Monday, August 29, 2005

The appointment of a new director of the D.C. HIV/AIDS Administration (HAA) caps two years of unsettling news about the city’s failure to effectively allocate and monitor tens of millions in local and federal dollars to prevent new cases and help those already infected. The longstanding problems prove that the Williams administration and the D.C. Council must work more closely with the private groups to resolve what can only be called a crisis.

Officials of the Whitman-Walker Clinic told Congress in 2003 that the city has one of the highest infection rates in the nation — a stunning 1-in-20 residents. We were startled last year to learn that Whitman-Walker mismanaged $2 million in funding. Now we discover that both the Williams administration and the D.C. Council have fallen far short of their respective comprehensive planning and strategic oversight responsibilities. The result is a delay of the city’s 2005-06 HIV prevention plan, vital to federal funding, and the fact that no one even knows exactly how many Washington residents are infected with the HIV virus.

Whitman-Walker, the region’s largest service provider, was hit with its own series of budget and funding problems, and threatened deep service cutbacks. Interestingly, Mayor Tony Williams and D.C. lawmakers managed to work together on a bailout for Whitman-Walker, as did their counterparts in Northern Virginia. A clinic in suburban Maryland, however, is slated to close this fall if there’s not an infusion of funds.

Rescuing Whitman-Walker, while crucial, could be a mere stopgap measure. While the bailouts help Whitman-Walker and its patients in the short-term, the question for the long run is this: Does the private sector have the capacity to effectively stem the tide of new HIV infections, particularly among at-risk groups, women and the young.

A 170-page study by the D.C. Appleseed Center for Law and Justice, released in August, concludes that the District has failed to curb the prevalence of the virus and has failed to monitor the effectiveness of the programs it does pay for. It cites a high-ranking official who says that the District “is in some respects 10 to 15 years behind where it should be in mounting a concerted, effective response.”

The D.C. government doesn’t distinguish between prevention programs that work and those that don’t. Indeed, statistics put the most important aspect of the crisis in chilling perspective: The 2001 reported AIDS infection rate was 119 per 100,000 residents; the one in 2003 was a staggering 170.6 — effectively 1 in 20. More than 9,000 D.C. residents are living with AIDS, or 1 in 50. But even those statistics fail to “[c]apture the extent of the epidemic because they do not include HIV-positive people who have not developed AIDS.” The study goes on to say, “Youth in the District face serious risk of HIV infection due to above-average rates of unprotected sex and substance abuse.”

An epidemic lies ahead if the status quo continues. As with the crisis in public education, as we have observed, money is not the issue. Walter Smith, Appleseed’s executive director, says, “We think the resources are there to get the job done.”

The city has several health-related lessons (including boosting childhood immunizations and curbing teen pregnancy) on which it can draw as it tackles the crisis over HIV/AIDS. Policies and resources must be directed at what works, and legislative oversight must be vigilant. HIV/AIDS patients should not have to suffer because of the mistakes of slow-moving officials.

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