Of the more than 600,000 residents of the District of Columbia, 2.7 percent are living with HIV, according to a new D.C. government report. This rate is double the amount needed for a disease to be called an “epidemic” by the World Health Organization.
Despite that fact, no children have been born with HIV since 2009.
The D.C. government’s success in eliminating HIV births, down from a high of more than three per month, is an “awesome” achievement, says Dr. Marta Gwen of the Centers for Disease Control and Prevention.
According to the CDC, mother-to-child HIV transmission can occur anytime during pregnancy, labor, delivery or breastfeeding.
Between 1988 and 1990, when AIDS cases were at their highest levels, Dr. Gwen led a team that tested thousands of delivering moms in D.C. over a given 12-month period. It was discovered that, of those tested, 121 mothers and an estimated 36 newborn babies were HIV-positive.
HIV infections of African-American mothers continue to rise
While D.C. celebrates no new HIV births, children remain at risk due to the increasing infection rates among women, particularly African-American women. In D.C., the rates of HIV infection among all women have doubled in the past four years to 12.1 percent — that’s more than one in every ten women.
Nationally, African-American women are among the highest group of newly infected persons. In 2009, of all women newly diagnosed with HIV, 57 percent were African-American — 15 times that of Caucasian women, and over three times the rate among Hispanic and Latina women.
Unlike years past, when intravenous drug use was the primary cause of HIV infection among women of color, most acquire HIV through heterosexual sex. Yet, fear remains a hindrance for some African-American women.
“There is still a large amount of stigma surrounding HIV in women of color,” says Chip Lewis, spokesperson with D.C.’s Whitman-Walker AIDS clinic. That makes it much less likely that large amounts of women of color will get tested or treated for HIV, he adds.
Winning formula, good investment
Eradicating mother-to-child HIV transmission hasn’t been easy, says Dr. Gregory Pappas, director of D.C.’s HIV/AIDS administration.
“Physicians have worked to provide HIV tests to all new moms in the District. Those found to be positive are immediately put on medication,” explains Pappas, who credits D.C. Mayor Vince Gray for ensuring that mothers and anyone else who tests positive can receive antiretroviral medication for free. These new medicines have allowed mothers to reduce their HIV viral loads so low that it is highly unlikely for them to transmit HIV to their infants.
Babies of infected mothers are also being delivered by C-section, which “eliminates much of the blood that causes mother-infant transmission,” states Pappas. And, after birth, HIV-positive mothers in D.C. are often instructed to feed their infants baby formula rather than breast milk.
Finding a solution for perinatal HIV transmission hasn’t been cheap. A lifetime pack of antiretroviral drugs costs the D.C. government $400,000 per person, notes Dr. Pappas.
But, the investment by the District makes sense according to Larry Warren, CEO of Howard University Hospital, who regularly delivered babies with HIV in the 1980s and 1990s. In terms of D.C.’s unique HIV prevention strategy, Warren asserts “I don’t believe the District of Columbia has a peer [that rivals us] in this country.”
Talib I. Karim manages a Washington, D.C.-based law firm that assists clients in resolving health, family, and construction-related legal issues. In addition to writing for his blog, talibkarim.com, Talib hosts a weekly talk show in Washington, D.C.