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AIDS in America
Reggie Jackson of Prevention Works, a needle exchange program that focuses on preventing the spread of HIV, talks during an interview in the Trinidad section of Washington on Wednesday, Aug. 13, 2008. (AP)

Reggie Jackson of Prevention Works, a needle exchange program that focuses on preventing the spread of HIV, talks during an interview in the Trinidad section of Washington on Wednesday, Aug. 13, 2008. (AP)

The public health headlines out of Washington, D.C. echoed around the world yesterday.

The HIV/AIDS rate in the U.S. capital is higher than in West Africa. On par with Uganda. At three percent, we learned, the capital’s infection rate now approaches the rate of San Francisco at the height of the AIDS scare. And this when many Americans have come to see HIV/AIDS as a monster that’s been tamed.

What do the new Washington numbers really mean, for the capital and the country? Who’s sick, and why?

This hour, On Point: HIV/AIDS in D.C., and across the nation, now.

You can join the conversation. Did you think the AIDS epidemic was behind us? Is it, in your community? Your state? What’s the meaning of the numbers from the District of Columbia?


Joining us from Washington is Jose Antonio Vargas, Pulitzer Prize-winning reporter for The Washington Post. His front-page story on Sunday reported on the new HIV/AIDS numbers released by the District yesterday. And today he reports that the reported 3 percent rate is likely too low. He wrote a year-long series on HIV/AIDS in the nation’s capital in 2006, and he’s the screenwriter and co-producer of a forthcoming documentary based on his HIV/AIDS reporting, called “The Other City.”

Also from Washington, we’re joined by Shannon Hader, senior deputy director of the District of Columbia Department of Health, HIV/AIDS Administration, which yesterday released its report (pdf) finding that 3 percent of the District’s residents are living with HIV/AIDS. Previously she led the Centers for Disease Control and Prevention’s (CDC) work in Zimbabwe, and helped coordinate the 2007 HIV Implementers Meeting in Rwanda, the first worldwide meeting of its kind.

And joining us from New York is Phill Wilson, founder and executive director of the Black AIDS Institute, a group dedicated to ending AIDS in African-American communities. From 1990 to 1993, he served as the AIDS Coordinator for the City of Los Angeles and worked as the director of policy and planning at AIDS Project Los Angeles from 1993 to 1996.

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  • Wilson Samuel

    I have been living in US for that last 3 years, and till date I cant recall a SINGLE Awareness Ad about HIV/AIDS NOR I have ever SEEN A SINGLE STORE where anyone can get “SEAMLESS ACCESS” to Condoms!

    The path we are on currently is not the best way to combat HIV/AIDS.

    Most of our sexually active generation (by the way, I’m one of them) should have “seamless access” to :

    1. Awareness Campaigns / Advertisements about HIV/AIDS
    2. Condoms

    Hope someone will initiate a process in the right direction.

    God Bless America!

  • david

    You have to be an idiot not to take precautions before having sex. If you choose to “live free” etc…then be ready to die a awful death. We have spent way too much money on this problem and need to cut back and take a more “tough love” approach.

  • Amy

    One major issue that I have never heard raised as a major cause of the spread of HIV infections is the role that incarceration plays in spreading the virus.

    Black men being on the “down low” is often cited, but prison sex/rape is perhaps a more closeted issue. Men’s bodies in prison are not their own and it may play a substantial role in the spread of this deadly virus.

    Could you please have your commentators discuss this?

  • Mark

    I think you should talk about how permissive and uninhibitated people are becoming because there are ways to live with HIV/AIDS. There is a large section of MSM situations in DC and the fact that same sex relationships are so common and celebrated, people drop their guard and ‘do what feels right.’ We really need to talk about the real reason why these statistics surprise us.

  • http://tombstone001.blogspot.com MOHAMMED N. RAZAVI

    In a society where we can say anything we want except ask people to act within a social boundry of one man one woman, where we want to teach children about sex before we teach them about family and or responsibility, we do not ask human beings to act better than animals in matters of sex, we say use condoms and you don’t hae to worry about anything (safe sex), children are exposed to sex before they can tie their own shoes laces, with with mom, dad, sister or someone on tv making out in front of them. Where talk about trans fats takes precedent over saying have sex and you will die ( wages of sin is death), we should not be showing beautiful people doing every body on tv but showing pics of body parts with genetal warts, and herpes sores, and ghonerrhea ravaged vaginas and penises. may be some will get the message , sex is not beautiful at all, “sex in the city” kills.

    Please also include child abandonment, child and partner abuse, psychological problems sucide, murder, even unemployment are also consequences of free wheeling sex

  • Doshi

    Mr. Vargas,
    Please answer the question on how the demographics break out.

    If 1% is epidemic, PLEASE talk about the 7% rate for black men. Talk about the increasing rates for black women in particular and the effect on communities.

    This is horrific.

    Kudos to Amy for finally raising the incarceration issue.

  • http://onanov.com Donald Baxter, Iowa City, Iowa

    HIV rates amoung gay men are going up in some cities because gay men are “serosorting.” That is, they are meeting each other on the premise of being HIV negative or thinking they’re HIV negative. As many as 30% of gay men are infected without knowing it. Men who serosort are more prone to have unsafe sex under the false premise of being uninfected. Universal precautions, knowing one’s status, and treating to undetectable viral levels (rendering HIV+ persons uninfectious for all intents and purposes) should be the strategy for fighting HIV in the United States. Internet sites and personal ads that allow men to advertise their HIV status and ‘negative’ should be banned.

  • emily

    i totally agree with all of you. i feel that most people rather ignore this issue and ban all those people who have and want to want to talk about it or don’t have but still want to talk about it. It is true that we have a natural human emotion to avoid anything that makes us scared or threaten our way of life. We believe that by ignoring it it will go away but it doesn’t in any case it just gets worse. DEFINATELY KUDOS TO MOHAMMED N. RAZAVI, he seems to have a great idea..if we could have this hurting image then we would be fine. MY DAD TAUGHT ME TO TREAT EVERY MALE LIKE THEY HAVE AIDS, TILL THEY PROOF NOT WITH PAPERS AND IT SEEMS TO BE WORK. I THINK THIS ISSUE AM NOT GONNA LIE IS SCARY BUT IT NEEDS TO BE BROUGHT OUT

  • Ed

    Interesting and timely story. Well done Tom. AID’s is still here. We shouldn’t forget.

    (Off topic – does anyone know what that sort of slow, electronic music played going to breaks in the middle of the show is?)

  • Lee

    Back in the 90′s I worked with a young gay designer who told me that his generation (early 20′s) was very nostalgic for the gay sexual revolution they’d missed out on – the heyday of free, unprotected, often anonymous sex, and lamented belonging to these overly-cautious, “safe sex” times. He confided that he’d rather throw caution to the wind for the experience of those that came before him, especially since antiretroviral drugs had been improving and made living with HIV “no problem”. I argued that getting HIV wasn’t worth the risk and he seriously tried to reassure me that now having HIV AIDS wasn’t that bad, that plenty people he knew or knew of lived with it through a daily cocktail of drugs. He also confided that many of his peers felt the same way. I was shocked & seriously hoped he didn’t reflect the gay community at large.
    Fast forward a decade later I come across a magazine article written by a gay man about the dark secrets of his community – 1 being the rampant use of Meth and the other the rising status symbol of having HIV AIDS! Explaining that the thought was if you didn’t have the disease you were somehow not part of the “real” community…

  • http://www.onpointradio.org/ Eileen Imada

    Hello Ed–

    The song that you heard was “In the Waiting Line” by Zero 7 from their album “Simple Things”. It was also featured on the soundtrack for the movie “Garden State”. Thanks for listening.

  • Ed

    Thank you kindly Eileen!

  • Joe Beckmann

    This report was so terribly researched it surely caused cases rather than reduced their probability.

    On One-in-Ten on Sunday (hardly a secret, but still not on their website, here http://wfnx.com/shows/oneinten/default.aspx), the MALE Center (AIDS Action’s in-house out-reach) finally announced the availability of Post Exposure Prophylaxis (PEP). This is a treatment, known for 27 years, which dramatically reduces the probability of contracting HIV/AIDS after a positive exposure. For nearly all those years it has been used among medical professionals – a small kit that includes a shot of a standard anti-viral, to be used within 72 hours of any contact with suspicious blood or bodily fluid.

    PEP has also eliminated the prospect of children born with HIV/AIDS, of which there were not one in Massachusetts or New York in the past three years. This is a function of PEP, and not of abortion, and is a huge and thoroughly ignored story. Ignored by your story no less than by other mainstream media.

    After a little more than 20 years of successful use, the Fenway Community Health Center finally completed a Clinical Trial on nPEP (non-professional Post Exposure Prophylaxis) last year. They reported (http://gateway.nlm.nih.gov/gw/Cmd?GMBookmarkable%26loc=lhc) their findings that clinical professionals are not chemically different from others, and that, lo and behold, PEP works most of the time.

    In other words, there IS a morning-after pill, although it’s neither a pill, nor does it need be in the morning, there are side-effects (minimal, for most treatments) and, in spite of one clinical trial, it remains unsure that it is 100% effective. But it surely is effective enough to change the transmission rate of the virus in a large population.

    It is, in fact and documented, effective enough for the Commonwealth of Massachusetts (http://www.mass.gov/?pageID=eohhs2terminal&L=6&L0=Home&L1=Provider&L2=Guidelines+and+Resources&L3=Guidelines+for+Clinical+Treatment&L4=Diseases+%26+Conditions&L5=HIV%26%2347;AIDS&sid=Eeohhs2&b=terminalcontent&f=dph_aids_c_pep&csid=Eeohhs2) to make it available in 22 different centers, at no cost, with minimal admission standards. In still other words, we could end the epidemic in this state – and in Washington, DC, your reporter’s target – within a short period. That is what really should have been your story – for it is both remarkable and local. But you chose to talk about DC, instead.

    Your report yesterday glossed over a number of OTHER critical variables. Talk about testing ignored the critical nature of the rapid-test (there are now five different tests that give reasonably reliable results within 20 minutes); and about self-testing, now available through places as diverse as CVS or Rite-Aide or by mail via the net; and about the disparity in information across racial and sex lines.

    In fact, your report only confirmed how ignorance in communities of color continue a policy of passive genocide. Ignoring self-tests and PEP in Washington, DC, clearly contributes to their high rate of infection, and your report only confirmed that ignorance.

    The report also did not mention the newer rapid-tests; tests that identify infections in the first few days after exposure! Given that such new cases are themselves far more infectious in their first weeks in a new host, such tests are critically important to stopping the epidemic – and your report talks, instead, about dropouts, homicides, poverty and VOTING! Ignorance – and continued ignorance after and during your own program – contributes more to this epidemic than any of those conditions.

    Your report yesterday also ignored other critical findings in this state, the only state with universal health care and a key pilot for this Obama reform. This state’s numbers, for 2008, were just being reported two weeks ago. There are controversies about their reliability – the undercount is still (as it is in Washington) dramatic, and the Bush administration’s requirement to collect names has surely reduced the accuracy of any estimate. Yet there is surely a real drop. According to DPH a month ago, that reduction is nearly 300 new cases from 2007′s rate.

    Your report discussed costs only tangentially, and remarkably inaccurately, in terms of transmission rather than lifetime costs. When a caller suggested that infected people might have a shorter career span, your reporter ignored the very real costs of SSI for which anyone is eligible as soon as diagnosed. Not only SSI, but also free health care from the date of that diagnosis: At an average of $200,000 to $600,000 per case, from diagnosis to death (Harvard AIDS Institute data), that represents between $100,000,000 and $300,000,000, surely much, much larger than this year’s $70,000,000 cut in the DPH budget! Yet neither DPH, the governor, nor the legislature considered these serious reductions in state liability in planning cuts and budgets.

    Because this is the ONLY state that has a universal health care system, it is the ONLY jurisdiction where those savings actually accrue to a public or private interest. And because of those savings, and the popular ignorance about their financial impact, national universal health is in serious jeopardy.

    Finally, and this is perhaps the most tender of subjects, your report ignored why public and private agencies have avoided discussion of preventive testing (test your date!, perhaps using a test you bought online like this one – http://www.htesting.info/), of PEP and of Pre-Exposure Prophylaxis (which is now in clinical trials, for pills before you go out, or if you might expect to be exposed in any other way), and of a variety of interventions which could loosen the grip of clinical providers on their control of cases. That might be excused for a morning program, but there never IS that discussion, and the medical and social conditions have changed profoundly, and permanently, since the early days of this epidemic.

    This is not rocket science. It barely touches on the real science of HIV/AIDS, already the most researched disease in the history of man. It does, however, suggest that WBUR ought to conduct more aggressive due diligence before reporting such naivete and superficiality.

  • Rich

    I wish they had talked further about how one root cause of the spread of AIDS is the deep-seated homophobia in our society. Let’s start with the ridiculous notion of having to use “MSM” rather than gay/bisexual because people can’t stand to self-identify as gay or bi.

    We’ve always lived in a homophobic country–it’s ironic how we’re in a panic because one community-African Americans-are experiencing a large uptick in AIDS cases when the gay community has been living with it all along and has been ignored.

    Quite frankly, I’m not surprised by the statistics. The only time we’ll actually change anything is if it affacts a majority of white, straight, male Americans.

  • Atoki

    Homophobic? Nonsense!! Same-sex marriage and relationships are a PERVERSION of normal male-female relationships, and are helping to spread HIV and other terrible STDs. How many animal engage in gay acts. Dont blind your mind to the truth or you will die in your sins. Give your life to JESUS today and he will save you from your sins.

  • Wilson Samuel

    Atoki, I understand your perspective, however would love to ask you, why Jesus??? Why only Jesus???

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