HIV prevalence in US capital is at epidemic levelBMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.b1205 (Published 23 March 2009) Cite this as: BMJ 2009;338:b1205
The prevalence of HIV infection in Washington, DC, is at least 3% among people aged over 12 years, as high as that in several African countries, a report by the District of Columbia’s health department says.
But prevalence is rising because of earlier detection and better treatment, so that people are living longer. The rate of new infections is falling.
A rate of 1% or more is classified as an epidemic by the World Health Organization and the US Centers for Disease Control and Prevention.
The true prevalence may actually be higher, the report from the Washington Health Department says, because studies indicate that a third to a half of those infected do not know they are infected.
Shannon Hader, head of Washington’s HIV and AIDS administration, who worked in Africa for the Centers for Disease Control and Prevention, told the Washington Post: “Our rates are higher than West Africa. They’re on a par with Uganda and some parts of Kenya” (www.washingtonpost.com, 15 Mar, “HIV/AIDS rate in DC hits 3%”).
The most severely affected group is men, especially black men, 6.5% of whom are infected. In terms of age, Washington residents in the 40-59 year age groups are disproportionately affected, the report says, with 7.2% of 40-49 year olds and 5.2% of 50-59 year olds infected.
Prevalence is 4.3% among black residents, 1.9% among Hispanic people, and 1.4% among white people.
The number of people infected with HIV has risen by 22% since 2006, the report says.
Nearly 72% of the cases are in men. Among men the most common mode of transmission was sex with another man (37%), followed by heterosexual contact (28%), and injecting drugs (18%). Among women the most common mode of transmission was heterosexual contact, accounting for 56% of cases, though this figure ranged from 42% in “other” ethnic groups (mixed race, Asians, Alaska natives, American Indians, Pacific Islanders, and unknown) to 51% in white women, 58% in black women, and 70% in Hispanic women.
The report says that, among people with AIDS, male to male sexual transmission was the most common mode of infection but that among people with a new diagnosis of HIV infection the most common mode of transmission was heterosexual contact, followed by male to male sexual contact.
The good news, the report says, is that “the number of newly diagnosed cases in Washington has declined since 2003, reaching its lowest point [since then] in 2007 with a rate of 127.9 cases per 100 000 population.” However, thanks to earlier detection and better drug treatment, the number of people continuing to live with AIDS rose from just under 1400 per 100 000 in 2003 to 1724 per 100 000 in 2007.
Progress has been made to stop the spread of HIV, the report says. In 2006 Washington became the first city in the country to implement routine testing for HIV.
The number of infants in the city born with HIV infection fell from 10 in 2005 to only one in 2006 and one in 2007. In 2007 the health department began working with labour and delivery centres to implement routine HIV testing.
Testing for HIV has increased among young people, as has access to antiretroviral drugs, a needle exchange programme, and free condoms.
Cite this as: BMJ 2009;338:b1205
District of Columbia HIV/AIDS Epidemiology Update 2008 is at http://doh.dc.gov/doh/frames.asp?doc=/doh/lib/doh/pdf/dc_hiv-aids_2008_updatereport.pdf.