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Excerpts: Chat With D.C. HIV/AIDS Administration Director

Dr. Shannon Hader, who leads the city's efforts to combat AIDS, took questions from readers this afternoon. Excerpts follow. To read the full transcript, click here.

Washington, DC: What plans does the District has in place to tackle this epidemic? Surely being rated higher than Africa is a scary thought in itself. I hope people will wake up and care enough about themselves and others to get tested, early detection is the key.

This news is very unsettling, disappointing, and scary. I hope we find a cure soon. Thank you.

Dr. Shannon Hader: Because our epidemic in Washington is both large and complex, with every mode of transmission represented, we often say we can't afford to do just one thing, we have to do it all. A lynchpin of our response -- because it is the link between prevention and care/treatment-- is regular, routine, voluntary HIV testing as part of regular, routine medical care. Care strategies include increasing the linkage between testing positive and establishing an medical home, reaching out to bring people back into care, and making sure those participating in care benefit maximally from what care and treatment offers for health. For prevention, we seek to make sure people get the information and skills to prevention gettting or giving HIV, by providing info, community-level mobilization, free condom distribution, harm reduction including needle exchange, and other evidence-based prevention interventions.

Washington, D.C.: Dr Hader, as a gay man living in the District (HIV Negative and test regularly) I am disgusted by the nonchalant attitude of many of my peers, that, "meh, you can just take a few pills and be okay." It seems to me, that unprotected sex is now accepted as a social norm. Does the HAA have any plans to conduct education or outreach concerning this?

Dr. Shannon Hader: HAA and the city do have plans to focus on the importance of safer sex. Starting in 2007, the District became the second jurisdiction in the country to support a public-sector condom distribution program. This program supplied 1.5million condoms in 2008, and is slated to expand greatly in 2009. We are developing a large scale social marketing campaign to support this expansion. But shifting social norms for healthier choices will take action on all fronts--the department of health, community leaders, friends and family. Afterall, friends can help friends make safer choices.

Arlington, Va.: Considering people are surviving longer with HIV due to improved treatments, would it not be expected that the prevalence of the disease would be high?

In layman's terms, the high rate either means more people are getting it, or people who have got it are surviving. I know the latter is true, what about the former?

Also, given the increased number and availability of resources for HIV patients in the District compared to Virginia and Maryland, is the high rate a byproduct of people migrating into the city to live to take advantage of these resources?

Understanding the reasons behind the statistics would go a long way in ensuring that city resources are allocated properly to address the real issues driving the numbers, don't you think?

Dr. Shannon Hader: THere are definitely many reasons driving the high numbers. Yes -- fortunately -- many HIV-positive people are surviving and leading healthy lives due to the effective treatments available. Therefore, we do not expect the overall rates to go down -- our goal is that everyone who is infected will lead long and healthy lives with the right care and treatment. However, it is also clear that we have not yet eliminated ongoing transmission and new infections. This requires a comprehensive response which we are building -- one major part of that is helping folks find out they are HIV-infected as early as possible, because most people once they find out they are HIV positive they take measures to prevent ongoing transmsission.

By Christopher Dean Hopkins  |  March 16, 2009; 4:36 PM ET
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