As we mark World AIDS Day -- aimed at continued global awareness of this never-ending pandemic -- let's focus on the United States, more specifically Washington, D.C., home to the first African Americans in the White House:
At least 3 percent of the capital city's population is HIV-positive, and that's a conservative estimate, according to the city's HIV/AIDS Administration. Nearly 7 percent of all black men, who carry the burden of the city's epidemic, are infected. A little more than 7 percent of all residents age 40 to 49 carry the virus. For the record, President Barack Obama is 48 and First Lady Michelle Obama is 45.
"Our rates are higher than West Africa. They're on par with Uganda and some parts of Kenya," Shannon Hader, the city's AIDS czar, told me and a former colleague earlier this year, when I was a reporter for the Washington Post, where I'd written about HIV/AIDS for years. "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."
Added Anthony Fauci, director of the National Institutes of Health's program on infectious diseases and one of the most respected voices in AIDS research: "This is very, very depressing news, especially considering HIV's profound impact on minority communities. And remember: The city's numbers are just based on people who've gotten tested."
To me, there's always been two Washingtons -- the federal city of monuments and museums, of the White House and the Capitol, the Washington of Georgetown, Bethesda and the inside-the-Beltway, I-read-Politico's-Playbook-because-I-have-to crowd.
Then there's this other Washington, the District of Columbia, a city within a city where health care access is a daily battle, where incarceration rate, drug addiction, poverty and illiteracy are high, a salad bowl of a city in which the majority African American population, the growing Hispanic community and the sizable gay enclave sometimes publicly intermix.
It didn't take long to realize these two Washingtons shortly after arriving in D.C., in the summer of 2003. You stroll the streets without an iPod and listen to people, you walk past DuPont Circle and take the 92 bus that runs through Eastern Market near Capitol Hill, you knock on some doors across the river in Anacostia, in Ward 8, the city's poorest neighborhood, you inhabit a city that's far from what many young, impressionable, ambitious D.C.-ists just like you call "the most powerful city in the world." I heard that a lot during my first months in Washington, not just from fellow young interns new to the city but from experienced, long-time Washingtonians. "The most powerful city in the world." As I got to know the city, as I met more residents and got to know the neighborhoods, I wanted to tell stories of people who, in one way or another, felt powerless.
I was born in 1981, the year the Centers for Disease Control and Prevention reported that "five young men, all active homosexuals," had shown up in hospitals with a rare infection. I grew up in the San Francisco Bay Area and worked at the San Francisco Chronicle, where Randy Shilts, author of the seminal book And The Band Played On, wrote his probing, landmark stories. I did not set out to write about HIV/AIDS, though the disease had always intrigued me. I wanted to write about issues surrounding HIV/AIDS. It's about drugs, it's about sex and sexuality, it's about class and race and identity, the very things that, in general, we're uncomfortable talking about. It's about people whom we consider "the other."
It's not an easy story to tell. At times, while writing and reporting the stories -- about a group of 40- and 50-something HIV-positive ex-cons, all black, many of them unemployed and living in half-way houses; about the mostly 20- and 30-something gay white men of D.C. Young Poz Socials, an HIV support group, interviewing a former U.S. Army officer who was sent home after testing positive; about 56-year-old Particia, who lost her younger sister Phyllis to AIDS, lives under the stigma and shame of being HIV-positive and fears that her daughter might get it, too -- I felt as if I wasn't up to the job. Not mature enough, not human enough, perhaps too simplistic in my thinking.
Yet I've been fortunate that my stories on HIV/AIDS, spanning five years, is now the subject of a feature-length documentary, bearing witness to the lives of AIDS patients, activists and workers who live at the forefront of the capital city's crisis. Susan Koch, the documentary's director, has given new life to the people and their stories. A native Washingtonian, Koch told me she had long wanted to make a film about the two Washingtons. Sheila Johnson, the BET co-founder and multi-faceted businesswoman, signed on as our main producer. After living in the D.C. area for many years, she, too, knows the two Washingtonians. But a documentary on AIDS? In America? In D.C.? Not exactly an easy sell. Still, they both felt that this story must be told. A film had to be made. We titled it The Other City because in every city, there's another city that many folks don't know about or want to see. After all, what's happening in D.C. is mirrored in other cities across the country -- with varying numbers and modes of HIV transmission -- from Atlanta, Chicago to San Francisco. The leading cause of death for black women ages 25 to 34 is AIDS. Look for our documentary to premiere in 2010.
And it's the people of The Other City who quickly came to mind on Nov. 30, when Valerie Jarrett, a long-time friend and senior adviser to the president, and Secretary of State Hillary Rodham Clinton spoke at a press conference on the eve of World AIDS Day, streamed live on WhiteHouse.gov. Jarrett talked about the sister-in-law she lost to AIDS. "Black women have a 15 times greater chance of being infected than white women," Jarrett said. Clinton called AIDS "the defining health challenge of our times." In the Obama administration's clearest and loudest declaration yet against homophobia, Clinton said that "any efforts to marginalize and criminalize and penalize members of the LGBT community worldwide" is unacceptable. Efforts to address the needs of "women and girls who are disproportionately affected" by the disease will be doubled, she added. After noting that the 22-year-old travel and immigration ban against people with HIV will be lifted in January, Clinton announced that Washington, D.C. will host the XIX International AIDS Conference in 2012 -- the first time the U.S. has hosted the gathering since 1991.
"While we are talking about our commitment internationally," Clinton said, "let's not forget our fellow citizens who are suffering right now."
As he does from Monday to Friday, Ron Daniels was riding his RV on Nov. 30, driving through the poorer parts of The Other City to run one of the city's needle exchange programs. He's been doing it for 15 years. As an HIV-positive and former drug addict himself, the 51-year-old collects used needles from drug addicts in exchange for news ones -- a controversial but effective strategy in curbing new HIV infections. Under Republican control, the U.S. Congress, which reviews and modifies D.C.'s budget, was wary of needle exchange. That meant that for almost a decade D.C. was the only city in the country barred by Congress to use its local tax dollars to fund needle exchange. The ban was lifted last year.
"When I think about World AIDS Day, I think about how behind we are. This is the nation's capital. Today, here in the city and in the rest of the country, we're not asking enough hard questions about our approach to this disease," Daniels, who runs Family and Medical's exchange program, told me in a phone interview. From 7 a.m. to 4:30 p.m., he said he collected about 3,500 used needles from about 77 addicts yesterday.
Added Patricia Nalls, 52, the founder and director of The Women's Collective, one of the city's havens for HIV-infected women and their families: "When we talk about World AIDS Day, and also when we talk about AIDS in America, people think, 'Oh, look, there are pills, there are medications, there's a solution.' But HIV is more than just a pill. HIV is a symptom of bigger problems. We're talking homelessness. How is a woman who's a mother going to worry about taking a pill when she doesn't a have a house for her kids? We're talking jobs. How's the mother, whose husband or boyfriend has left, going to put food on the table?"
Daniels and Nalls are just two of the many people featured in The Other City. I met Nalls in the summer of 2003. She lost her husband and daughter to AIDS before finding out that she, too, was infected. Right now, Nalls counts about 250 HIV-infected women and their families as clients. She has 5 case managers. Yes, that's 5 case managers for 250 families.
Nalls has a message for Michelle Obama, who lives just a few miles from the temporary offices of the Women's Collective, about three blocks from the Rhode Island subway stop, not too far from the White House: "Women need your powerful voice and your presence to help us fight this battle to save our lives. And our community."
Here's hoping the Obamas are listening.
Jose Antonio Vargas: "The Other City" -- AIDS in America, Nearly 30 Years Later
Jose Antonio Vargas: WATCH: "The Other City" is "The Real D.C."
You can imagine the look on their faces when I pointed out that they did not know who there by men friends were having sex with . I scared them getting blood work and using protection. I know some got made at me I don't care if it meant they were safe. And yet people are still just choosing to forget the dieases is still out there along with many others. SEX is a strong drug.
Did he just imply that Barack and Michelle Obama have HIV?
With that said, I think we should lift up those who are infected, they already live a life nearly in isolation.
http://americaspeaksink.com/2009/12/americas-decade-from-hell-indeed/
One more time HIV is the VIRUS that depletes the human immune system and eventually in most cases leads to an AIDS diagnosis. You cannot spread AIDS, you can only spread and catch HIV.
As for likening it to the flu vaccine, there is no comparison. It is apples and oranges. HIV is extremely complex and more virulent than the flu virus.
1) Even identifying the majority of HIV positive residents (let alone treating them) is not going to be an achievable task without putting a safety net of subsidized medications and/or subsidized high risk insurance pool into place. As it stands now, people who believe they are better off not knowing whether they are HIV positive may be right in some ways. Mainly, it would be next to impossible to obtain or maintain insurance when faced with that sort of diagnosis. Couple that with the stigma of the disease and the expense of the medications and you've got powerful financial and social incentive to not get tested.
2) Race matters. This is a problem that affects a large number of black people and there is a long history of white abuses against blacks in the public health systems in this country; a black distrust of public health departments is both real and rational. The DC public health officers will have to overcome this as well as a variety of other social and logistical challenges.
3) The DC DOH has been ineffective in dealing with this epidemic and is in danger of losing its HUD funding for HIV/AIDS prevention efforts due to lack of oversight. The DOH needs to acknowledge its failures, regroup and push for better solutions, not just wait around for more federal cash.
2) TRUE. Having worked with HIV communities over the years, i have to say that you are correct about the distrust, which in this day and time of course, is mostly UNFOUNDED.
3) PREVENTION efforts are important to be sure, but there are many programs in place in DC that provide services for the HIV Community, funded through the Ryan White Care Act (FEDERAL).
While the DOH may need to regroup there are many success stories throughout many of the cities non-profit programs to service the HIV community.
1) Yes, that's my point. It is a dangerous rationalization, but it that rationale that is helping cause the potentially low testing rates -- many people don't want to know. There are safety nets, but the majority is for very low income people. The programs don't reach enough of the populace; unless they're in place you won't see widespread enough testing. This is about social justice, not market justice -- there are solutions out there for individuals, but they need to be available for all citizens systematically.
2) Unfounded? The Tuskegee syphilis study is a pretty powerful and relatively recent example of the public health infrastructure wronging black citizens. There was suspicion in black communities that AIDS was a plague manufactured by whites as an attempt at genocide -- it was a major hurdle in University of Maryland public education attempts. There is plenty of reason to be distrustful and the DOH needs to work through that by making better and more open displays of cultural competency including further education.
3) There are some success stories, but the overall experience - as reported in this story - has been failure. An HIV positive rate higher than West Africa shows systematic failure in prevention, education, and treatment. My point was that the city DOH is not working effectively to combat the epidemic as evidenced by the current stats.
I'm lucky because my mother dodged the bullet when she left her ex-husband 24 years ago way before we knew about AIDS and what it was.
EDUCATION IS THE KEY FOLKS. It's the only way to protect yourself.