December 26, 2006
DC'S LOUSY REPORT CARD
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Dr. Marsha Martin, Director of the Administration for HIV/AIDS Policy and Programs in DC, cannot win the fight without higher level political support, says new Appleseed report. |
Washington, DC's $8 million HIV testing campaign has been poorly planned and is lacking in results, according to a new report by the DC Appleseed Center for Law and Justice. Based on a draft version of the CDC's federal testing recommendations, the "Come Together D.C., Get Screened for HIV" initiative garnered celebratory press coverage at its launch in June. Six months and millions of squandered taxpayer dollars later- the push for routine testing is already a cautionary tale to the rest of the country.
Like the rest of the nation - about a quarter of HIV-positive District residents don't know their status. With the highest rates of HIV prevalence in the country, testing is just not rolling out fast enough and not in the communities that need it most.
Squandering resources & ignoring IDUs
The report praised the testing initiative for getting underway, but showed that lack of planning has already led to wasted resources. The Administration for HIV/AIDS Policy and Programs (AHPP) bought 80,000 testing kits at $800,000, which organizers planned to distribute at no cost to hospital emergency departments, private physician offices, community health programs, detoxification centers and substance use and sexually transmitted infection treatment clinics. From June through September 2006, however, only 16,707 HIV tests were conducted in the publicly funded testing sites.
Many of the testing kits expired. Organizers rescued some on the verge of expiration but because they could not yet be used in the District, they gave the kits to the Maryland Department of Health and Mental Hygiene.
The Appleseed report gave the city grades ranging from B+ to D+ in critical areas of AIDS prevention, treatment and care:
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In addition to wasting taxpayer money on unused kits, the AHPP is ignoring opportunities to make testing accessible to those most at-risk of HIV infection. For example, testing at several public clinics that serve high-risk populations (TB, STD and detoxification) is not available on a full-time basis. Further, testing of the most marginalized injection drug users in the city was conducted for a brief period in Ward 7, but it has not continued.
"The Appleseed report reflected back to many of us who work in the field what we already knew - DC is interested in being perceived as a city that fights HIV/AIDS, but if you look at what they prioritize, the programs do not reach those who need them most," said Naomi Long, DC Area Director for the Drug Policy Alliance.
She argues the AHPP needs to focus on some of the root causes of new HIV infect rates and less on the perception of DC being HIV/AIDS conscious. The city needs "safe spaces" so injecting drug users - the most marginalized and at risk population - can move through the entire continuum of care. That may start with testing but must also include drug treatment, mental health counseling, job training and housing placement.
"IDUs are so hard to reach, but once you reach them, you can set them up for success," said Long.
"Part of that is AHPP working with other agencies and part prioritizing the resources they have on IDUs."
Overall - the city will allot about $8 million for the project, some of which will go toward counseling and medical referrals for those who test positive for the virus, according to Gregg Pane, director of the city Department of Health. Cost-effectiveness data, including the cost per positive case found, is not yet available; insiders predict maybe next year.
Awareness raising not enough
Dr. Marsha Martin, director of AHPP, said the goal of the campaign is to "raise the public health consciousness of a community about a virus" and criticism of the effort is "off base." She defended the HIV/AIDS administration, stating that the number of HIV tests that the city is administering is "double, triple at a minimum what we've done in previous years."
The report acknowledged the increases and praised the testing campaign's $500,000 publicity component to "reinvigorate the dialogue" around HIV. AHPP had palm cards with testing information passed out in the Metro stations, and mobile van units conducted testing once a week at Freedom Plaza. A larger, social marketing component is in the works.
Local awareness-raising is important, but the District has promised its residents a testing campaign, which people getting tested, counseled and connected with prevention, treatment and care.
On testing, the report concludes, "In order to bring measurable success in testing a significant percentage of the population, DC Appleseed hopes AHPP, in concert with other relevant District agencies and officials, will produce a detailed plan ... including strategies both for reaching the most high risk populations and areas on an urgent basis, and for ensuring that individuals who test positive for HIV receive appropriate counseling and are connected to care."