Prevention Works
Prevention Works, one of D.C.'s leading needle exchange programs closed its door on due to funding delays. (Photo/Angelia Levy)

Note: Article was originally posted April 30, 2011 on American University’s

PreventionWorks!  a syringe exchange program in Washington, D.C., provided clean needles to intravenous drug users as a prophylactic measure against HIV infection for more than 12 years.

On Feb. 25, it closed its doors. It had run out of money, a casualty of apparently diminished interest in HIV/AIDS in America, according to its director of programs and services, Mary Beth Levin. “Our work, like HIV/AIDS in general, had gone from being a high priority, to low priority to no priority,” she said.

The organization started distributing free, clean needles in 1999.  It also provided free HIV testing and used a mobile unit and volunteers to distribute condoms and information about HIV awareness. “It was great way to do outreach,” she said. Intravenous drug users account for 20 percent of those infected with HIV.

HIV prevention efforts in the District receive most of their funding from community partners, such as nonprofit organizations, community programs, and local constituents, according to Michael Kharfen, bureau chief for Partnerships, Capacity Building and Community Outreach at the D.C. Department of Health.

Private donors and foundations “assumed we got a lot of government money; therefore, they didn’t need to give a lot of money,” said Levin.  According to Levin, people didn’t realize the organization “never received federal funding” until 2007 because of the federal ban that restricted use of federal funds for needle exchange programs.

Even after the ban was lifted, government funding did not trickle to the organization. “Preventing HIV in intravenous drug users is not a huge priority” when it comes to funding, said Levin.

HIV Infection in the District

HIV infection rates have risen steadily since 2004.  In 2009, the Centers for Disease Control and Prevention reported that the District of Columbia had a higher rate of AIDS diagnoses than any other metropolitan area in the United States.

HIV Chart: District of Columbia’s 2009 HIV/AIDS Epidemiology ReportHIV Chart: District of Columbia’s 2009 HIV/AIDS Epidemiology Report

The 2008 District of Columbia epidemiology update found that more than 3 percent of the District’s population, or 3,000 out of every 100,000, had been diagnosed with HIV and AIDS.  The report stated that 21 percent of new infections came from intravenous drug use.  In an interview with NPR in March 2009, former D.C. Mayor Adrian Fenty said D.C.’s HIV rate is “one of the worst, not only in the region or the country, but in the world.”

Funding HIV Programs

In 2009, D.C. received $54.5 million in federal funding from the Ryan White program, which raised D.C.’s total HIV budget to $88 million. The program, administered by the U.S. Department of Health and Human Services, provides HIV/AIDS resources to all 50 states, including the District of Columbia.  It has a budget of $2.1 billion.

Kharfen said D.C.’s 2010 HIV/AIDS budget was approximately $85 million. Of that, $75 million came from federal funds and the other $10 million came from D.C. tax revenue. According to AIDS United, the lifetime medical cost of treating a person living with HIV/AIDS is approximately $355,000.

The District’s Department of Health’s HIV/AIDS Administration (HAA) manages and distributes funds from the Ryan White program.  It gathers data on HIV/AIDS in the area and distributes federal money to community organizations’ HIV prevention efforts, such as free HIV testing, condom distribution, or providing HIV drugs.

Kharfen said “The majority of HIV funding is distributed to about 70 to 80 community partners,” who  provide HIV testing, education, prevention, counseling, and medication, but not harm reduction programs.  Until 2007, federal funding could not be used for a clean needle/syringe exchange program, such as PreventionWorks!, despite the high rate of HIV transmission rates due to intravenous drug use in the District.

Levin said that D.C.’s lack of statehood meant reliance on federal funding and compliance with its conditions and rules. She said D.C.’s HIV prevention programs had to “adhere to fed guidelines,” which may not address needs unique to the city.

Future of HIV Programs in the District

D.C. has encountered roadblocks in HIV prevention and education–such as five leadership turnovers in the HIV/AIDs Administration office in seven years; mismanagement of funds; and lack of program accountability.

Mayor Vincent Gray this month announced that he was putting together a 27-member Mayor’s Commission on HIV/AIDS.  In a March press release, Gray said that “by bringing together HIV/AIDS leaders from our best medical institutions, our universities and the community, this commission will ensure that we fight HIV as One City.”

Levin questions the commission because it does not have a public health specialist to create policies that reduce harmful consequences associated with drug use. In addition, the commission does not have representation from the HIV-infected community.

Levin believes that the District has done a good job with “documentation and treatment” of HIV/AIDS in the area, but it is still playing “catch-up” when it comes to HIV prevention.