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In Washington, a Focus on Testing and Fighting Stigma in the Fight Against HIV

AIDS is not a foreign sickness to the residents of Washington, D.C. According to U.N. statistics, the HIV infection rate there is higher than five countries in Africa. Ray Suarez assesses the challenges in testing for HIV and treating AIDS in the nation’s capital.

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    Our second story is about the crucial role of testing for HIV here.

    Next week's global AIDS conference marks the first time it's been held in the U.S. in more than two decades. But when tens of thousands of people descend on the nation's capital, they will be visiting a place that's more than just a host city. Many neighborhoods in Washington, D.C. have felt the pain of AIDS acutely. And experts are looking for ways to turn the epidemic around.

    I worked on this report with our partner GlobalPost.

    This week, an estimated 1,000 Americans were newly infected with HIV, the virus that causes AIDS. Next week, another 1,000 will join the estimated 1.2 million people in this country who are already HIV-positive.

    And those new infection numbers haven't changed in 10 years. While there's been steady progress in moving the disease from a death sentence to a chronic, treatable condition, Washington, D.C., has remained the U.S. state or territory with the highest infection rate.

    DR. GREGORY PAPPAS, Washington, D.C., Department of Health: D.C., like the rest of urban America, has a very serious epidemic on going. Two or three people are infected every day in the District of Columbia.


    Dr. Gregory Pappas is the senior director at the D.C. Health Department in charge of HIV and AIDS.


    D.C. is not a country, it's not a state, it's not even a city. We're a jurisdiction. We're a cutout of the center city.

    We are 600,000 people within a metropolitan area of five million people. And we happen to be a cutout where there are a lot of gay people and a lot of disenfranchised black and Hispanic people, poor people. Poverty and poor education are the main drivers of new infections in the United States.


    Three percent of all D.C. residents over 12 years old are HIV-positive, and that number zooms higher for poor people, black men and black women.

    The neighborhoods across the Anacostia River include concentrated pockets of poverty and HIV infection. It's been that way since the earliest years of the epidemic.

    But GlobalPost reporter John Donnelly, who covers the AIDS beat around the world, says city officials are adjusting their approach by incorporating ideas that are working in less developed countries. Testing is an important one.

  • JOHN DONNELLY, GlobalPost:

    And what's happening is, a lot of the lessons that the United States really learned from its global fight in AIDS in Africa are being brought back home, back to Anacostia, back to the Bronx, back to San Francisco and Miami.

    And there are using some of the tactics to really reach the population, to educate them, to let them know about the dangers, and to make sure that they themselves know if they are HIV-positive or not.


    Street health educators funded by the D.C. government, federal and private grants fan out on the streets of a Washington neighborhood.

  • WOMAN:

    Do you want to do this free HIV testing?

  • MAN:


  • WOMAN:

    May I take your last name?


    Knowing your HIV status is now believed to be one of the most powerful weapons in the AIDS prevention arsenal. It's simple to test, and fast.

  • MAN:

    What we will be doing is — here, you can have some condoms. And what we will be doing is we're doing — actually a free HIV test.


    Terrence Young is the manager of testing and field operations for the Community Education Group.

  • TERRENCE YOUNG, Community Education Group:

    We have seen a constant increase in our annual amount of tests, in our annual amount of positives diagnosed.

    We're in these neighborhoods constantly. We're not coming one time and saying, hey, look, guys, you need to get tested and people never see us again. People who have grown accustomed to seeing us in the communities. It's to the point now where, literally, my staff will pull up, and we have to do very little, if any outreach. They know what we're doing.

  • WOMAN:

    Do you think it's important to get tested for HIV?

  • MAN:


  • WOMAN:

    Why is that?

  • MAN:

    Because I would like to know if something is wrong with me. So, I won't have to give something to someone else.


    Here's why testing matters.

    Here in Washington, D.C., a high percentage of people have health insurance, and lifesaving anti-retroviral drugs are widely available. But if you don't know your status, you can't even begin to take the medicine that manages your infection and protects your sex partners.

    Intravenous drug use and risky sex are risky anywhere. But you're taking an even bigger chance anywhere in a high-infection area where a lot of people don't know their status. They aren't protecting themselves or their partners.

    So street health workers like Donald Head deliver, over and over, one simple message: Get tested. If you're positive, we will get you help.

  • DONALD HEAD, Community Education Group:

    People come in and they get tested, right? And, sometimes, you get preliminary positive.

    We have what's called a red carpet service, where we will take them from that chair that they are sitting in, and immediately take them to care, where they can get their doctor, they can get the mental health, they can get everything that they need, right, concerning the virus. And we have to stick with them up to a year, take them to their appointments.


    Two years ago, Head got the news he now has to break to others. His test was positive. He says the news can throw people into a panic.


    What actually gets them to become a little calm is when I tell them that I'm HIV-positive, right? Then they kind of — they come around a little bit, right, because they look at me, and, like, nah, he ain't HIV-positive.

    It's something that lives or originates in the bloodstream. And you can't look at me and tell whether I have it or not.


    Dr. Lisa Fitzpatrick of Howard University said one of the biggest hurdles to treating the infection is stigma. Fear and shame keep too many patients away from the doctor, until their disease has progressed.

  • DR. LISA FITZPATRICK, Howard University:

    And I ask them, what took you so long to get here? And they say, well, I didn't want to talk about my AIDS, or I didn't want to hear you telling me I have AIDS.

    We have people who will be tested repeatedly, in hopes that one of those tests will be negative, so that they can say, I don't have HIV. We have people who think they can pray their HIV away.

    So there are many, many barriers to getting people to accept that HIV is a reality in the community, but also to accept that are things that you can do about it. You can get treated. You can live a long time. You can be healthy and take care of your family.


    Dr. Wafaa El-Sadr has done decades of AIDS research in the U.S. and the developing world. She said outreach done in Africa, part of the President's Emergency Plan for AIDS Relief, or PEPFAR, made progress, slowing the spread of the disease.

    Wafaa leads the International Center for AIDS Care and Treatment Programs at Columbia University, a PEPFAR partner.

    DR. WAFAA EL-SADR, International Center for AIDS Care and Treatment Programs: I realize, sometimes, when we say that the epidemic in parts of the United States is similar to epidemics in parts of Africa that this is a quite alarming statement and maybe disturbing statement to many. But it's true. And there are lessons learned, that — lessons that we can learn from the response in some African countries.


    She says PEPFAR-style outreach could work in high-incidence American neighborhoods.


    To actually reach out, go to the homes in those most affected communities and approach people, talk to them about HIV, talk to them about the importance of knowing whether they have HIV or don't have HIV. And if you find out that they are HIV-infected, linking them to care. And if you find out that they don't have HIV infection, then to offer them prevention — prevention interventions.


    African countries have had more success normalizing testing, building down stigma, and talking openly about AIDS. And new infection rates are dropping.

    Doctors specializing in AIDS prevention say the great leap forward in testing in the U.S. will come when a screening for HIV becomes as routine during a doctor visit as a blood pressure or cholesterol check, as is becoming more and more common in sub-Saharan Africa.

    Dr. Pappas says Washington still isn't close to efforts there.


    People go to the doctor in the District of Columbia and they are not getting an HIV test. The issue, it's got to be standard practice.


    Once an HIV-positive person has been identified, these experts say it's vitally important to get people on medication, and keep them taking it properly to prevent drug resistance. Again, the U.S. can look to Africa for examples.


    Africa actually excels at staying on their medication.

    It was early in the epidemic, people said, oh, well you can't do HIV in Africa. People won't take their pills on time. Well, African communities actually have mobilized to support one another. There are people, village workers that go from house to house and encourage people to take their medication. That same sort of approach, that community-based approach to helping people stay in care, is what we have got to get to in the United States.


    Thirty years into an epidemic that has been so devastating in so many African countries, there's a kind of irony in seeing U.S. cities like Washington adopt some of the methods pioneered in Africa.

    With no complete cure available, researchers emphasize that knowledge, prevention and treatment all work hand in hand.

    Online, we examine how two very different places deal with AIDS. Washington, D.C., and Zimbabwe are literally worlds apart, but they both have some of the highest HIV rates in the world and face remarkably similar challenges. Tonight, we explore how prisons are dealing with the disease.

    Visit our website for much more of our joint reporting with GlobalPost ahead of this weekend's AIDS conference.

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