Baltimore has ambitious plans for its public health sector in the next three years: By 2015, city officials plan to cut new HIV/AIDS infections by 25 percent. While public funds are limited, government leaders say they're confident that the detailed plan, which seeks to reallocate placement of intervention programs and revamp city programs, will reduce the transmission of a disease that has plagued Baltimore for decades.
The city announcement comes just in time for World AIDS Day, celebrated each year on Dec. 1.
"For the last 30 years, the HIV epidemic has been rampant in Baltimore city and we haven't managed to get out of the top 10 cities [for highest rates of HIV in the U.S.]," said Dr. Oxiris Barbot, city health commissioner for Baltimore. "We wanted to take a fresh look at what we're doing to reduce the epidemic."
According to the Centers for Disease Control and Prevention, Miami has the highest HIV rate of all U.S. cities. More than 64,000 Miami residents carry the deadly virus.
Baltimore Mayor Stephanie Rawlings-Blake announced the new plan Tuesday to combat a disease that affects more than 13,000 Baltimore residents, and more than 1.1 million nationwide.
In accordance with the new plans, Baltimore city officials will extend needle exchange programs; use mobile medical services and primary care to implement HIV testing and diagnoses; and target locations such as schools, sex clubs, prisons and other areas where there may be a higher-than- average rate of unprotected sex and drug use. Particularly high-risk populations include gay and bisexual men, African American men, and those who participate in unprotected sex with many partners and intravenous drug use.
While Barbot acknowledged that the 25 percent reduction within three years is an "aggressive benchmark," she said the city needed to set the bar high because the epidemic has been so devastating to the city.
Barbot also noted a particularly jarring detail about Baltimore's HIV/AIDS patient population from past city-wide research—about 27 percent of newly diagnosed patients have full-blown AIDS by the time it is discovered. Those people could have been unknowingly carrying the HIV virus years before diagnosis, said Barbot.
"There is currently a movement for aggressive intervention," said Dr. Myron Cohen, chief of the division of infectious diseases at University of North Carolina at Chapel Hill. "We've gone for 30 years with about 50,000 new cases every year. I applaud Baltimore for trying to move forward courageously and creatively. Their plan serves as a model for others to look at."
While Baltimore officials say they could use millions more in funding to revamp the program, about $6 million to $7 million in city funding is available for HIV/AIDS initiatives. They plan to stretch resources and reallocate outreach efforts. Clearer guidelines and strategic budgeting have been considered to make the most out of the resources available.
"Unfortunately, national funds to the state of Maryland were cut by 10 percent, so now we have to look at what we have and what's the smartest way to utilize that money to make the difference," said Barbot.
"The strategy that Baltimore has developed is in line with the president's HIV/AIDS plan and incorporates the latest scientific evidence," said Thomas Coates, the Michael and Sue Steinberg professor of global AIDS research at UCLA. "Baltimore should make maximal use of resources of Johns Hopkins University and the University of Maryland Medical Center and those resources already available in Baltimore. This could be an important breakthrough for a city hard hit by the AIDS pandemic."
In July, the Obama administration released a national HIV/AIDS strategy, which also seeks to reduce HIV/AIDS by 25 percent within five years. The initiative also plans to increase access to care and concentrate HIV/AIDS prevention outreach in high-risk populations.
"Other cities should do the same thing, including New York City, Washington D.C., Atlanta, Houston, Dallas, Miami, Los Angeles and San Francisco," said Coates. "These cities should develop ambitious strategies and share best practices."