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HIV/AIDS in the Nation’s Capitol

On Tuesday, Whitman Walker Health Center of Washington, DC, hosted “Return to Lisner: A Forum on HIV/AIDS” to discuss the current state of the HIV/AIDS epidemic. The event marked the 29th anniversary of DC’s first HIV/AIDS forum at George Washington University’s Lisner Auditorium.

Jeanne White-Ginder, the mother of Ryan White, an Indiana teenager who died from AIDS in 1990 and for whom the Ryan White Care Act is named, delivered an impassioned keynote address. Mrs. White-Ginder reflected on the fear and uncertainty that characterized the early days of the epidemic and talked about her son’s ordeal and the stigma and discrimination he encountered.

A panel of medical, research, public policy, and education experts also discussed the state of the HIV/AIDS epidemic and expressed hope and optimism about finally reaching “the beginning of the end” of the HIV epidemic. Among the challenges the speakers highlighted were the need to increase testing, overcome barriers to engaging and maintaining individuals living with HIV in care, provide more comprehensive sex education to the American public, and train more culturally competent clinicians. Despite these challenges, panelists remained optimistic that advances such as treatment-as-prevention and pre-exposure prophylaxis have put the end of the HIV/AIDS epidemic within reach.

DC Partnership for HIV/AIDS Progress
On Wednesday, in the AIDS 2012 Global Village, the National Institutes of Health (NIH) also hosted a panel to give an update on the current state of the epidemic in Washington, DC. Specifically, speakers shared updates on the DC Partnership for HIV/AIDS Progress, a collaboration between NIH’s National Institute for Allergy and Infectious Diseases (NIAID), the NIH Clinical Center, and the DC Department of Health (DC-DOH).

Washington is one of the 12 cities in the United States with the highest HIV rates (2.7%). Before 2006, DC had very little community-based data available, which made it difficult to address the changing nature of the epidemic. NIH’s Carl Dieffenbach explained that, in 2006, DC only had eight HIV-related research grants, but now the city has 22.

The goals of the partnership include: 1) Performing research that develops effective measures to control HIV in DC; 2) Establishing a city-wide data system to measure the effectiveness of the programs; 3) Identifying at-risk populations; 4) Piloting the voluntary test-and-treat concept;  5) Augmenting HIV-related subspecialty care in DC; and 6) Providing access to promising research strategies.

The DC partnership has established a city-wide HIV database that links the electronic medical records of the 12 largest care providers, who cover 80% of the HIV-positive population. The partnership is coordinating that data system with the DC-DOH database.

Development Center for AIDS Research (D-CFAR)
The partnership also established the Developmental Center for AIDS Research (D-CFAR), which has $3.75M in funding over five years, 54 investigators, 16 awards (R-series), 16 new investigators, four scientific workgroups, five pilot research awards ($580K), and five administrative supplements ($2.5M).  The D-CFAR is a collaboration between American University, Children’s National Medical Center, Georgetown University, George Washington University, Howard University, and Veterans Affairs Medical Center.

HIV Prevention Trials Network (HPTN)
Dr. Dieffenbach talked about the various HPTN studies that helped to identify the city’s at-risk populations and pilot test-and-treat protocols. HPTN 061 was designed to assess whether community-level interventions intended to prevent HIV infection would be used by the study population (i.e., black men who have sex with men). A separate study, HPTN 064, was designed to estimate HIV incidence among African American women from areas with high rates of HIV and poverty. The preliminary results of HPTN 064 show higher HIV incidence in the study cities than among black women overall in the United States.  Included in these studies are Community Advisory Boards that work with the researchers to include the voices of the DC community and people living with HIV in the research process.

DC HIV Behavioral Surveillance
Dr. Manya Magnus presented on the National HIV Behavioral Surveillance Exit Disclaimer (NHBS). The NHBS multisite study takes cross-sectional “snap shots” in time every year. The study assesses the prevalence of, and trends in, sexual-risk behaviors and HIV-testing behaviors. It examines the impact of prevention, gaps in prevention services, and missed opportunities
for community-researcher collaboration. Dr. Magnus mentioned that, in the absence of the prevention data, they could not make interventions that are culturally relevant.

Nearly 30 years have passed between the first Lisner forum and AIDS 2012. The DC epidemic has changed and the approach to the epidemic has changed.  With continued partnerships between the Federal government, researchers, and the community, Washington, DC will continue moving forward to create an AIDS-free generation.

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