District of Columbia Criticized for Not Treating AIDS as a Citywide Health Crisis

A report released today details numerous failures in the District of Columbia's response to what is probably the worst HIV/AIDS rate for a major US city. Conducted by the public-interest D.C. Appleseed Center for Law and Justice (ACLJ), with 4,000 hours of research and writing donated by the law firm Hogan & Hartson and the support of Mayor Anthony Williams (D), "HIV/AIDS in the Nation's Capital" advises that city officials create an executive-level commission to begin a turnaround.

Among the report's findings:

• The HIV/AIDS Administration (HAA) has yet to release any data since it began collecting HIV case reports in December 2001, hampering prevention efforts and allocation of treatment and care resources.
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• The HIV surveillance program has had long-term vacancies of over 50 percent and continuing interim leadership.

• Coordination and supervision of government agencies and private service providers are inadequate, including for enrolling patients into medical assistance, paying and managing grants, and monitoring programs' effectiveness. (A letter in the appendix from Deputy Mayor Neil O. Albert said the city is working to consolidate eligibility and enrollment procedures for medical benefits.)

• The district has no strategy for incorporating HIV testing into settings such as TB and STD clinics, substance abuse centers, and hospital emergency rooms.

• District schools pay insufficient attention to HIV education for teens and lack "clear, consistently applied" program standards.

• The district lacks any HIV prevention strategy targeting its more than 10,000 intravenous drug users and has short-changed its substance abuse programs' budgets.

• The district offers substance abuse treatment to less than 2 percent of detained inmates, the "vast majority" of whom have a substance abuse history.

Among several dozen recommendations, the report urges quickly filling the city's HIV surveillance positions; combining HIV and AIDS databases; providing case managers more specialized training; and increasing interagency collaboration. ACLJ also recommended the city call a fall public meeting to discuss how it should proceed. The group said it would issue a follow-up report in six months.

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