Today, Mayor Vincent C. Gray and officials from the D.C. Department of Health (DOH) released the 2011 District of Columbia HIV/AIDS, Hepatitis, STD and TB Epidemiology Annual Report. Additionally, DOH officials released a new study on heterosexuals and HIV infection rates in the District and announced new recommendations for medical providers to start treatment immediately for all persons newly diagnosed with HIV.

"Addressing the critical HIV epidemic in the District of Columbia has been a top priority for my administration," said Mayor Gray. "Through uniting government agencies with private-sector health experts and community organizations – via vehicles like the Mayor’s Commission on HIV/AIDS – we are creating solutions to curb the HIV infection rate in our city."

The DOH reports released today provide the annual update on the state of HIV, hepatitis, sexually transmitted diseases (STDs) and tuberculosis (TB) in the District through the end of 2010 and a more in-depth look at how behavioral risk factors contribute to HIV infection among heterosexuals. This latest snapshot of the epidemic shows that the District continues to make progress in reducing new cases and improving health outcomes for those infected with HIV.

"One accomplishment we can already point to is that we are getting people diagnosed with HIV infection earlier and directly into care with our treatment-on-demand policy," Mayor Gray said. "Next month, when the District will welcome thousands of HIV/AIDS advocates, leaders and researchers to the AIDS 2012 conference, we will be able to say proudly that the District of Columbia is leading the way in HIV prevention and treatment."

This year’s annual report features improvements from previous years, such as:

• An adjusted number of total HIV cases in the District, made possible by eliminating duplicate cases, cases originally diagnosed in other locations and up-to-date death statistics;
• For the first time ever, there is a report on viral-load data among newly diagnosed cases of HIV; and
• This year’s report introduces a new analysis of persons diagnosed with multiple diseases in the District.
• The report found that 14,465 residents of the District of Columbia – equal to 2.7 percent of the population – are living with HIV. The 2.7 percent exceeds the World Health Organization definition of 1 percent as a generalized epidemic.

Additionally, the report found that:

• The HIV infection rate in all racial/ethnic groups in the District exceeded 1 percent of their respective populations, with African Americans disproportionately impacted at 4.3 percent.
• The number of deaths among persons with HIV in the District decreased by almost half in four years – from 399 deaths in 2006 to 207 in 2010.
• Men having sex with men and heterosexual contact are the two leading transmission modes of new HIV cases.
• Among STDs, there were 5,592 new cases of chlamydia, 2,104 new cases of gonorrhea and 134 new cases of primary and secondary syphilis reported.
• There were 3,127 cases of hepatitis B and 13,236 cases of hepatitis C diagnosed between 2006 and 2010.
  43 new cases of TB were reported.

In line with the National HIV/AIDS Strategy, the report highlights progress the District has made to reduce the burden of the disease on District residents:

Increasing Access to Care and Improving Health Outcomes

• The number of new AIDS cases decreased by 32 percent, from 700 in 2006 to 477 in 2010.
• Between 2005 and 2009, 4,879 HIV cases were diagnosed.
• In approximately 89 percent (4,347) of cases diagnosed between 2005 and 2009, the patients were linked to HIV medical care by the end of 2010.
• Of diagnosed cases, 2,730 HIV cases (60 percent) achieved viral suppression.
• Average CD4 count at diagnosis jumped from 355 in 2009 to 391 in 2010. Overall, the average count has nearly doubled from 191 in 2006.
• The number of deaths among persons with HIV decreased by almost half, from 339 in 2006 to 207 in 2010.

Reducing New Infections

• The number of newly diagnosed HIV cases in the District decreased slightly, from 853
• There have been no children born with HIV in the District since 2009.
• There was a 72 percent decrease in the number of newly diagnosed HIV cases attributable to injection-drug use from 150 in 2007 – prior to significant investment in the District’s needle-exchange program – to 42 in 2010.
• STD rates dropped between 2009 and 2010: chlamydia cases by 15 percent (from 6,568 in 2009 to 5,592 in 2010); gonorrhea cases by 18 percent (from 2,567 in 2009 to 2,104 to 2010); and primary and secondary syphilis by 17 percent (from 162 in 2009 to 134 in 2010).

Heterosexual HIV Study

The study on heterosexual relationships surveyed two similarly situated sample groups of heterosexuals living in HIV-prevalent/low-income parts of the District. One sample group was surveyed in 2008, and the second in 2010. The study found a high rate of HIV infection among the heterosexual subjects studied. It also found that many heterosexuals thought their partners were having sex outside of their relationships and that many reported having sexual partners outside their primary relationships. The study also found that only a small percentage of the subjects were using condoms.

The study compared the 2008 and 2010 heterosexual sample groups and found that the overall rate of HIV infection climbed from 5.2 percent in 2008 to 8.0 percent in 2010. The rate among women doubled, from 6.3 percent to 12.1 percent. Though these rates are significantly higher, DOH officials attribute the increase to the District’s efforts to get more people who were previously unaware they were HIV-positive tested and diagnosed. DOH estimates that between 20 and 40 percent of people infected with HIV in the District are unaware of their status.

New Treatment Recommendation

DOH also announced that it has adopted a new HIV treatment recommendation for medical providers in the District. The recommendation calls for treatment to start immediately when a person is diagnosed with HIV. Previously, treatment began when a person’s CD4 or T-cell count was at or around 350. As the District has increased HIV testing overall, more people are being diagnosed early in their HIV infection when T-cell counts are much higher. Recent scientific studies have shown that early treatment is highly effective in suppressing HIV to very low levels, which helps prevent the spread of the virus to others. DOH will send educational information to all medical providers to bring awareness on the new treatment guideline.

Select one of the following links DC HET-2 Study Final 06-19-2012 or 2011 Annual Report Final to review the reports.