Posted by: davidjolson | 10/29/2010

Two continents, one AIDS epidemic

The speakers talked about a society with an AIDS epidemic driven by a devaluation of girls and women, young people denied evidence-based sex education, parents in denial about their children’s behavior and religious leaders who sometimes do more harm than good.

They were talking about sub-Saharan Africa.

And they were also talking about the District of Columbia.

The most striking fact to emerge from a panel discussion at Howard University this week on “UN Millennium Development Goal #6: Combating HIV/AIDS” was how similar some of the drivers of HIV/AIDS are in Africa and in Washington, D.C. Indeed, it was said several times that D.C. has the HIV prevalence of a developing country. The event was organized by the D.C. League of Women Voters, Howard University Hospital and the United Nations Association in observance of United Nations Day.

Pauline Muchina, the senior partnership advisor at UNAIDS, gave a sweeping panorama of the African AIDS epidemic. Muchina, from the Rift Valley of Kenya, has lost a cousin, an uncle and nine good friends to AIDS. She attributed much of the cause for the high rate of HIV and AIDS among women and girls in Sub-Saharan Africa to cultural and social norms, the failure to address major drivers of the AIDS epidemic such as discrimination and violence against women and girls and taboos about openly discussing and educating youth about human sexuality. She said religious leaders have done a lot in the AIDS epidemic, but some have undermined the global AIDS response by perpetuating stigma and discrimination and rejecting appropriate sex education in their religious institutions, schools and communities around the world.

Marilyn Johnson, who trains health providers in the District on HIV/AIDS, finds it frustrating that high school nurses cannot initiate discussions of on sex with students, but only in response to questions. She is the director of provider outreach for Howard University Local Performance Site of the Pennsylvania/Mid Atlantic AIDS Education and Training Center.

Johnson said that Washington, despite having the highest adult HIV prevalence rate of any city in the nation, has no requirement that doctors receive HIV/AIDS training in order to be licensed. Florida requires it, and she is working to ensure that D.C. does too. She sees doctors as part of the problem (recounting the story of a doctor who wanted nothing to do with HIV/AIDS) and also the solution (“Doctors have more credibility than anyone else in the African-American community”).

Walter Smith is the executive director of DC Appleseed Center which, since 2005, has been issuing report cards that evaluates the District’s progress in implementing the recommendations  in DC Appleseed’s report. Report Card No. 5, issued last year, shows important progress has been made in a number of areas:

  • The city’s HIV/AIDS strategy is now driven by data. “Those data show the city’s HIV/AIDS cases are staggeringly high, but at least we now know what we face and where our efforts need to be focused,” said Smith.
  • The District has dramatically improved its testing for HIV/AIDS. In fact, the number of tests conducted in the District is exceeded only by New York City and Florida.
  • The needs of some of the most at-risk populations are being better addressed. The D.C. Jail is cited as a national leader in HIV testing and support for those who test positive. And the overturning of the needle exchange ban by the federal government has allowed the city to significantly increase its efforts at reducing HIV/AIDS among drug users.
  • The D.C. public schools have instituted a health curriculum that includes age-appropriate lessons on HIV/AIDS.
  • Condom distribution in the district has dramatically expanded, from a little over 100,000 in 2006 to nearly 3 million in 2009.

The District got four As in Report Card No. 5: An A in HIV Surveillance, HIV testing and HIV/AIDS Among the Incarcerated, and an A- for Interagency Coordination. All the rest of the grades were Bs, except for a C+ in Public Education in the District.

Smith said the result of all this good activity has been a “dip” in the absolute number of new AIDS cases. But, with a prevalence of 3.2%, the district is still “at epidemic levels.”

He praised the progress that has been made under Mayor Adrian M. Fenty and seemed equally optimistic about the incoming administration of Vincent Gray and a majority of the City Council.

The audience of about 25 was not what I would have expected at a Howard University event. About two-thirds were white-haired older white women (members of the DC League of Women Voters or the UN Association) and the other third were female Howard students who are also peer educators working in District high schools to educate adolescents on HIV/AIDS.

One of them spoke passionately about another contributor to Washington’s AIDS problems — parents. She said parents were in denial about their children’s behavior , resulting in parents’ preventing their children from getting the HIV/AIDS education they needed to make informed decisions.

Except for a reporter from The Hilltop, the Howard University student newspaper, there was a total absence of male students, and that itself drew the attention of several speakers at the event, who said that to address seriously the AIDS epidemic — in Africa and the District — boys and young men would need to be engaged much more than is the case now. The event at Howard was a good proxy for that lack of male engagement.

Dr. Sohail Rana, a native Pakistani who has taught pediatrics and hematology at Howard University for 30 years, spoke movingly about his experience dealing with HIV/AIDS at Howard and the oppressive stigma that still impedes an effective response to people with HIV or at risk of HIV infection. Such is his concern about stigma, that he is helping organize a one-day “International Conference on HIV-Related Stigma: The Attitude that Spreads HIV” on World AIDS Day on Dec. 1. The conference will feature top HIV/AIDS experts and activists.

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