New D.C. HIV data shows uptick in diagnoses due to pandemic

The report found that 11,904 D.C. residents, about 1.8 percent of the population, are living with HIV. The disease disproportionately affects Black residents, who make up about 44 percent of the District population but nearly three-quarters of HIV cases. Nationally, Black and Latino people account for a disproportionate share of new HIV diagnoses, as has been the case since the early days of the epidemic.

“We do expect for those numbers to continue to increase because of the changes in health-care-seeking behavior from covid,” said Clover Barnes, senior deputy director for D.C. Health’s HIV/AIDS, Hepatitis, STD and TB Administration. “A lot of preventative appointments or wellness visits haven’t been done because of all the capacity changes and closing that happened during the pandemic.”

Barnes joined District and federal public health and housing officials on Tuesday — National Black HIV/AIDS Awareness Day — at the Town Hall Education Arts Recreation Campus in Southeast to discuss work to reduce the stigma associated with HIV testing, treatment and prevention.

The District’s plan to end the HIV epidemic prioritizes boosting health equity and eliminating structural barriers to care. Officials aim to have fewer than 130 new HIV diagnoses per year by 2030 under a plan that sets aggressive goals for diagnosis and treatment: 95 percent of people should know their HIV status, 95 percent of people diagnosed should be on treatment, and 95 percent people on treatment should reach viral suppression.

The District last year launched a federally funded pilot program for up to eight residents, ages 24 to 35, that pays for their housing for one year while they go through intensive case management and employment training. The clients set aside 30 percent of their income and agree to take PrEP, or pre-exposure prophylaxis, the once-a-day pill that protects users against HIV infection, with a goal of living on their own.

“All the people who moved in stayed in, and they’re all still on PrEP,” Barnes said of the seven clients living in an apartment building through the program, managed by Supporting and Mentoring Youth Advocates and Leaders, a nonprofit serving LGBTQ young people.

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Local public health officials recently started a podcast, “Positive Voices,” in hopes of reducing the stigma of living with HIV; it features residents in D.C. and Maryland’s Prince George’s and Montgomery counties. Topics have included dating, aging, mental health, Black women and self-care.

“A lot of people won’t even come out and try [to get tested], they’d rather not know,” Barnes said. “If we can show you people who are living and thriving with HIV, who are happy and healthy and not afraid to talk about it on a podcast that’s broadcast around the world, then maybe we can reduce some of the stigma.”

Among people living with HIV in the District who died in 2020, about a third of the deaths were attributed to HIV-related causes, an increase from 2019, when about a quarter died of such causes. The overall number of deaths in 2020 also increased, to 399, nearly double the 2019 total and the highest number since before 2016, a jump that public health officials say is probably due to the pandemic.

In June 2020, the District launched a free at-home HIV and STI testing program in response to the dwindling opportunities for in-person screening in the early days of the pandemic. Test takers scan a QR code to see their HIV results. If they test negative they will see methods for maintaining their status, such as PrEP; a positive test will display resources for help and treatment. Uptake was slow at first but has picked up in the last six months, Barnes said.

HIV testing decreased from 2019 to 2021 by 32 percent, leaving infected people who are asymptomatic the most vulnerable to under-diagnosis and underreporting, the report says.

Lindsey Dawson, associate director of HIV policy and director of LGBTQ health policy at the Kaiser Family Foundation, said although home testing could skew surveillance data, it is a key tool for people to get care or reduce behavior that could spread the virus.

Compared with U.S. states, D.C. has the most HIV cases per capita and nearly three times the national rate, according to a Kaiser Family Foundation analysis of Centers for Disease Control and Prevention data. Among EHE jurisdictions — the areas in the United States with the highest number of HIV diagnoses — D.C.’s per capita rate ranks seventh, just below those of Baltimore and Prince George’s County, another Kaiser analysis of CDC data shows.

Demetre C. Daskalakis, director of HIV/AIDS prevention at the CDC, said public health officials can’t prevent HIV without considering that at-risk residents also contend with racism, homophobia and transphobia, which complicates their ability to access care. That’s on top of challenges such as finding housing and getting enough to eat.

“Housing is health care,” he said. “It prevents HIV and prevents worse outcomes of HIV in those living with the virus. Housing people on PrEP provides us the opportunity to address a key social factor that we know drives HIV infection, especially among young LGBTQIA+ and two-spirited people of color.”

Daskalakis said that Black people — and Black women in particular — are underrepresented among PrEP users and that HIV risk and outcomes are made worse by unstable housing or homelessness.

“Being housed means you have the oxygen you need to care more about your health, to care about HIV and to connect with interventions such as PrEP that we know work. Not having to couch-search or exchange yourself for a safe place to sleep means you can go on PrEP and stay on PrEP,” he said.