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2005-12-01-US capital faces serious HIV challenge
Although it is home to the wealth and power of the US government, Washington DC has a poor record when it comes to HIV/Aids. Government statistics show the city has the highest incidence of Aids in the country - about 170 cases per 100,000 people, and high rates of HIV infection.
At a recent service at Washington's oldest black Catholic church, helpers handed out badges picturing an Aids ribbon turned into a question mark.
"Have you been tested?" the priest asked the congregation, urging anyone who hadn't to get themselves tested soon.
The initiative highlights a shocking statistic in the nation's capital. Of the one in 20 adults infected with HIV, up to a third don't know they have the virus. And that means they are more likely to pass it on.
"It is serious. It is a pandemic of catastrophic proportions," says Kwame Roberts, administrator of RAP incorporated, which works with drug users living with HIV/Aids in Washington.
He says African American males in the city are the worst affected, with as many as one in seven carrying the virus.
And he cites a number of reasons for that figure, including disparities in health care and high rates of substance abuse in the city, with poverty the key underlying factor.
But, he says, "the main point seems to be that we are not getting tested and we are not getting treated early enough".
Campaigners say Washington does not have adequate prevention, testing or treatment programmes.
They blame, in part, its unique status as the nation's capital, which means it has to get approval in Congress for much of its spending.
Activists say, for example, that the city does not have a needle exchange, which could help reduce transmission of HIV between drug users.
They also cite a reluctance among conservative politicians to allow funding of education and prevention messages because of fears it may encourage promiscuity.
In October, the District of Columbia health department announced it was expanding its rapid testing services to reach anyone seeking care at its STD clinic in the impoverished south-east of the city and those entering the DC jail system.
This "will increase our chances of reaching every District resident with life-saving interventions", said Gregg Pane, the department director.
Results from rapid tests are available on the same day and the programme has been shown to increase the likelihood that people will get tested.
Marsha Martin, the senior deputy director of the city's HIV/Aids administration, said the expansion was part of a "commitment to fully embrace every opportunity to stop the spread of HIV in the District".
For activists like Kwame Roberts, all segments of the city - from the government to church groups to individuals - have to get involved in fighting the disease.
At the moment, the HIV/Aids situation in Washington DC "is as bad as or worse than some third world countries", he says.