The HIV/AIDS global epidemic has ravaged millions of lives across the world. In the past, prior to the discovery of effective control measures through medication such as antiRetroViral medication, the disease had infected millions of lives. At the present time, although the discovery of a vaccine has not yet been made, scientific research has made some leeway with regards to this issue. One would expect very low prevalence rate of the disease in the most powerful country in the world owing to the high level of medical technology and innovation systems available. However, this situation is further from the truth. An even more dramatic scenario is having the capital of the United States, Washington D.C, with the highest prevalence rates in the country, at 3%. This high rate can be shockingly compared to some sub-Saharan countries in Africa such as the Congo and Nigeria, which have similar rates (Gilbert and Wright, 2003).
Despite being at the centre of vital health public policies, Washington D.C has continued recording these high figures as a result of three underlying reasons. Firstly, the District of Colombia’s population is characteristic of individuals who are at high risk of contracting HIV/AIDS. These groups include homosexual men, injecting drug users, and also heterosexuals with risky sexual lives. In addition, individuals in these categories have their social and sexual networks interloping, thereby increasing their risk to HIV/AIDS infection. Secondly, Washington D.C is home to a relatively smaller human population of approximately 600,000 residents in comparison with other American cities. In this instance, this situation is coupled with the high number of HIV infections thereby increasing the prevalence rates. Lastly, the state is recognized as one of the regions where economic disparity and poverty is pronounced. As a result, access to quality and affordable healthcare has been a daunting task for a majority of this population (Greenberg et al., 2009). This situation explains the high numbers of infected individuals totaling to approximately 15,000 individuals. Laurencin, Christensen, and Taylor (2008) indicate that in a population comprised of 100,000, Washington D.C has 117.07 reported HIV/AIDS cases. This figure is in comparison with other states such as Philadelphia with 96.6, Baltimore 68.3, New York City 50.7, and Chicago with 30.9 cases (Laurencin et al., 2008).
According to Greenberg, Hader, Masur, Young, Skillcorn, and Dieffenbach (2009), of the 15,000 individuals infected with the disease, 71% were male, while 29% were female. The Centre for Disease Prevention and Control (CDC) indicates that approximately 27% of the cases that were diagnosed at less than 30 years of age, only 12% were currently less than 30 years old. In relation to the population’s ethnic composition, people of color accounted for approximately 82% of HIV/AIDS cases. In this case, 73% of the population living with HIV in the state are Black while 5% Hispanic, and 4% other ethnicities (Greenberg et. al., 2009).
However, recent data indicates that Washington D.C has made tremendous progress with regards to combating the HIV/AIDS epidemic. This situation is indicated in the drop of the reported number of HIV case from the period 2009 to 2013, signifying a decline of approximately 39.6%. In addition, the number of deaths from people living with AIDS in the same period has also dropped by about 43.5% (Greenberg et al., 2009). This trend was attributed to improved accessibility to testing services and also impactful sensitization efforts by the public health institutions. However, this progress has been impeded by the increase in the number of new reported HIV cases in which case between the period 2012 and 2013, approximately 1200 new cases were reported in Washington D.C.
Stone (2009) indicates that the emerging issue in the District of Columbia in relation to HIV/AIDS lies in retention and engagement in care associated with HIV. In this case, statistics indicate that only 64% of individuals recently diagnosed with the illness are fully engaged in HIV care while only 47% of those with HIV have received viral suppression. This means that such individuals less likely to transmit the virus. These rates indicate the need for urgent intervention measures in order to control the epidemic in Washington D.C.
The situation inciting greater worry is that involving racial composition of individuals infected and living with HIV. This aspect is in relation to the African-American category in which case See (2010) indicates is a serious issue that needs address as indicated above. In this instance, See (2010) indicates that the African-American population accounts for approximately 75% of newly reported cases. In addition, approximately 5.8% of the male population in the state is living with the illness. In terms of gender, men are considered to have the higher rates of infection than compared to women, although the latter is heavily affected, and who account for approximately 24.2% (Stone, 2009). This situation is made worse by the vulnerability of the youth group in relation to HIV infection in which case accounts for approximately 37% of new infection rates of the youth group between 13 and 29 years of age. In relation to the African-American group and in which case bears the largest burden in the population infected with HIV, homosexual men and those with injection drug behavior bear a 25% risk of infection, followed by female heterosexual African-Americans at 18% and male African-American heterosexuals at 13% (See, 2010).
Significant Trends and Current Situation
In comparison with data from the 1980s, the HIV rate among young black women in the United States has significantly dropped. This situation is also reflective of Washington D.C in which case, current data indicates an improved management of HIV cases as well as newly reported incidences. In this instance, medical technology has enabled the development of effective medication that has contributed significantly to controlling the advancement of the virus. In the past, the most affected group in the society was women, and more especially black women as a result of their economic status. In this case, they were not able to obtain quality health care and as such, a majority ended up succumbing to the illness.
The above situation is different from the current state in which case health care has been made accessible and affordable to a wide range of individuals in the country. The determination of HIV/AIDS as an epidemic in accordance with the standards established by the World Health Organizations has prompted the state to take the health issue of HIV/AIDS into closer review and analysis. According to a report by an independent Non-Governmental Organization, Appleseed, the war against HIV in Washington D.C has been gravely affected by various factors such as an ineffective surveillance system that compromises the collection of reliable data and also its dissemination in a timely manner. In addition, the continuous changes in the Department of Health in the state have greatly affected the performance of the industry. Moreover, the lack of a proper system in place has created immense challenges in grant management.
As a result, this aspect has compromised the proper functioning of programs ran by health institutions and organizations which are focused on combating the epidemic. The state also lacks a broad control program with a special focus on testing and condom distribution. In this case, the lack of reach hinders efforts meant to diagnose new HIV cases as well as the provision of adequate control measures as these symptoms are restricted in terms of geographical coverage and financial support. Another factor affecting the combat of HIV/AIDS is that of lack of public education about HIV prevention among the population. As such, people lack awareness of the severity of the illness and the ideal prevention measures they can adopt to avoid contracting the disease, and for those already infected, ways to take care of themselves to achieve longevity while at the same time facilitating quality lives.
In spite of the falling rate of incidence of the illness among young black women, the incidence rate is relatively high in comparison with women from other races. The predominant factor that has resulted in this situation is that of challenging economic and financial conditions. This situation can be ascertained by Gilbert and Wright (2003) who indicates that the Black community in Washington D.C is greatly affected by economic disparity rampant in the state. As such, this population segment is financially segregated as the majority of individuals are from poor backgrounds. This situation is further precipitated by the fact that a wide range of African-American individuals have low-income jobs. As in the case with most communities, African-American women in such situations are forced to bear the brunt of taking care of their families. As such the meager wages they receive from their low-paying jobs are directed towards serving household bills and towards the upkeep of their families. In the end after the appropriation of their income, only a little is left as savings. As a result, the access to quality healthcare is jeopardized. This situation is confirmed by Stone (2009) who indicates that owing to the economic difficulties which African-American women have to contend with, access to health care is in most instances considered a luxury.
However, recent trends have provided an encouraging outlook in that the rate of prevalence of newly reported HIV cases among African-American women has fallen with time. This aspect is indicated in the statistics carried out in 2010 that shows a 21% decrease in incidence among African-American women between the years 2008 and 2010. This change can be attributed to socio-economic factors as well as policy changes in Washington D.C. in this case, as a result of increased enrollment rates to learning institutions among African-American women, their employment marketability has improved. In this regard, the increased number of African-American women graduates in the market has increased substantially thereby increasing their chances of obtaining better paying jobs. In this case, such women are able to secure employment that pays relatively better in relation to the level of education acquired and are also eligible to obtaining health benefits from their employers.
Therefore, this aspect provides an ideal ground for improved access to health care. In addition, this situation necessitates the consideration of HIV testing. In addition, such aspects also provide ideal learning situations as more women become aware of HIV/AIDS and the measures they can adopt in controlling the spread for those already infected, and prevention measures for the unaffected individuals. In this regard, women have access to information about latest research on health matters including that of HIV, and also learn about the dangers of certain lifestyle choices as well as effective prevention measures. This consideration follows research that indicates that African-American women are more likely to be infected during heterosexual encounters (Gilbert and Wright, 2003). This instance is different in terms of assessment of White women population in which case, the majority is infected as a result of injection drug use.
In spite of the tremendous progress achieved in controlling the prevalence of HIV among African-American women, they still account for the largest share of newly reported HIV infections, that is, approximately 6,100 cases (64%) in the year 2010. In terms of incidence rates, African-American women are 20 times that of White women and 4 times that of Latinas. In addition, African-American women accounted for the largest proportion of women living with HIV, that is, at approximately 60% in 2010 (Gilbert and Wright, 2003). In relation to the comparative rates in specific ethnic compositions in terms of new HIV infection rates, African-American women accounted for an approximate 29% rate (3 in 10) of all African-Americans. This composition accounts for the largest share in relation to women in other ethnic groups. In this case, Latinos register a new infection rate of 14% and 11% among White women (Gilbert and Wright, 2003).
In as much as individual factors contribute to the rate of prevalence of the illness, policy makers are also responsible in such instances. As mentioned above, leadership and a lack of proper measures to monitor the prevalence of the disease has lingered further than it should. In this case, Washington D.C leadership has made drastic policy measures and actionable steps that are meant to reduce the rate of infection and incidence among residents of Washington D.C, African-American women notwithstanding. In this regard, the leadership including the state’s mayor has embarked on aggressive programs meant to achieve this aim. In this regard, as indicated above, the lack of proper surveillance systems has hampered the determination of the actual figures of HIV infection rates, both new and existing. To this regard, the D.C. Department of health in conjunction with George Washington University carried out a joint effort to undertake required surveillance activities. This program was sponsored by the Center for Disease Control and Prevention (CDC). This arrangement led to the compilation of a health report that provided for epidemiology results which illustrated the rate of HIV infections in the District of Colombia.
In order to complement the findings of the report, the state Department of Health launched HIV screening campaign citywide with the aim of sensitizing individuals of the importance of being screened. This undertaking represented the first of its kind in the United States. In addition, the core objective of this activity was rested on the focus to raise HIV/AIDS awareness in an effort to reduce the stigma associated with the illness, expand screening activities to other parts of the state, and provide adequate assistance to those newly infected individuals to provide guidance on appropriate care and treatment approaches and services available.
The state has also embarked on sensitizing couples on HIV, as a result of research results that indicate that both women and men involved in relationships are unaware of their partner’s HIV status. This has been carried out in terms of social marketing activities that are focused on spreading awareness and instill the need for undergoing HIV testing.
Conclusion
In spite of African-American women having one of the highest incidence rates of new infections in Washington D.C, tremendous progress has been achieved. In this instance, the support provided by the Department of Health in conjunction with other health institutions has facilitated achievement of considerable achievement with regards to sensitization of HIV/AIDS and the consequent reduction of infection rates among African-American women.
References
Gilbert, D. J., & Wright, E. M. (2003). African American women and HIV/AIDS: Critical responses. Westport: Praeger.
Greenberg, A., Hader, S., Masur, H., Young, T., Skillcorn, J. & Dieffenbach, C. (2009). Fighting HIV/AIDS in Washington , D.C. Health Affairs. Vol. 28, No. 6. Retrieved from https://www.princeton.edu/cbli/student-projects-1/Washington-DC-analysis-Greenberg.pdf
Laurencin, C., Christensen, D. & Taylor, E. (2008). HIV/AIDS and the African-American community: A state of emergency. Journal of the National Medical Association. Vol. 100, No. 1. Retrieved from http://northstarnews.com/userimages/references/HIV%20AIDS_National%20Medical%20Association%20Journal.pdf
Stone, V. E. (2009). HIV/AIDS in U.S. communities of color. New York: Springer.
