Turning around the HIV epidemic in the nation's capital "has been like turning around the Titanic in the Potomac [River]," prominent HIV-testing advocate A. Toni Young said.
The reference to the river that runs through Washington, D.C., was significant for two reasons. For one, Young happened to be speaking at the International AIDS 2012 Conference, hosted this year in Washington.
But it was also relevant in light of the fact that the city through which the Potomac River flows struggles with an HIV prevalence rate of nearly 3 percent.
Yet, there seems to be signs of real progress. Young is founder of the Community Education Group, a nonprofit organization working to increase HIV testing and provide HIV education in the District, particularly for black women. She was joined by city officials and researchers at the AIDS conference to showcase the results.
"The results speak for themselves," said Dr. Mohammad Akhter, director of the D.C. Department of Health.
The number of deaths among people with HIV has declined by nearly half, from 399 in 2006 to 207 in 2010. The number of AIDS cases -- a signal of a late diagnosis of HIV -- dropped by nearly one-third in the same time period. No babies have been born with HIV in the District since 2009.
What's driving this change?
"One of the drivers of this decline [in HIV deaths] is a very successful needle-exchange program," said Dr. Gregory Pappas, director of the D.C. Department of Health's HIV/AIDS, Hepatitis, STD and TB Administration.
From 2007 to 2010, there was more than a 70 percent drop in the number of newly diagnosed HIV cases attributable to injection drug use. The District scaled up its needle exchange program in 2007. It distributed more than 340,000 needles last year.
Pappas is quick to point out that needle-exchange programs do more than provide clean needles to injection drug users. "We've brought thousands of people into treatment for substance abuse," he said.
D.C. has also expanded HIV testing, tripling the number of tests it provides in the past several years. It has established partnerships with the National Institutes of Health and other institutions in the city to improve HIV surveillance and to promote research to improve HIV care in the District.
Despite these gains, however, there is significant work to be done to ensure long-term treatment after an HIV diagnosis. Only one-third of patients receiving HIV care in the Washington show a suppressed "viral load," a measure of control of the virus for an individual.
For some D.C. residents, dealing with an HIV diagnosis and staying in treatment is a matter of community support. Hazel Smith, a 65-year-old black woman and lifelong District resident, was diagnosed with HIV in 2001. At the time, she was struggling with drug and alcohol addiction, and having unprotected sex.
She was "in denial" for months after her diagnosis, until she found The Women's Collective, a D.C.-based organization that has been supporting women living with HIV since 1993.
"[They] gave me hope, and let me know that I can live [with HIV]," she said.
Hazel has since completed treatment for alcohol and drug addiction, which she said was the first step in treating her HIV.
Today she is on antiretroviral therapy, and doing well. At The Women's Collective, she provided HIV testing and counseling, as well as education about female condoms.
"Some people see me as a mother figure, for others I'm a sister or an aunt," Smith said as she talked about identifying with girls and women of many ages.
She also provides HIV education to some of the District's poor and less-educated residents. "I always keep it on their level," she said. "I speak their language."
But despite the efforts of people like Hazel, as well as health officials and researchers, the prevalence of HIV in Washington is 2.7 percent, remaining well above the World Health Organization's 1 percent threshold for declaring a "severe and generalized epidemic."
And mirroring the national epidemic, racial disparities are striking. More than 6 percent of D.C.'s black men have HIV, more than double the prevalence among white men. An estimated 2.6 percent of black women in the District are living with HIV, compared with only 0.1 percent of white women.
While the District's progress in combating the epidemic is evident, there is still a long way to go.