DC HIV Efforts: Challenge to what we learned in class, or support for it?

DC HIV Efforts: Challenge to what we learned in class, or support for it?

My hometown, Washington DC, has an HIV infection rate of over 3%, exceeding the 1% required to define it as a generalized and severe epidemic (Vargas). It has one of the highest rates of any US city, and this has come as a shock to many who consider such high rates to be the worries of “developing” countries only. The District is no better than an average African country, and if it were somehow the 54^th African nation, it would have the 24^th highest rate (Schatz). So the current situation in DC with HIV and AIDS looks pretty bleak.. This is higher than West Africa and about the same as Uganda and Kenya (Vargas). This epidemic is not spread out evenly over the population either. In 2008, Black men bore the weight of the population with 7% infected (Vargas). In 2012, Black women had an alarming rate of 12.3% infected, a number that has doubled since a 2007 survey (Sun). With the infected population increasing, and with the widening difference between black and white, rich and poor, homosexual and heterosexual rates, DC is truly a mess. 

This graphic, though a little old (infected rate of black women is now 12.3%, for example) shows some facts that helped scare DC into making changes to their HIV policies.  http://www.globalpost.com/sites/default/files/imagecache/use-with-caution_original/rsz_africa-final.jpg

Many DC policy makers deny the epidemic because they continue to cling to the idea that the US is developed, or first world, and could therefore never have the same problems as a developing or third world country. This has been a policy burden over the past few years, especially because public health officials who left to work on HIV for developing countries in the early nineties on US government grants are coming back home. These returning veterans of the fight against HIV in Africa and all over the world have learned from their experiences some of the best ways to spread awareness and aid, but find many obstacles when they try to work here. Politicians and local leaders have resisted the use of this knowledge and experience because they are wary of “any comparison involving AIDS between Washington and an African country because it implies that largely African-American communities here are on par with the developing world” (Schatz). Oddly enough, much of the new knowledge proposed was gained from PEPFAR (President’s Emergency Plan for AIDS Relief) projects. PEPFAR provides relief for the foreign countries with the worst infection rates, but DC actually has a higher rate than five of them (Schatz). 

            Since the initial friction that came with proposals for African-inspired aid efforts subsided, many great and effective programs have emerged in DC based on programs that worked in Africa and other countries. Veterans reworked the way DC thought about the epidemic: “for years, the District had failed to do in-depth surveillance of the AIDS epidemic and had perceived it to a problem largely limited to the gay community and injectable drug users. But new data uncovered a new reality: AIDS was centered in the African-American community, infiltrating the general population of heterosexual couples” (Schatz). This has created programs that distribute condoms on the metro by areas with large black populations and also offer free testing on the streets. These new programs have been very effective so far and are starting to chip away at the high rate in these wards.            

In this case, policies used in foreign countries and supplied by NGOs helped revive the efforts against HIV in my city. In some ways, this contradicts many of our readings and class discussions that have addressed the pitfalls of a privatized global health paradigm. This is a sentiment summarized well by Pfeiffer and Nichter: “All too often, national health systems have been overcome by new NGO and donor pet projects, growing donor demands, and heightened expectations. As private health services and NGOs have multiplied, they have often contributed to the “brain drain” of health workers from public systems. Beyond the health sector, the push for privatization and free market reforms has in some cases stimulated economic growth but has also deepened social inequality and insecurity.” In addition, we have also learned that external aid is often detrimental in that it undermines community and local health systems and creates a system of dependence.

            I think that, while it seems that taking experience from African AIDS efforts into DC through NGOs is very privatized and external, this might not be true here. First of all, the aid is not very external considering that, while it does come from some African programs, these programs were headed by DC officials. They just returned to apply their experience to their own homeland. It seems likely, given the unconsidered consequences of foreign aid, the ideas of these DC officials will work better in DC anyway. As for the private nature of the help, only some of it was actually from NGOs. The DC Department of Health and Safety funded much of the research that lead to restructuring the overall HIV strategy, and NGOs just implemented the new projects. The NGOs involved were also mostly local, like CHAMPS and the Community Education Group. When I was reading about this hopeful new future for the dire HIV situation in DC based on programs developed for other countries and dependent on NGOs, I thought this went against what we have been learning in class. However, it seems that these new efforts are successful because they are designed by local people and mostly run through the DC government, which is in complete agreement with our lessons.

HIV and AIDS are a huge concern worldwide and control efforts are clearly unable to keep up with the transmission and mutation rates. I picked this issue because I’ve learned so far in class how local community based efforts are the most comprehensive and effective, and I want to look at an issue that plagues my country, and in particular, my city. As we learned in class, and as we can see in DC, public health organizations should be the driving force behind health change, and the change must come from within the community. 

By Molly Reid

 

Sources:

Vargas, Jose Antonio. "At Least 3 Percent of D.C. Residents Have HIV or AIDS, City Study Finds; Rate 

     Up 22% From 2006." Washington Post [Washington DC] 15 Mar. 2009: n. pag. Print. 

Sun, Lena H. "HIV infection rate skyrockets among some D.C. women." Washingtonpost.com. Washington

 Post, 20 June 2012. Web. 24 Oct. 2012. <http://www.washingtonpost.com/national/ 

health-science/in-dc-hiv-infection-rate-nearly-doubles-for-some-poor-black-women/2012/06/20/ 

 gJQAXIqKrV_story.html#>. 

Schatz, Juliana. "Groups fighting HIV/AIDS in DC find lessons in Africa." Global Post. Global Post, 

     11 June 2012. Web. 24 Oct. 2012. <http://www.globalpost.com/dispatch/news/health/120530/ 

     dc-aids-organizations-learn-africa>. 

 Pfeiffer, J, and M Nichter. "What Can Critical Medical Anthropology 
Contribute to Global Health?: a Health Systems Perspective." Medical Anthropology Quarterly. 22.4 

(2008): 410-415. Print.