From a death sentence to a manageable disease, the story of HIV/AIDS has shifted dramatically in the two decades since the United States last hosted the International AIDS Conference in San Francisco. Twenty two years on however, Washington DC, the host of the latest summit, has become the AIDS capital of the country, with African-Americans emerging as the new face of the disease.
WASHINGTON D.C. UNITED STATES (REUTERS) -Daina Jackson, student and mother of three, rushed to a clinic at the United Medical Center (UMC) in Washington D.C.'s Anacostia neighborhood to check on a painful leg infection, but stayed back to get tested for HIV-AIDS as well. The 31-year old from Gaithersburg, Maryland told Reuters she is tested regularly because HIV, she said, was "out here and real".
"Some people just don't want to know, you know, but it's something that, like I said, it's out here and it should be known by everyone and it should be offered to everyone, conveniently, so no one has a reason to not get it done," Jackson told Reuters.
Most people who go through UMC's emergency room are persuaded to take an HIV test. It is free of charge and the results are speedy.
The clinic, that administers 8,500 HIV tests a year, was started in response to the staggering HIV prevalence rates in Washington, a fact brought back into the spotlight as the U.S. capital prepares to host the International AIDS Conference or AIDS 2012 on Sunday (July 22) -- only the second American city after San Francisco in 22 years to do so.
Home to a large poor and minority population, Washington stands out as a hotspot in the fight against AIDS with 2.7 percent of the city's population living with HIV--- figures that far exceed the World Health Organization definition of 1 percent as a generalized epidemic.
While African-Americans account for just under half of D.C.'s population, three quarters of the those living with HIV are black. At the end of 2010, 4.3 percent of black residents were living with HIV.
African-American women make up 92 percent of the Washington's female HIV patients, according to a study released by the Department of Health.
Infection rates for heterosexual African-American women living in low-income neighborhoods nearly doubled in two years.
The numbers reflect the gradually changing face of the epidemic that was once stigmatized as a "homosexual disease," but in the last decade has affected a disproportionate numbers of African-Americans, particularly black women.
There are 1.2 million people living with HIV in the United States. While African-Americans make up 14 percent of the U.S. population, they account for 44 percent of new HIV infections. Government studies show the largest number of new HIV infections continues to occur among men who have sex with men of all races, followed by African-American heterosexual women.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health says the challenge to battling HIV/AIDS partly lies in a complacent attitude towards the disease. Despite 50,000 new infections in the U.S., each year polls show a declining sense of national urgency in tackling the epidemic
"The good news is that we have good therapies, we have good methods of prevention. The sobering news is that there is some complacency because if you look here in the US, early in the years of the pandemic, when you looked at the number of newly infected people each year it soared up in the 80s till it went up to 120, 130,000 new infections a year. Then it peaked and started to come down, but when it came down it sort of settled into a plateau of about 50000 new infections each year in the United States. That is completely unacceptable and we've got to do better that," Fauci said.
In sharp contrast, infection rates have steadily dropped in 33 other countries, including parts of Africa that were the worst hit by the pandemic.
In sub-Saharan Africa the number of new HIV infections has dropped by more than 26 percent, from the height of epidemic in 1997, led by a one third drop in South Africa, the country with the largest number of new HIV infections in the world, according to a 2011 UN report.
The United Nations now estimates that about 34 million people are living with HIV. Most of them live in low and middle-income countries where an estimated 8 million people are receiving antiretroviral drugs.
In a report released ahead of the AIDS meeting, the UN said that the number of worldwide AIDS-related deaths fell to 1.7 million last year from some 1.8 million in 2010. AIDS deaths peaked at 2.3 million in 2005. The decline has been fueled by greater access to medications that help more people live with the disease, but treating more people infected with HIV remains a priority in the developing world.
"Less than half of the people who really need therapy are actually getting it and unfortunately for every one person we put on therapy in the developing world two people get newly affected so its fighting almost a losing battle which means we have to ratchet up our combination-prevention modalities, which is going on right now with some success and some countries are doing much better than others," Fauci said.
Challenges persist in the field of scientific research. A safe and effective vaccine remains elusive as does a definitive cure that would prevent the virus from bouncing back in patients once they are taken off therapy.
Despite those challenges, the veteran researcher sees a light at the end of the tunnel and believes the disease will be eradicated.
"I believe we see the end in sight, I couldn't have said this 10 years ago but right now we can skip the inflection of the epidemic we can get that curve to stop pointing downward, it was going like this for a long time, now it flattened out and maybe its going, we've got to get it to significantly decrease in the trajectory of the epidemic and I believe that's possible," Fauci said.
For UMC supervisor and emergency room nurse Nona Resumadaro the path to eradication starts with the first step --getting tested for HIV/AIDS. One in five Americans are unaware that they are infected. Of the 8,500 HIV tests administered by the clinic, 170 or two percent come back positive.
"When you go from zero testing to these large staggering numbers, and you are getting a 2 percent positivity rate, this is people that never knew that they had it. So, you know, they are living their lives and doing their every day things not knowing that they have the disease and there's actually treatment out there for it. And they can live a long life with it. With the proper care. So, it's important. I think it's important for everybody to know, including myself. You should know your status."
Making it easier for people to know their status is a new in-home test for HIV, making it the first over-the-counter, self-administered test for the virus that causes AIDS. Called OraQuick, the test provides results in 20 minutes by analyzing an oral fluid sample taken by swabbing the upper and lower gums inside the mouth. U.S. health regulators recently approved the kit that's scheduled to hit store shelves in October. Healthcare professionals hope the in-home test will enable people to take a test in the privacy of their own home, given the stigma that still surrounds HIV and AIDS.
AIDS 2012 convenes in Washington at a time when medical breakthroughs have dramatically changed HIV/AIDS from a death sentence to a manageable chronic disease. The conference will focus on issues such as universal access, expanding testing, putting more people on antiretroviral drugs and creating more programs to treat infected pregnant women.
With 25,000 people expected to attend, the event raises hopes that the city with some of the highest rates of HIV infection in the U.S. will lead the way in finding a cure to stem the epidemic and eradicate the disease.