HIV/AIDS

HIV/AIDS is a Regional Issue

New data on the numbers of people living with HIV/AIDS (PLWHA) in the Washington, DC area clearly demonstrate that HIV/AIDS is an important regional health issue.  While the District of Columbia remains the epicenter of the regional epidemic with over half of the cases and highest prevalence, 47% of all people living with HIV and AIDS are residents of the “inner suburbs” – two Counties in Suburban Maryland (Montgomery and Prince George's) and five health districts in Northern Virginia (Alexandria, Arlington, Fairfax, Loudoun, and Prince William).

Addressing HIV/AIDS effectively means working together, across the region, to make sure education, prevention, testing and care are readily available to people regardless of where they live.  The information and resources on this page are designed to:

  • Provide information the nature and changing face of the epidemic and implications of health reform on the system of community-based HIV/AIDS services;
  • Help identify ways that the region as a whole, as well as the individual jurisdictions, can better coordinate their efforts, and make their services more effective and more readily available; and
  • Highlight some of the innovative work already underway in the region and elsewhere.

                                            

Current Data on HIV/AIDS in the Region

As of December 31, 2009, 31,436 people in the District of Columbia and its inner suburbs were living with HIV/AIDS.  While the District of Columbia remains the epicenter of the regional epidemic with over 50% of the cases, 47% people living with HIV and AIDS are residents of suburban communities (27% in Northern Virginia and 20% in Suburban Maryland).  And, these numbers do not include projections of undiagnosed cases, which CDC estimates to be 21% nationally.  If this estimate holds true here, the total number of people in the metro area with HIV/AIDS is probably close to 40,000. In the metro area the proportion of new cases that are 50 and older is growing, partly because people diagnosed in their 20s and 30s are living longer and partly because there are reported increases in new diagnoses among older people.

The prevalence, or number of living cases of HIV/AIDS per 100,000 population, as of 2008 varies across the region; it is highest in DC (3,234), followed by the City of Alexandria (894), Prince George’s County (675), and Arlington County (621). 

This update was prepared for the Regional Primary Care Coalition by Emily Gantz McKay, Mosaica, using 2009 Data from health departments presented to the Metropolitan Washington Health Services Planning Council for the Ryan White “Part A” Program.

How the Region is Responding to HIV/AIDS: Snapshots in Time

 

dc: dc appleseed monitors progress in the district

In 2005, DC Appleseed issued a report that called for major reforms in the way that the DC Government was responding to the city’s HIV/AIDS epidemic.  The report, which contained specific recommendations, has become a “blueprint for change, embraced by the DC government and a broad group of stakeholders.  DC Appleseed reports that “… several key recommendations have been implemented, including: an overhaul of the District's system for collecting and analyzing HIV and AIDS epidemiologic data; a citywide HIV testing campaign designed to make HIV testing a routine part of all medical care; and a citywide condom distribution program”.  It continues to play an on-going monitoring role and issues annual report cards that look at progress in several areas including leadership, interagency coordination, HIV surveillance, grants management, monitoring and evaluation, HIV testing, condom distribution, public education, youth initiatives, syringe exchange and complementary services, substance abuse treatment, and HIV/AIDS among the incarcerated.  Learn more about DC Appleseed’s on-going work and view the 2011 report card at: DC Appleseed: HIV/AIDS.

dc suburbs: the profiles project

Lacking detailed information on how the DC Suburbs were responding to HIV/AIDS, the Washington AIDS Partnership commissioned The Profiles Project: How Washington DC Suburbs Respond to HIV/AIDS which provides a comprehensive look at how seven inner suburbs (Montgomery and Prince George’s Counties in Maryland and Northern Virginia’s 5 health districts – Alexandria, Arlington, Fairfax, Loudoun and Prince William) are approaching HIV education, prevention, testing, and care and provides action steps for enhanced collaboration and public policy work to improve the regional response to HIV/AIDS. Funded by the Partnership and Kaiser Permanente, Mosaica, the Center for Nonprofit Development and Pluralism, undertook this community research project in collaboration with the Regional Primary Care Coalition. The Project products include a full report, summary reports for Northern Virginia and Suburban Maryland, and more detailed reports on each jurisdiction. It provides an information base for action by local jurisdictions, community-based organizations, and other stakeholders to enhance collaboration, strengthen systems and services, and improve links between HIV/AIDS providers and safety net clinics.  In undertaking the project, Mosaica spent most of 2009 collecting data from over 120 individuals and organizations, consulted with regional advisory bodies and examined HIV/AIDS statistics and funding information. RPCC and its participants will be using the information learned through the Profiles Project to inform its work.

View the full Profiles Report at: Mosaica: Profiles Project. 

Regional Work and Innovations

 

There are several efforts to improve HIV/AIDS care throughout the region. Here are a few examples:

  • Metropolitan Washington Cross-Part Collaborative: The HIV/AIDS Bureau and the National Quality Center (NQC) are leading an initiative to improve HIV/AIDS care across the region through a partnership to improve quality improvement throughout the metro area and across Ryan White Parts and grantees. It will also strengthen consumer involvement in quality activities. Health departments, AIDS service providers, and people living with HIV/AIDS in DC, Virginia, Maryland, and West Virginia are participating in training, planning sessions, and collaborative work. The initiative began in January 2011. For more information on NQC and links to QI resources, Click HERE. A brief description of the collaborative may be found HERE.
  • Washington AIDS Partnership: The Washington AIDS Partnership is a collaboration of local grantmaking organizations and individuals dedicated to fighting HIV/AIDS in the region for over 20 years.  It is the region’s largest private funder of HIV prevention, education and advocacy.  For information on its initiatives and funding, Click HERE.
  • The Metropolitan Washington Health Services Planning Council for the Ryan White  “Part A” Program:  Each year, as part of the planning and decision making about HIV/AIDS treatment, this Planning Council works with the grantee (the DC Department of Health) and suburban administrative agents for Northern Virginia and Suburban Maryland to review data on HIV/AIDS cases, service needs and gaps. It identifies service priorities and allocates funds to specific service categories. This helps to determine how about $30 million in federal Ryan White “Part A” funds are used. (Part A provides funding to the metropolitan areas with the largest number of AIDS cases.) The Council has diverse membership as required by legislation, and must be at least one-third consumers of Ryan White services who are not affiliated with funded service providers. The Ryan White Planning Council, working closely with the jurisdictions and with PLWHA groups in each area, has taken a number of new actions to increase equality in access to Ryan White services throughout the metropolitan area. These include directives and funding decisions – which will be addressed in future updates.

The RPCC E-newsletter provides additional updates on regional HIV/AIDS work.

Implications of Health Reform

The implementation of the Patient Protection and Affordable Care Act (ACA) will create fundamental changes in the structure and delivery of health care in the United States. Implications will be particularly significant for lower-income Americans and for individuals with chronic health conditions – including people living with HIV and AIDS (PLWHA). RPCC’s Policy and Practice analysis paper provides a national perspective on how health care reform is likely to affect the system of community-based HIV/AIDS services, with a special focus on implications for safety-net clinics that provide HIV/AIDS prevention, testing, and/or care. The report begins by setting the context for health reform, providing an overview of the current federal funding sources for HIV/AIDS, and highlighting the services provided by safety-net clinics, particularly under Part C of the Ryan White Act. The report then offers an in-depth analysis of changes in payment, testing, and treatment of HIV/AIDS under federal health reform, including the potential benefits of expanded Medicaid coverage and challenges resulting from the transfer of patients from HIV/AIDS care under the Ryan White Act to Medicaid. It concludes by listing key health reform issues that are likely to impact HIV/AIDS care as health reform is implemented, such as Medicaid expansion, Ryan White Program changes, federally qualified health center expansion, and accountable care organization formation. This report was prepared for RPCC by Mosaica: The Center for Nonprofit Development and Pluralism, a values-based nonprofit that works extensively with HIV/AIDS programs and safety-net clinics in the Washington, DC area and nationally.