In 1987, just 35 years ago, scientists introduces AZT as the first treatment for HIV. Previously considered a terminal diagnosis, this new treatment gave hope to those diagnosed with HIV.
Over the past 35 years, scientists, healthcare providers, and the government have worked together to develop antiretroviral treatments, which, enhanced over time, have made it possible to live a long, healthy, happy life with an HIV diagnosis. Additional medications bring HIV to undetectable levels, preventing the spread of HIV to others and contributing to the end of an epidemic.
But the epidemic can only end if people have access to and utilize these treatments. For DC, a city that has made remarkable steps in decreasing the spread by encouraging testing and connecting people to treatments, creating access and developing trust in the medical system for the most vulnerable populations is the next challenge in ending the epidemic.
DC has the highest rate of HIV in the country, with a rate of 39.2 people infected per 100,000 people (CDC.gov). That’s 1.8% of the DC population that is living with HIV (2020 HAHSTA Surveillance Report). The city is taking great strides to address these statistics. In 2015, the city introduced their “90/90/90/50 plan.” The plan’s name reflects its goals: by 2020, 90% of all District residents with HIV will know their HIV status, 90% of District residents living with HIV will be in sustained treatment, and 90% of those in treatment will reach “viral suppression.” If completed effectively experts predicted the plan to reduce new HIV cases in DC by 50% by 2020.
The plan focused on a model that emphasized increased screening for HIV, linking those who test positive with resources like mental health and substance abuse counseling, engaging and retaining people in treatment so their HIV remains undetectable and non-transmissible, and providing drug therapy.
Additionally, the plan also acknowledged the systemic factors that contribute to people of color and vulnerable populations (like the unhoused community) contracting HIV at higher rates than their counterparts, while also having decreased access to treatments.
After the completion of this plan in 2020, DC examined its successes and areas of improvement. Taking into consideration these learning opportunities, DC is now operating under the newest iteration of the plan to end the HIV epidemic, DC Ends HIV. This plan has loftier goals than the 2020 plan, as it aims for fewer than 130 new HIV diagnoses per year, 95% of DC residents knowing their HIV status, 95% of HIV positive people in treatment, and 95% of people in treatment living with viral load suppression (decreasing transmissibility) by 2030.
To achieve these higher goals, the government added another arm to their “Diagnose, Treat, Prevent, Respond” strategy: Engage. This strategy acknowledges that the push to end HIV in the District must now go towards the hardest to reach populations, the ones with the least trust towards the medical community.
This is where Thrive DC comes in. The city needs connections with the most vulnerable residents, connections that are built on trust and respect, in order to communicate effectively about the benefits of testing and treatment. But for these vulnerable populations–especially people of color, women, and individuals with low-income who are more likely to experience medical mistrust–these connections could take a long time to build with someone like a government official or traditional medical provider because of the preexisting mistrust.
But at Thrive, we already have these connections with our clients. We are a safe space for them to receive food, take a shower, get their mail, take employment training, share their experiences with domestic abuse or being a victim of a crime, or opening up about substance abuse or mental health. We’re here for them. Consistently. Every day. For the past 40 years.
Our clients are disproportionately affected by HIV, with 3.3% of unhoused adults living with HIV/AIDS, as measured during the 2021 Point In Time Count. As we serve predominantly people of color, we conservatively estimate that at least 20 - 25% of our current client community are HIV positive or living with HIV. We also estimate that at least 40% of our clients are engaging in behaviors that significantly increase their risks of becoming HIV positive.
By utilizing the connections we’ve already established with our clients, we can connect them with the resources that the city and other providers have, that our clients might not otherwise use. We’ve partnered with the CDC to provide HIV self-test kits to our clients, so they can learn their status. We also provide safe sex supplies, substance abuse & mental health counseling, victim services, and general case management to encourage safe decision-making and support our clients in achieving the greater self-sufficiency and stability that promotes healthy decisions.
DC government has reached all the easy to reach HIV+ communities - what comes next are the hard to reach: the unhoused, residents with low trust towards medical institutions, and people engaged in risky behavior who aren’t connected to traditional healthcare. This is the population that Thrive serves, and we’re proud to be part of the effort to create safer, healthier communities with our clients through a model of trust and support.