issued a report critical of the city's response to the epidemic."
• In the same April 5, 2007, story quoted above, the Post notes: "The mayor's promise of momentum follows a year of ups and downs for the agency, which leads the city's response. It launched a testing campaign last summer, drawing national attention with its goal to encourage all District residents between 14 and 84 to find out their HIV status." The campaign netted a huge increase in people getting tested but it also fell well short of testing several hundred thousand residents (total tested: about 48,000). And "the data collected at the test sites were not complete enough to provide the demographic breakdowns needed for the best prevention and treatment planning."
• In a March 10, 2007, story, the Post wrote about funding to nonprofit groups who deal with AIDS/HIV prevention. It reported that in 2005, D.C. Council Chairman Vincent C. Gray had noticed a "disparity" in funding—of the 121 nonprofit groups and agencies who received city dollars, not one cent had gone to a nonprofit based in Ward 7. Two years later, Gray was able to funnel hundreds of thousands of dollars to nonprofits who would target Ward 7 and Ward 8. But why did it take Gray two years after he realized this disparity to get funding? Where were other councilmembers on this issue? The Post story noted that these wards had the highest rates of infection in the city. And then there's this little nugget: The District would shell out an additional $300,000 to help these organizations "to implement training and help with writing grants." That's a lot of money to teach a nonprofit Grant Writing 101. That's a lot of money for "training." Effi Barry—who's expertise on the issue was what?—had been assigned to coordinate the Ward 7 part of the initiative.
• In late June 2007, the District government announces that it will launch a massive outreach effort aimed at teenagers and young adults. "We want to push the envelope....We have to be aggressive," Fenty says in a June 28 Post story.
• In late September 2007, the District pulled out of the condom producing business. The Post reported in a Sept. 29 piece that "as many as 70,000" government condoms were returned due to complaints related to the "mustard-yellow packets' durability and appearance." The District's outsourced condom producer agreed to replace the mustard-yellow packets with name-brand Trojans. The Post noted that "in addition to the inventories sent back in the past several days, the department's HIV/AIDS Administration still had 350,000 condoms that were never distributed....The Health Department has promised to retool the entire condom distribution program."
• A Nov. 26, 2007, Post article cites a District report calling the city's infection rates "a modern epidemic." The report was the first of its kind since 2000. "District health officials have long been faulted for the lack of HIV information and lagging AIDS data," the Post wrote. "Not until forced by federal funding requirements did the health department start tracking HIV." The city report found that more than 80 percent of the HIV cases were among black men, women and adolescents. Among women, nine in 10 were African American. The article quotes a letter Fenty had written that accompanied the report's release. He wrote: "We must take advantage of this information with the sense of urgency that this epidemic deserves."

The new report released last week revealed a 22 percent increase in the number of infected individuals from this 2006 study.

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.)