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HIV(E) and AID(E)S in DC

Testing for H.I.V. at Stores, on Street Corners and at the Motor Vehicle Office

Mary F. Calvert for The New York Times

Natrussa Williams of the Family and Medical Counseling Service with a Washington resident after he agreed to take an H.I.V. test last week while waiting at the Department of Motor Vehicles.
By DONALD G. McNEIL Jr.
Published: July 21, 2012
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WASHINGTON — Angela Byrde, 27, is getting only the second H.I.V. test of her life — at the Department of Motor Vehicles.

Her situation exemplifies what is wrong with Washington’s AIDS epidemic, and America’s — and what the nation’s capital is finally doing to fix that. As a diabetic with Medicaid coverage, Ms. Byrde has seen doctors several times a year since she was 12, but they never suggested that she be tested, even though she lives in a city with one of the country’s highest H.I.V. infection rates.

Now the city, trying to find the estimated 5,000 Washingtonians who are infected but do not know it, is offering tests in grocery stores and high schools, on corners where addicts gather and even in motor vehicle offices. And it is paying people to take them.

“Seven dollars to take a mouth swab?” Ms. Byrde said. “It just works. And they make sure you don’t lose your place in line.”

Starting on Sunday, Washington will host 20,000 scientists, public health officials, activists and journalists at the biannual conference of the International AIDS Society, the world’s biggest gathering devoted to the disease. It is the first time in 22 years it has been held in this country, where the epidemic was first spotted 31 years ago. And it has come here because the Obama administration lifted the Reagan-era prohibition on people who are H.I.V. positive entering the country.

Despite decades of alarm over the AIDS epidemic and many advances in treatment, testing is so inadequate in the United States that about 240,000 Americans do not know they are infected, and many spend years spreading it.

The District of Columbia is a microcosm of both the best and worst trends in modern AIDS prevention and treatment. Infection rates here were so bad that they were compared to those in Africa. But the city’s innovative new programs, like testing people at motor vehicle offices, have been paying off.

New cases have fallen to 835 from 1,103 in 2006. And the number of mothers who infected their babies shrank to zero in 2010 from nine in 2005.

“It’s a tale of two cities,” said Phill Wilson, executive director of the Black AIDS Institute. “You can see the epidemic as bad as it is anywhere around the globe, and you can see some of the best practices.” As such, he said, Washington is “the perfect city to have this conference in.”

A new political will is driving the city’s turnaround.

“D.C. used to be a bureaucratic nightmare,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, which is just three subway stops outside the city, in Bethesda, Md. When Adrian M. Fenty took office as the mayor of Washington in 2007, Dr. Fauci said, “it was a whole new morning in America.”

The change is evident on many fronts. The number of H.I.V. tests given has tripled to 122,000 a year, from 43,000 in 2007. The city gave away five million male and female condoms last year, 10 times as many as it did in 2007. More than 300,000 clean needles a year are given away, both to heroin users and to an even higher risk group: transgender prostitutes who inject hormones.

Patients are being found in earlier stages of their illness, when it is more treatable. And 89 percent of those who test positive see a doctor within three days. Under the city’s Red Carpet program, nonprofit organizations are paid to drive new patients to the doctor.

Washington has some major advantages over rival cities. Almost 94 percent of its residents have health insurance, second only to Massachusetts. And there are no waiting lists for AIDS drugs or addiction treatment.

Also, Washington has switched from anonymous to name-based testing, so it can better track infection trends. And in 2007, Congress, which oversees the city’s administration, dropped its ban on clean-needle distribution; since then, infections attributed to dirty needles have plunged by 72 percent.

Black men here are the hardest hit: 6.3 percent in Washington are infected, a rate that rises to more than 30 percent for middle-aged black gay and bisexual men. Even so, the Black AIDS Institute just named Washington one of “the three best cities to be a black gay man in,” based largely on available medical care. (The others were New York and Los Angeles.)

Still, the city has tremendous weaknesses.

Washington finances 70 nonprofit groups, and their effectiveness varies greatly. Each has its own executive salaries, ingrained habits and political patrons. Some are excellent, some have sunk in financing scandals, and some are “left over from the days when all they did was hold people’s hands and watch them die,” said Dr. Gregory Pappas, chief of AIDS for the city’s health department. “The game has changed — but some, God bless them, are the same old people doing the same old things.”

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