A WAMU series explores gun violence and aggressive policing in the nation's capital.
At least 3 percent of D.C. residents are living with HIV/AIDS. But a new report finds that the city is falling behind in its fight against this epidemic. We examine that “report card” and what it means for the new mayor’s public health strategy.
- Walter Smith Executive Director, D.C. Appleseed
- Gregory Pappas Director, D.C. HIV/AIDS, Hepatitis, Sexually Transmitted Disease and Tuberculosis Administration
MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. Later in the broadcast, where the Washington's expanded theater scene is living up to the expectations of the spring season.
MR. KOJO NNAMDIBut first, at least one in 20 District of Columbia residents is HIV positive. That sobering statistic means we have the highest rate of HIV of any city in the United States far beyond the CDC definition of epidemic. D.C. Appleseed, a nonprofit which works on addressing the region's civic and health problems, issued its sixth report card about the city's efforts to combat HIV/AIDS earlier this week. The results are mostly positive, but there are concerns that efforts to fight the disease are slipping. Prevention Works! and Needle-Exchange Program recently closed its doors, and there are worries that east of the river where new cases are greatest, people are not being reached.
MR. KOJO NNAMDIJoining us now to talk about the report card and about how the city is working to combat the disease is Walter Smith, executive director of D.C. Appleseed, as we mentioned, which is dedicated to solving the city's civic and health problems. Walter, good to see you again.
MR. WALTER SMITHThank you. Glad to be here.
NNAMDIAlso with us in studio is Dr. Gregory Pappas. He is the head of the D.C. Department of Health's HIV/AIDS, Hepatitis, Sexually Transmitted Disease and Tuberculosis Administration, also known as HAHSTA. Dr. Pappas, thank you so much for joining us.
DR. GREGORY PAPPASSo kind of you to invite me, Kojo.
NNAMDIWe love having you here. If you'd like to join the conversation, you too can call 800-433-8850 with your questions or comments. Walter, it's worth noting that the report card was mostly A's and B's, which is a reflection maybe of how far we've come as a city since the report card first came out in 2005. Well, in your view, what have -- has improved since then, and what are the problems? What may even be getting worse?
SMITHWell, the good news is that nearly everything has improved. I think that the city has made tremendous progress since we first got involved in this in 2005. And if you look at the arc of the grades we've given through the report cards, the general trend is up. And most people would say if you're getting all A's and B's on the report card, what's not to like about that?
NNAMDIOh, there's one C on this one.
SMITHWell, there is. There is a C, but our answer to that is the one that Adrian Fenty, who's responsible for a lot of the progress, used to give, and that is it's important that we make all A's on this issue and make all A's for a very sustained period of time, given the crisis that we're facing. It's the one you mentioned a minute ago. Our statistics are some of the worst in the country.
NNAMDIMayor Gray has called HIV/AIDS his number one health priority, recently creating a new commission on the disease, which met for the first time on Tuesday. Dr. Pappas, what will the role of that commission be?
PAPPASOh, I think the role is going to take the response to the disease to fighting the virus really up several notches. First of all, we're working together as a whole city. Early success of the commission, something already that's happening is that the head of our parole, former Police Chief Fulwood, announced at the first commission meeting that he's gonna work to make controlling your disease, staying on your medication for HIV, a condition for lenience in parole. This is a very progressive step and really shows that we're -- that the city is willing to work across administrative boundaries and think creatively about how to control the epidemic.
NNAMDI800-433-8850 is the number to call. Are you living with HIV? How have city services helped you, and what do you think needs fixing? 800-433-8850 is the number to call, or you can go to our website, kojoshow.org. Join the conversation there. Send us a tweet @kojoshow, or e-mail to firstname.lastname@example.org. The role of new infections is highest in the eastern half of the city, and the director of Metro TeenAIDS has said he would like to see more youth and east of the river representation on the commission. Dr. Pappas, who is likely to fill these seven vacant commission spots on this 27-member commission?
PAPPASActually, Kojo, there aren't seven vacancies. The mayor wants to move very quickly on this. And it was because of the short notice for meetings that some of the commissioners weren't able to attend. So, actually, we had a very good response from a very impressive group of community members, scientists, physicians, leaders of our -- some of our institutions in town. So, again, the mayor is giving high priority to this, and we're moving forward as best we can now.
NNAMDIWalter Smith, what is your view about what's going on east of the river and among young people?
SMITHWell, one of our concerns -- and you mentioned the C grade a minute ago, one of our concerns...
SMITHYes. Is the educational component in our opinion is not yet what it should be. In fact, over the course of the six report cards that we have issued that's where the grades have been the worst. There's even been D's given with regard to what the public schools are doing. And, again, although there's been improvement, DCPS got the highest grade we've ever given this time. It's a B-plus.
NNAMDIThey got a B-plus.
SMITHThey have still not put in place measurement devices from our viewpoint to determine how efficient and effective the education has been in DCPS, which we think is a key component of any curriculum. But our main...
NNAMDIIf, indeed, we say our youth are the future, Dr. Pappas, is there anything you can do about that in terms of trying to push DCPS to do more about educating young people in terms of your administration being able to try to, as Walter Smith was saying, public education involves beyond the public school system itself?
PAPPASExactly right. And people from the education sector are going to be on this commission. But I want to say something about the report. We welcome the report and welcome Appleseed, but even if the District got all A-pluses, we still wouldn't be doing enough to address this epidemic. And we need to measure -- I'm working with Walter, and I'd love to see Appleseed take on some of the harder things to look at measuring issues or treatment. There's no measure of treatment. And most of what I do every day is think about how to get people into treatment, how to keep people on their medications.
PAPPASThe new thing that we -- I want you and your listeners to understand is that treatment is now prevention. We've got to get people on medication as soon as possible because when they're taking their pills on a regular basis, not only are they staying alive and healthy, which is a humanitarian goal. And I'm a physician sworn an oath to try to improve people's health. But by staying on your medication, you drive down the viral load, that is there is no virus in your bodily fluids to pass on. So it makes you less infectious. It makes the disease more difficult to...
NNAMDIWalter Smith, ironically enough, the success, if you will, of the medication is, in fact, what drives the need for greater public education...
NNAMDI...because people are living longer now.
NNAMDIIt is no longer a death sentence. There are, it would appear, an increasing number of young people who feel there's really nothing...
NNAMDI...to fear at all.
SMITHRight. Which makes the educational component that much more important. We have to drive this message home over and over again, and we've said that in a lot of our report cards. And can I just say we agree with Dr. Pappas completely that looking at the treatment side is critical, not only because we want an effective treatment program but also because testing and treating is itself an effective prevention tool.
NNAMDIWe talked about D.C. public schools getting a B-plus. Charter schools got an incomplete...
NNAMDI...grade. Why is that?
SMITHWell, the charter schools, at least based on our information and investigation, have been very slow off the mark to put in place comparable sorts of effective systematic programs in their schools to educate young people on this issue. It's now the law. It's in the Healthy Schools Act. And the Office of the State Superintendent for Education has an oversight role to make sure that it's done effectively. Based on what we know so far, the charter schools haven't begun to put in place comparable programs to those in DCPS, but I assume and think they will be moving along in that regard. And that OSSE will be playing a role to make sure that happens.
NNAMDIHere is on the phone Art in Washington D.C. Dr. Pappas, you have to put on your headphones so that you can hear Art. We don't have headphones for Dr. Pappas, so I'm gonna put you on hold, Art. Until we do that, in the meantime, after 12 years, Prevention Works!, a program which provided needle exchanges for drug users as well as other health services, closed its doors. This is probably one reason for the report card giving the city a B on syringe exchange. Walter Smith, what -- who will fill the void left by Prevention Works! closing?
SMITHWell, the current hope and plan is that the other three providers who were active in this space will take up the slack. I mean, that's certainly what is hoped for now. Of course, as you know...
NNAMDIThe other three providers being Bread for the City, Helping Individual Prostitutes Survive or HIPS, and Family and Medical Counseling Services.
SMITHThat's correct. That's correct. And all of them knew that Prevention Works! was closing its door and, I think, are ready to step up to the plate and working with the District government to try to reprogram the dollars that had gone to Prevention Works! to go to those other three entities. But I have to say...
PAPPASThat's exactly right. I mean, the dollars actually have already been reprogrammed. We're sad to see Prevention Works! go, but we're working very hard to maintain services to those vulnerable populations in the District. And I think it -- but it also raises one of the other five priorities that Appleseed mentions that -- advocating for maintaining funding for syringe exchange in the District. Mayor Gray has already gone on record very strongly supporting needle exchange.
PAPPASBut, as you know, there are forces beyond our control in the District that may make it impossible for us to do any needle exchange in the future that it would be federally funded. And I think that's an extreme concern because this is a program that's long been demonstrated as scientific -- science based, a very effective way to control the spread of the epidemic.
NNAMDIWhen he says beyond D.C.'s control, for those of you without the institutional memory, in the past, when the House of Representatives was led by Republicans who opposed needle exchanges in the District was prevented from doing that, and Dr. Pappas is talking about the possibility of that happening in the future. Dr. Pappas, what role do you think needle exchanges play beyond just giving clean syringes to drug users, which is what its opponents argue that it just encourages intravenous drug use and that -- therefore it should be stopped? What other role does it play that people need to understand?
PAPPASWell, first of all, the science is very strong that it does not encourage needle exchange -- needle use to drug addiction. That myth needs to be put to rest. The issue is that people who share needles have a high risk of spreading the disease. It's the most effective way to get the disease really, other than a transfusion with somebody who's got HIV. It's a very effective way and...
NNAMDIAlmost 20 percent of cases in the District contracted in that way, as I understand.
PAPPASYeah. It's always been a major -- and all around the world, rates of new infections have tumbled, and one of the reasons is because it's been very aggressive use of a clean needle program. There are some countries, like Australia and like New Zealand, who are really having dramatic improvements in decline of new infections. It's because they're having really effective prevention programs, which we are not -- we're still somewhat inhibited by. We need more money, not less money, in a needle exchange program in the District of Columbia.
SMITHKojo, can I just add one point to what Dr. Pappas just said? The science not only shows what he just said, that it doesn't increase the use of the drugs, but well-run needle exchange programs have complementary services that actually decrease drug use and have effective drug rehab programs associated with them.
PAPPASIt becomes a bridge to a person who has serious problems and draws them into a treatment environment.
NNAMDIThe U.S. Conference of Mayors says that it costs an average city about $160,000 to run a needle exchange program, about $20 per user or per year, whereas one syringe infected AIDS patient will require upwards of $120,000 per year in public health expenditures. Here is Art in Washington, D.C. Art, you're on the air. Go ahead, please.
ARTGood afternoon, gentlemen. My name is Art Jones. And, Kojo, this is my very first time ever calling in on this -- on your show. I listen to you all the time, and I wanted to say that it's an honor to actually be able to speak on your show.
NNAMDIThe honor is mine, Art. Go ahead, please.
ARTOkay. I work with a media production company who just came back, not too long ago, from creating a Web broadcast of a freshman orientation for a university in Bahrain. And in the course of the first 10 days of that broadcast, we had over 13,000 hits from over 20 different countries across the globe. When I came back to the United States and I learned about the HIV epidemic that was happening, in the African-American community specifically, I became alarmed, to the point where I started asking people, especially those in the faith-based community and those who were nonprofit leaders about what -- to what degree they will utilize the media to raise awareness.
ARTAnd almost of all them said that we were thinking about it, we're planning to do it, but nothing actually have been executed at this point. Therefore, I recreated a -- essentially, a virtual resource center that's in embryonic stages. But I spoke with Mayor Gray, I mean, just last week with regard to this…
NNAMDIWhat did he say? We're running out of time.
ARTOkay. And I'm just saying -- simply saying that the proposal for doing this was actually presented to Dr. Pappas, I think, by Mr. Gray. And what I wanted to ask Dr. Pappas is, to what degree, if any, are you considering embracing media, social networking, the Internet to help raise awareness among those that really need to know?
NNAMDIHere's Dr. Gregory Pappas.
PAPPASI'm on the radio today talking to Kojo, and I'm thrilled to be here. I've -- in previous positions, I've worked very hard to use media, and I'm looking for Dr. Akhter, the -- who's the D.C. director of health -- director of Department of Health, also, is very conscious of the role of the media in this fight against the virus. So I think you'll be hearing a lot from us.
NNAMDIThank you very much for your call, Art. Walter Smith, your report card also grades the city's HIV/AIDS fighting efforts on leadership, a grade which has slipped this time around. What exactly do you mean by leadership? How is it important? Who are you looking for -- who are you looking to for leadership?
SMITHWell, the primary person we look to for leadership is the mayor him or herself and the people in the position as Dr. Pappas has and Dr. Akhter has. And although, as I've said before, we think great progress was made by the Fenty administration, that in the waning year or so of the administration, we didn't see the kind of exposure, given to the issue that we had seen earlier. The mayor of this city has a bully pulpit through which he can reach other segments of the community, reach individuals in the community, can bring key players to the table, can keep the issue out there.
SMITHIt's partly the visibility of this issue, as your last caller suggested, that helps make prevention efforts effective. And I hope and think Mayor Gray understands all of that, and we're going to see and hear from him a lot on this issue.
PAPPASI have to say, you know, since I've been on the job, which is only three weeks now, he's had three press conferences on HIV/AIDS, which I'm -- as someone who's -- that's my full-time concern, I'm thrilled about. He is personally chairing this mayor's commission on HIV/AIDS and is taking great personal interest on it. So I think we're very fortunate to have a continuation of high-level concern.
NNAMDIAs I said earlier, we're running out of time. But I'd like you to address this e-mail we got from Maggie in Fairfax, Walter Smith. "Is it possible that D.C. appears to have the highest AIDS rate because it tracks AIDS cases better than other cities in the U.S.? Also, it was recently revealed that Alexandria, Va. has the highest AIDS rate in Northern Virginia. Can you throw some light on that issue?
SMITHWell, there are different ways to look at what our rate is, but the numbers that we have so far show that the percentages of the population here in the District with HIV or AIDS are very, very high by almost any measure.
PAPPASKojo, may I say...
PAPPAS...something about -- I had worked as a statistical analyst for many, many years, and numbers are important to me. Two things. Your caller -- your e-mail says -- asked about whether it's because we're looking at it better. We've been looking at it well for some time, so I don't think that's the reason for the increase. One of the important reasons we have more people in the District living with HIV is because more people are living. We have medication, and so people who would be dead by now are still living.
PAPPASSo the absolute numbers of people, who are in our communities living with the disease is gonna continue to go up as we become more successful getting people on medication. We still have people dying of AIDS that shouldn't be dying of AIDS. I'm gonna make one more subtle point and, again, not, in any way, to undercut the severity and importance of the statistic. Seven percent of African-American men in the District of Columbia are HIV positive. That's a horrendous figure.
PAPPASBut think about this. D.C. is a cutout of a metropolitan area, so we're not comparing apples and oranges here. If we compared inner city Baltimore to inner city New York to inner city Philadelphia, inner city D.C., we'd see very similar sorts of patterns. So we've got a microscope. The microscope is on the District, and I'm glad about it because we need to improve here.
NNAMDIDr. Gregory Pappas is head of the D.C. Department of Health's HIV/AIDS, Hepatitis, Sexually Transmitted Disease and Tuberculosis Administration, also known as HAHSTA. Dr. Pappas, thank you for joining us. Good luck to you.
NNAMDIWalter Smith is the executive director of D.C. Appleseed, which is a nonprofit, dedicated to solving civic and health problems in the city. Walter, thank you so much for joining us.
NNAMDIWe're gonna take a short break. When we come back, we'll look at the spring theater season. See whether it's living up to the expectations of our expanded theater scene. I'm Kojo Nnamdi.
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