The District will launch a campaign next week urging every resident between the ages of 14 and 84 to be tested for HIV, an ambitious undertaking that public health officials say is critical to reversing rates of infection that are among the worst in the country.
The citywide campaign, which appears to be unprecedented in its breadth, will target 400,000 men, women and teenagers and encourage them to learn their HIV status through an oral swab that delivers results in 20 minutes.
Organizers want the rapid test to become as common a part of any medical exam as blood-pressure monitoring or a cholesterol check. The hope is that the results, especially if positive, would influence a person's sexual behavior and motivate him or her to seek treatment.
The D.C. Health Department has 80,000 tests on hand for free distribution to hospital emergency rooms, private physicians' offices, community health programs and public settings such as the city's detoxification center and substance abuse and STD clinics. Officials aim to exhaust that supply before the end of the year, which would mean reaching a fifth of their key population in the next six months.
"If we are serious about addressing this epidemic in our community, then screening for HIV has to become routine," said Marsha Martin, who heads the city's Administration for HIV Policy and Programs. "Because we'll miss too many people otherwise."
That approach dovetails with proposed guidelines from the federal Centers for Disease Control and Prevention. The CDC is considering a recommendation "strongly encouraging" doctors to offer HIV tests as a matter of course to patients ages 13 to 64.
One in 50 afflicted by AIDS
City officials do not know how many people have HIV, the virus that causes AIDS, because local data are incomplete. But AIDS afflicts one in 50 District residents, or almost 10,000 people. The nation's capital has the highest rate of new AIDS cases in the country, at 179.2 per 100,000 people, with African Americans disproportionately affected.
Nationally, the CDC estimates, 25 percent of the more than 1 million Americans living with HIV are unaware they are infected.
"We have to start making it part of the public consciousness, that HIV is of and among us," Martin said.
In a review this past spring of the District's HIV/AIDS programs, the D.C. Appleseed Center for Law and Justice recommended a citywide strategy for standard HIV screening. The public service organization has been critical of local officials' response to the epidemic, which it considers one of the most dire health problems facing the District.
Appleseed Executive Director Walter Smith applauded the campaign yesterday. "I don't think you'll find routine citywide testing anywhere in the country," he said. "It's an important and bold step forward, and we welcome it."
But, he said, "It's crucial that along with testing goes appropriate pre- and post-testing counseling."
Smith's caveat was echoed by Patricia Nalls, executive director of the Women's Collective in Northwest Washington. The nonprofit provides care to 350 HIV-positive women, from teenagers to senior citizens, and is among the community groups that the city government is counting on to help newly diagnosed residents. Nalls, however, has heard few specifics about the initiative. She said that without greater funding, it would be difficult to handle significantly more clients.
"So there's going to be a group of people who find out they're positive," she said. "How are we going to take care of them? Is there a plan in place to take care of them?"
Details unclear as kickoff nears
Many details of the campaign remain in flux, despite a kickoff scheduled for Tuesday morning as part of the 12th annual National HIV Testing Day. Starting at 10 a.m. at Freedom Plaza, HIV tests and information will be offered along with speeches by city officials, religious and health-care leaders and people living with the virus.
Some leaders may be tested publicly to underscore the message that anyone can be at risk.
Martin promised in an interview this week that "Come Together D.C., Get Screened for HIV" -- the slogan headed for billboards and promotional blurbs -- will extend beyond screening. Her administration will expand outreach, counseling and treatment services in the community, she said. It is planning a program that would provide HIV-positive residents with helpers to get them through rough periods and to keep them on medication schedules.
Celia Maxwell, assistant vice president for health sciences at Howard University, foresees certain hurdles in the screening effort. "The biggest challenge is going to be getting all providers on board and having them see how this could be a benefit to their practice," she said. "But at the end of the day, it will provide for a healthier D.C."
Administration officials have mailed information about the campaign to 45 physician groups in the city and have held discussions with emergency room doctors in the city's larger hospitals. The doctors are learning why the city wants to test even residents in their mid-eighties, two decades past the CDC proposal.
"Sixty-four seemed to be an arbitrary cutoff for assuming participation in sexual behavior and other behavior that might make [people] vulnerable," Martin said. And 14 is the jumping-off point to high school for most youths.
A life-or-death difference
The campaign is the city's most dramatic action on HIV/AIDS since Martin took office last summer, after D.C. Appleseed's first report resulted in her predecessor's firing.
She has advocated widespread distribution of condoms and a broader needle exchange program, both of which are to come, she says.
In the District, said Vanessa Johnson, deputy executive director of the National Association of People with AIDS, "there's an urgency to the matter."
"Many people will not get tested or are afraid to get tested," said Johnson, who has been living with HIV since 1990. "They don't want to be ostracized or rejected."
Yet early testing can make a life-or-death difference, she said: "Once the virus has done substantial damage to the immune system, it's almost impossible to rebound."