HIV in D.C. Worse Than in West Africa

That’s right, it’s official: Chocolate City has a developing world AIDS epidemic. Three percent of the population is HIV positive, city officials are announcing today. And that’s just counting the people who have actually been tested—federal health officials believe anywhere from a quarter to a third of people living with HIV in the U.S. don’t know it....

These are important, grave numbers in the global-health world. At the U.S. epidemic’s worst, in 1992, San Francisco hit 4 percent. At just 1 percent, an epidemic is considered “generalized and severe.” That means the contagion has spread population-wide rather than remaining clustered in one subset—and thus that it is substantially more difficult to control. Crossing that threshold is a big, big deal. It’s a significant part of what has made the sub-Saharan African epidemic so unmanageable, for instance.

As the WASHINGTON POST reports [1]:

“Our rates are higher than West Africa,” said Shannon L. Hader, director of the District’s HIV/AIDS Administration, who once led the Federal Centers for Disease Control and Prevention’s work in Zimbabwe. “They’re on par with Uganda and some parts of Kenya.”

“We have every mode of transmission” -- men having sex with men, heterosexual and injected drug use – “going up, all on the rise, and we have to deal with them,” Hader said.

This is truly just the beginning. My colleagues and I at the Black AIDS Institute detailed in a report last summer [2] the many ways in which the black American epidemic resembles that of the developing world more than it does the U.S. It sounded like a provocative claim, but here we are. D.C. will not be the last black-heavy place to report these kinds of numbers. Watch for similar developments all around the Southeast in coming years. And if the shoddy state of the AIDS care safety net isn’t fixed, we will start seeing deaths like the early 1990s, too.

Some other quick facts about the D.C. findings: Seven percent of black men in the city are positive and 3 percent of black women. More than three-quarters of all HIV-positive D.C. residents are black. Yes, more than 75 percent. And more than 25 percent of all positive D.C. residents are black women.

America declared victory against AIDS in 1996, but the triumph was not universal. That year began a dramatic and ongoing trend in which blacks—and black-heavy locales—have accounted for greater and greater shares of both new HIV infections and AIDS deaths. Now we’re fully half of the epidemic [3], and it’s getting worse. There are lots of complicated reasons for this grim reality, and we’ve been discussing them here at The Root [4]. But here’s the simple bottom line: Time’s up. We either take bold action to deal with this or city after city will find itself past the point of return.

—KAI WRIGHT