Viewpoint: Progress towards ending HIV/AIDS in the District

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Achieving the 90/90/90/50 Plan's goal is in the interest of every District resident. (photo courtesy of clinicalcorrelations.org)

By Channing Wickham and Walter Smith

As 2018 begins, it is a good time to reflect on the progress toward making the District a safe, inclusive place for people to live and work, and look ahead to our next steps. For DC Appleseed and the Washington AIDS Partnership, that reflection includes assessing our efforts to work with the District to end the HIV epidemic in Washington, D.C. once and for all.

Generally, D.C. has seen a reduction in new HIV infections of about 75 percent since 2011. Now is the time to capitalize on our momentum and take things to the next level. To this end, our two organizations partnered with Mayor Muriel Bowser and the DC Department of Health in December 2016 to release a new strategic plan for fighting the HIV epidemic in D.C.

The plan is called the “90/90/90/50 Plan” and is named for its four goals: (1) 90 percent of District residents will know their HIV status; (2) 90 percent of those who test positive will be in sustained medical treatment; (3) 90 percent of those in treatment will have “suppressed” the virus to such an extent that not only will their own health improve, but they will not transmit the virus to others; and (4) the result will be that by 2020 the number of new HIV infections will be reduced by 50 percent. The ultimate result of meeting and sustaining these goals will be, as Dr. Anthony Fauci of the National Institutes for Health has said, HIV “burning itself out.”

Now, one year after the release of the plan, we are checking in to see how the District performed on the four goals, and the 42 tasks outlined in the plan to reach those goals. Our first progress report on the 90/90/90/50 Plan showed some good news. On Goal 1, the District is at 86 percent of people knowing their HIV status; on Goal 2, 78 percent of people who know they are positive are in treatment; on Goal 3, 82 percent of people in treatment have successfully “suppressed” the virus; and on Goal 4, the District has so far seen a 33 percent reduction in new HIV cases.

While these statistics are encouraging, our progress report also highlighted how the work ahead may be even more challenging than the work to date. Data from the department of health show that 347 District residents were newly diagnosed in D.C. in 2016. The disparities revealed in the data tell an important story. While less than half of District residents are black, 75 percent of all HIV cases are among the city’s black residents. D.C.’s trans residents are also disproportionately burdened by the virus (as many as one-in-five of D.C.’s trans residents are HIV-positive); as are young residents, who account for nearly one-third of all new infections. In other words, those who remain most affected by HIV are those who have historically been underserved by medical providers, government and other key supports.

As the District begins the new year, efforts to eradicate HIV will have to focus on reaching and serving these populations. This will involve addressing the social determinants of health – the socioeconomic and living conditions that shape a person’s health. In D.C., that includes ensuring residents with HIV have access to safe, stable and affordable housing, which improves a person’s ability to adhere to treatment. Sexual health education in our schools will also be key, given that HIV infections are trending younger. And taking meaningful steps to reduce stigma and discrimination – in the doctor’s office and beyond – will be critical to improving take-up and maintenance of treatment.

Achieving the goals of the 90/90/90/50 Plan is in the interest of every District resident as it will lead to a healthier city. We celebrate the breakthroughs the District is making and we urge it creatively and comprehensively to address the tough social issues and resulting disparities we see in the local HIV epidemic.

Channing Wickham is the executive director of the Washington AIDS Partnership. Walter Smith is the executive director of DC Appleseed.