Study Reveals HIV's Impact on D.C. African American Community

B_Italian1

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More Than 80 Percent Of Recent Cases Were Among Black Residents

By Susan Levine
Washington Post Staff Writer
Monday, November 26, 2007; 2:25 PM


The first statistics ever amassed on HIV in the District, released today in a sweeping report, reveal "a modern epidemic" remarkable for its size, complexity and reach into all parts of the city.

The numbers most starkly illustrate HIV's impact on the African American community. More than 80 percent of the 3,269 HIV cases identified between 2001 and 2006 were among black men, women and adolescents. Among women who tested positive, a rising percentage of local cases, nine of 10 were African American.

The 120-page report, which includes the city's first AIDS update since 2000, shows how a condition once considered a gay disease has moved into the general population. HIV was spread through heterosexual contact in more than 37 percent of the District's cases detected in that time period, in contrast to the 25 percent of cases attributable to men having sex with men.

"It blows the stereotype out of the water," said Shannon Hader, who became head of the District's HIV/AIDS Administration in October. Increases by sex, age and ward over the past six years underscore her blunt conclusion that "HIV is everybody's disease here."
"We must take advantage of this information with the sense of urgency that this epidemic deserves," D.C.

Mayor Adrian M. Fenty said in a statement shortly after the report was released. "Today, the District plans to build on our past efforts to aggressively work to reverse some of the trends that have plagued our community. "

The new numbers are a statistical snapshot, not an estimate of the prevalence of infection in the District, which is nearly 60 percent black. Hader, an epidemiologist and public health physician who has worked on the disease in this country and internationally, said previous projections remain valid: One in 20 city residents is thought to have HIV and 1 in 50 residents to have AIDS, the advanced manifestation of the virus.

Almost 12,500 people in the District were known to have HIV or AIDS in 2006, according to the report. Figures suggest that the number of new HIV cases began declining in 2003, but the administration said the drop more likely reflects underreporting or delayed reporting. A quarter-century into the epidemic, the city's cumulative number of AIDS cases exceeds 17,400.
"HIV/AIDS in the District has become a modern epidemic with complexities and challenges that continue to threaten the lives and well-being of far too many residents," the report states.

District health officials have long been faulted for the lack of HIV information and lagging AIDS data. Not until forced by federal funding requirements did the health department start tracking HIV.
Until that began in 2000, critics said, neither the government nor organizations responding to the disease knew whether their dollars and efforts were effectively addressing the problem.

The report notes that its comprehensive picture "offers the District a new tool to help improve the scope, quality and distribution of care and treatment and prevention services."

HIV information is particularly valuable because it represents the most recent infections and can indicate changes in transmission patterns. It is mainly collected through the investigation of cases forwarded by laboratories and health-care providers.

The compilation signifies a major step forward for the HIV/AIDS agency, which has gone through repeated program and leadership upheavals in recent years. "For us, this is a milestone," said Hader, its third administrator since 2004.

A letter from Mayor Adrian M. Fenty (D) accompanies the release: "We must take advantage of this information with the sense of urgency that this epidemic deserves."

The District's AIDS rate is the worst of any city in the country, nearly twice the rate in New York and more than four times the incidence in Detroit, and it has been climbing faster than that of many jurisdictions.

One explanation might be the high percentage of infected residents labeled "late testers," people who learn they have AIDS within a year of the HIV diagnosis. Although the proportion of adults and adolescents screened for HIV is greater in the city than nationally, the finding raises questions about the strategy of the District's "know your status" campaign.

People who learn of their infection late face serious consequences. By the time symptoms arise or infections occur, their immune systems have suffered considerable damage. They face increased medical costs and death rates.

More than two-thirds of local AIDS cases fell into this category during the past decade, according to the report, compared with 39 percent of cases in the United States. "I think that's dramatic information for our care and treatment providers," Hader said.

No longer is HIV a crisis primarily among younger adults. Starting in 2004, the number of new HIV cases among men and women ages 40 to 49 outpaced every other age group in the city.

But the data made public today expose an alarming dimension of pediatric HIV. Each of the three dozen District children to test positive in the past five years was infected during birth.

"This is a line that should be zero," said Hader, who is pushing for routine HIV testing during pregnancy, quick-results oral swabs during labor and "fast tracking" of the antiretroviral drugs that can prevent transmission during delivery.

The administration said it wants to use the report to begin asking and answering, "What next?" Given the scope of HIV and AIDS in the District, health leaders say they can't focus on just one aspect of the disease or one at-risk group.

"We don't have the luxury of only picking one," Hader said. "We have the imperative to do it all."

Study Reveals HIV's Impact on D.C. African American Community - washingtonpost.com
 

Principessa

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I'd heard about it before but didn't realize the problem was that huge. And avoiding DL. :wink:


I lived in Washington, DC from 1995-1996, while attending George Washington University, for my masters degree.

I had a cousin who was then about 40 and recently married. He told me that the ratio of single black women to single black men was 10 to 1. The men all knew they were in high demand and short supply so there was no need for them to be gentlemen, or cultivate social skills. The women were so desperate they didn't mind sharing a man with one or two other women. :eek: Not sexual threesomes, but two different women having allegedly exclusive relationships with the same guy.

I think my cousin exaggerated, it was more like 7W to 1M.:biggrin1:
Since I was doing a one year, 36 credit, masters degree I had no time to date. I barely had time to eat!
 

horneyoldguy

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The CCR5 Delta 32 Gene and HIV / AIDS Immunity
No one knows exactly why, but in the late 1320s or early 1330s, bubonic plague broke out in China's Gobi desert. Spread by flea-infested rats, it didn't take long for the disease to reach Europe. In October of 1347, a Genoese ship fleet returning from the Black Sea -- a key trade link with China -- landed in Messina, Sicily. Most of those on board were already dead, and the ships were ordered out of harbor. But it was too late. The town was soon overcome with pestilence, and from there, the disease quickly spread north along trade routes -- through Italy and across the European continent. By the following spring, it had reached as far north as England, and within five years, it had killed 25 million people -- one-third of the European population.

The bubonic plague is caused by a bacterium called Yersinia pestis and is characterized by chills, fever, vomiting, diarrhea, and the formation of black boils in the armpits, neck, and groin. Though the disease was originally called the "Great Mortality" and the "Great Pestilence," the name "Black Death" was eventually adopted because of these black boils, which derive their color from dried blood under the skin caused by internal bleeding. In certain cases the bacterium spreads to the victims' lungs, causing them to fill with frothy, bloody liquid. This derivation of the disease is called pneumonic plague, and can quickly spread from person to person through the air. It is almost always lethal.

The plague first spread to Britain in 1348, travelling from Bristol to Oxford and London in several days. In 1665, perhaps the worst of the English epidemics broke out in London. That summer, the nobility and clergy fled the city, as some 7,000 people died each week. As many as 100,000 lives were lost before winter killed the fleas and the epidemic tapered off. Contemporary medicine could provide no explanation for the sickness, and most doctors were afraid to offer treatment. In an attempt to keep from being infected, the few physicians who did risk exposure wore leather masks with glass eyes and a long beak filled with herbs and spices that were thought to ward off the illness. Even one person in a household showing plague-like symptoms was enough to mandate a 40-day quarantine for the whole home -- a virtual death sentence for everyone living in it.

In September 1665, George Viccars, a tailor in the small, central-England village of Eyam, received a parcel of cloth ridden with plague-infected fleas from London. Four days later, Viccars died. By the end of the month, five more villagers had succumbed to the plague. The panicked town turned to their rector, William Mompesson, who persuaded them to quarantine the entire village to prevent the bacterium from spreading throughout the region. It seemed like suicide. A year later, the first outsiders ventured into Eyam, expecting a ghost town. Yet, miraculously, half the town had survived. How did so many villagers live through the most devastating disease known to man?

Local Eyam lore tells befuddling stories of plague survivors who had close contact with the bacterium but never caught the disease. Elizabeth Hancock buried six children and her husband in a week, but never became ill. The village gravedigger handled hundreds of plague-ravaged corpses, but survived as well. Could these people have somehow been immune to the Black Death?

Dr. Stephen O'Brien of the National Institutes of Health in Washington D.C. suggests they were. His work with HIV and the mutated form of the gene CCR5, called "delta 32," led him to Eyam. In 1996, research showed that delta 32 prevents HIV from entering human cells and infecting the body. O'Brien thought this principle could be applied to the plague bacteria, which affects the body in a similar manner. To determine whether the Eyam plague survivors may have carried delta 32, O'Brien tested the DNA of their modern-day descendents. What he found out was startling.

For a disease-causing microorganism to infect the human body there must be a gateway or portal through which it enters into human cells. The plague bacterium works this way, hijacking the white blood cells sent to eliminate it. Traveling inside the white blood cells to the lymph nodes, the bacteria break out and attack the focal point of the human immune system. Dr. Stephen O'Brien felt that the mutated CCR5 gene, delta 32, may have prevented the plague from being able to enter its host's white blood cells.

Eyam provided O'Brien an ideal opportunity to test this theory. Specifically, Eyam was an isolated population known to have survived a plague epidemic. Everyone in the town would have been exposed to the bacterium, so it's likely that any life-saving genetic trait would have been possessed by each of these survivors. "Like a Xerox machine," says O'Brien, "their gene frequencies have been replicated for several generations without a lot of infusion from outside," thus providing a viable pool of survivor-descendents who would have inherited such a trait.

Knowing who died and who lived through the early years of the plague is somewhat problematic. Deaths among the general English population were not recorded in the 14th Century, and most communities did not begin recording parish registers until around 1538. Fortunately, Eyam began keeping a parish register in 1630. Thus historian John Clifford began by examining the register, noting everyone who was alive in 1665, the year the plague came to Eyam. He searched for evidence of life through the year 1725 -- marriages, baptisms, burials that took place years after the plague had left the village. Deleting the names of those lost during the plague period, he was able to determine who the survivors were.

DNA samples could only be collected from direct descendents of the plague survivors. DNA is the principle component of chromosomes, which carry the genes that transmit hereditary characteristics. We inherit our DNA from our parents, thus Eyam resident Joan Plant, for instance, may have inherited the delta 32 mutation from one of her ancient relatives. Plant can trace her mother's lineage back ten generations to the Blackwell siblings, Francis and Margaret, who both lived through the plague to the turn of the century. The next step was to harvest a DNA sample from Joan and the other descendants. DNA is found in the nuclei of cells. The amount is constant in all typical cells, regardless of the size or function of that cell. One of the easiest methods of obtaining a DNA tissue sample is to take a cheek or buccal swab.

After three weeks of testing at University College in London, delta 32 had been found in 14% of the samples. This is a genetically significant percentage, yet what, really, did it mean? Could the villagers have inherited delta 32 from elsewhere, residents who had moved to the community in the 350 years since the plague? Was this really a higher percentage than anywhere else? To find out, O'Brien assembled an international team of scientists to test for the presence of delta 32 around the world. "Native Africans did not have delta 32 at all," O'Brien says, "and when we looked at East Asians and Indians, they were also flat zero." In fact, the levels of delta 32 found in Eyam were only matched in regions of Europe that had been affected by the plague and in America, which was, for the most part, settled by European plague survivors and their descendents.

Meanwhile, recent work with another disease strikingly similar to the plague, AIDS, suggests O'Brien was on the right track. HIV, the virus that causes AIDS, tricks the immune system in a similar manner as the plague bacterium, targeting and taking over white blood cells. Virologist Dr. Bill Paxton at the Aaron Diamond AIDS Research Center in New York City noticed, "the center had no study of people who were exposed to HIV but who had remained negative." He began testing the blood of high-risk, HIV-negative individuals like Steve Crohn, exposing their blood to three thousand times the amount of HIV normally needed to infect a cell. Steve's blood never became infected. "We thought maybe we had infected the culture with bacteria or whatever," says Paxton. "So we went back to Steve. But it was the same result. We went back again and again. Same result." Paxton began studying Crohn's DNA, and concluded there was some sort of blocking mechanism preventing the virus from binding to his cells. Further research showed that that mechanism was delta 32.

Scientists studying HIV first learned about the gateway-blocking capacity of the CCR5 mutation in 1996. Several drug companies, then, quickly began exploring the possibility of developing pharmaceuticals that would mimic delta 32 by binding to CCR5 and blocking the attachment of HIV. Previous methods of treatment interfered with HIV's ability to replicate after the virus has already entered a cell. This new class of HIV treatment, called early-inhibitor -- or fusion-inhibitor -- drugs seek to prevent the virus from ever attaching at all. These pharmaceuticals are still in relatively early stages of development, but certainly stand as a hopeful new method of approaching HIV treatment.


http://steelturman.typepad.com/thes...e_immunity.html
 

Bbucko

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?????

Is there some suggestion that all of the Americans of European descent who happen to be HIV+ somehow do not have this "Plague gene" Delta32? How would a genetic mutation preventing infection by a certain bacterium have any practical application in preventing infection by a virus?

Sadly, none of this, any of this, is news to anyone who follows the spread of HIV. Communities of color (Black & Latino) have dealt with rising levels of HIV infection for the last decade, mostly in silence. Perhaps it's the influence of the church within these communities, perhaps it's the utter neglect of these communities over the last two presidential administrations.

Certainly the "Abstinence only" message has failed miserably to reach much of any audience. And certainly the stigma of an HIV+ diagnosis plays a huge role in its spread. And most certainly the prevention effort has suffered since the introduction of Protese Inhibitors in 1996 when HIV became a "manageable condition" and control of the dialog shifted from AIDS advocacy groups to the Pharmaceutical companies.

I have said from the very beginning that until the daughters of CEOs are being diagnosed as HIV+ efforts aimed at prevention will be stifled and vague.
 

B_Italian1

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Not sexual threesomes, but two different women having allegedly exclusive relationships with the same guy.

Sounds like Jan and Dean's Surf City, "two girls for every boy".

Communities of color (Black & Latino) have dealt with rising levels of HIV infection for the last decade, mostly in silence. Perhaps it's the influence of the church within these communities, perhaps it's the utter neglect of these communities over the last two presidential administrations.

We can't keep blaming churches and the presidential administrations. The people have to start doing it for themselves. Hopefully now that this report is out, more awareness and action will take place sooner rather than later. According to that report, DC has an HIV/AIDS infection rate that is 10 times the national average, and about 1 in 20 city residents has HIV and 1 in 50 have AIDS. To see this happen to our nation's capital is devastating beyond belief.

I have said from the very beginning that until the daughters of CEOs are being diagnosed as HIV+ efforts aimed at prevention will be stifled and vague.

A lot of progress has been made in 25 years, and you're right, when something hits home action happens much more quickly.
 

dhsdad

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:frown1: Sadly, this is not news. However, it does re-inforce my predilection for sex with hung, white men. :biggrin1::wink:


The data is skewded..DC is called chocolate city..ergo, most of the city residents are black.

You can stay with white men ( no offense to them) we don't want you.
 

slate_australis

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I'll try to track it down, but I read a study which makes PERFECT sense to me.

There seems to be a direct correlation between the community's level of "acceptance" toward gay and bisexual men and the HIV infection rates. Essentially - the greater the degree of closeting, more likely it will be that risky sexual practices will occur.
 

B_icem

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The data is skewded..DC is called chocolate city..ergo, most of the city residents are black.

You can stay with white men ( no offense to them) we don't want you.

amen to that... i can't imagine her being in very high demand among hung white males anyway
 

Bbucko

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amen to that... i can't imagine her being in very high demand among hung white males anyway

The data is skewded..DC is called chocolate city..ergo, most of the city residents are black.

You can stay with white men ( no offense to them) we don't want you.

What's up with hating on njqt? She's a valued senior member of these boards as well as being a friend.

It is undeniable that, after gay men, the hardest-hit community in the US for HIV is African American. This isn't "skewed data": it's simply the truth.

I get my HIV care from a county (public) clinic in South Florida. The overwhelming majority of fellow patients is black.

I joined a support group for HIV+ men when I moved to New Haven, CT in 1999, and about half of the members were straight men of color.

This is not news except for those so apathetic to the plight of living with HIV that they never bothered to educate themselves.
 

DC_DEEP

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We can't keep blaming churches and the presidential administrations. The people have to start doing it for themselves.
Yes, we can keep blaming them. The people cannot start fixing the problem themselves if they don't have information, the very thing that the conservative churches and the current administration don't want the people to have.

The churches and the government need to drop the "head-in-the-sand" approach to human sexuality, and start more comprehensive efforts. Knowledge is power.
 

simcha

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The data is skewded..DC is called chocolate city..ergo, most of the city residents are black.

You can stay with white men ( no offense to them) we don't want you.

amen to that... i can't imagine her being in very high demand among hung white males anyway

Hey, what is all of this? Why are you guys attacking njqt? She's a sweetheart and she is very beautiful. I can see that and I'm gay. Just because you two have race issues and aren't attracted to her doesn't mean that the rest of the male population are like you.

I would think men of any stripe would give their right arms to be with njqt. The only two reasons I don't go after her are because:

a) I'm gay.
b) I'm only average sized so I wouldn't stand a chance.

But I still think she's rockin' hot and if she ever comes to the Bay Area I'd love the chance to take her out and show her a good time...
 

B_VinylBoy

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Things like this just causes more fear and divides lines between people. I read that headline and the first thing that came to mind was that the article claims 4 out of 5 African American men are HIV+. You actually have to read deeper into the story to figure out that they're talking about one city, where the population is 60% black. And that's assuming if the reader wasn't turned off or scared after reading the headline, making a huge generalization about black men in the process.

If HIV Awareness is really about informing people with the facts, they should have the decency to word it properly.
 

B_icem

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i dont have any "race issues" for the person who said that... but no i do not like njqt judging by what ive read of her responses in many threads on this board, especially concerning black men... i dont think hes a "sweetheart" and shes not very attractive either... im not really trying to be mean, but it is what it is......
 

OmnibusGuy

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Sad thing is that with such a small population its blown much more out of proportion than a bigger city like new york, chicago, LA, Atlanta, or Houston, etc. with a small population of only about 500,000 people and 1/3 of that African Americans the data compared to other cities is going to be much more blown up than larger cities. It's still sad that African Americans are now the center of attention of the AIDS epidemic and i think we need to educate people more about this (White, Black, Latino, Asian, etc). Luckily, I condone safe sex, and only women who do not open their legs freely.
 

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]The data is skewded..DC is called chocolate city..ergo, most of the city residents are black. Then you better tell the mayor of New Orleans because he thinks he runs "chocolate city."[/SIZE]

You can stay with white men (no offense to them) we don't want you.

Counts to 3, nope can't quite turn the other cheek this time. :biggrin1: Why would I want your ridiculous little chocolate chode? :mad::confused: