/ 12 July 2012

US grapples with neglect of HIV

Protesters outside the White House in Washington DC
Protesters outside the White House in Washington DC

Most of those who arrive at the HIV clinic in the vast plate-glass building that houses the United Medical Centre in Anacostia come through the emergency room, where they are persuaded to take an HIV test.

A positive result is devastating, says Daveda Hudson, the patient navigator whose work is to connect those tested with medical care straight away. “A lot of them are in a bad state. Most people cry until they pass out and then they wake up and cry and pass out again. When you come into the emergency room because you have a sinus infection, it’s not what you expect.”

The clinic is in Washington, DC, capital city of the richest and most powerful country in the world – and home to HIV rates higher than some countries in Africa. Here, 3.2% of the population is infected with the virus that leads to Aids, a greater proportion than in Gambia, the Democratic Republic of Congo and Senegal.

The United States’s record on Aids is about to fall under the spotlight when Washington becomes the setting later this month for the International Aids Conference, a mighty gathering every two years of scientists and campaigners who inevitably end up embarrassing the political leaders of the host nation. It happened in Durban, when Thabo Mbeki was castigated for his doubts over the cause of Aids, and in Bangkok, which experienced protests over the jailing of drug users.

The US has regularly been the subject of criticism. President Barack Obama was attacked at the last event, held in Vienna in 2010, over cuts in US Aids funding to developing countries. This time the event will be on his own turf and demonstrations are already being planned.

Disappointed in Obama
Gregg Gonsalves, a leading Aids activist who works and studies at Yale University, is one of those who is disappointed in Obama, for whom he voted. “He hasn’t invested a lot of political capital in HIV. I don’t think it is a priority for him. He has cut Pepfar [the President’s Emergency Fund for Aids Relief, which aims to alleviate epidemics in developing countries] by $200million. He has been an absolute disappointment.”

Gonsalves says the infection rate in the US – 50000 a year – is shocking. He is concerned about the lack of attention to young, black, gay men and does not understand why Obama does not act to end the waiting lists for drugs. Since May this year, more than 2700 people across 10 states were waiting for treatment – something that is hard to defend because recent studies showed that prompt treatment made those with HIV less likely to infect others. “This is something he could do in the blink of an eye,” said Gonsalves.

What Washington has in common with Aids-afflicted Africa is a marginalised and impoverished population. As you take the metro green line south, away from the downtown offices and upmarket bars where young and aspiring political interns congregate, white people get off and African-Americans get on. Before the train crosses the Potomac River, everybody in the carriage is black. Washington is changing again after the “white flight” that followed race riots in the 1980s, but none of the young Wasps working downtown heads home to Anacostia.

HIV today is not the “gay plague” that hit San Francisco in the 1980s. The people worst affected are heterosexual African-Americans. HIV is rife in places beset by poverty and low levels of education. That is why Dr Lisa Fitzpatrick, an expert in infectious diseases at Howard University, set up the pioneering HIV clinic just more than a year ago at the United Medical Centre in Anacostia, amid the homes of the people who need her help. The city, she says, “is disenfranchised. It has high levels of illiteracy and ­poverty and huge health and social disparities.” And Anacostia has greater concentrations of all these social ills than anywhere else in the city.

Hudson’s job is at the heart of what makes this clinic different. She gets the call and heads straight to the emergency room to ensure that patients see Fitzpatrick or a nurse practitioner immediately. “Just by getting people to walk through the door you begin a relationship,” said Fitzpatrick.

Difficult patients
Then there is a mental health assessment, which will reveal any substance abuse and other issues that must be tackled if the patient is to be successfully treated. And it is vital to keep them linked to the clinic. Antiretroviral drugs keep people with HIV alive and well and prevent them infecting others, but they must be taken regularly or they stop working. Hudson, helped by other staff, refuses to let these sometimes difficult patients drift away from care. They call people every day, visit them in their homes and sort out their housing problems, their children’s schooling and their debts. The only way to defeat HIV in these deprived places, they believe, is to take on the problems that make people vulnerable.

However, many patients fail to follow up, says Fitzpatrick. “Once, I had to meet a patient on the street. I had to explain to him about HIV because he was afraid to come in. He had Aids and he thought he was going to die anyway. He was homeless, so I arranged to meet him. He showed up a week later at the clinic and he’s still in care now. He is doing fine.”

David Catania, the independent chair of the Washington health committee, took over in 2005 and figures now show a drop in the death rate from Aids and the numbers of those with HIV progressing to Aids.

Catania introduced a testing programme and 100–000 people are now tested every year. In the jails, people are tested unless they opt out and those with HIV are given continuing care on release. Grants and help have been given to non-profits setting up Aids programmes in the poorest parts of the district. The infrastructure that existed was mostly for gay men, who were no longer the majority of those affected or at risk.

He is proud of what has been done, but knows HIV will continue to be a difficult issue for the city. “The big question now is what do we do about this population of 3.2%. It is a ­horrifying number. It is going to be unbelievably high for a long time.” – © Guardian News & Media 2012