As of 2019, 12,408 people who live in the District of Columbia are diagnosed with HIV. That figure — an estimated 1.8% of DC’s population — is based on case reports and laboratory data collected as part of routine monitoring of disease, also referred to as disease surveillance. However, the true burden of HIV in DC is higher than what is documented. Statistical modeling suggests that about 1,200 DC residents are living with HIV but unaware of their HIV status.
While the District continues to observe a reduction in the annual number of newly diagnosed HIV cases, the rate of decline has varied over the past decade. In 2019, 282 individuals were newly diagnosed with HIV in the District, marking a 29% decrease from the 399 newly diagnosed HIV cases documented in 2015.
Unfortunately, such declines have not been consistent across all populations, contributing to persistent demographic disparities in the risk and burden of HIV within the District. We saw a 42% decline in the number of newly diagnosed HIV cases within the white population over the past five years, compared with 24% and 37% declines over the same time period documented within the Black and Latino communities, respectively. Overall, the largest proportion of newly diagnosed HIV cases from 2015 through 2019 was Black men who have sex with men (31%), followed by Black women (21%), for a combined total of 1,766 residents. The next highest figures are white men (9%) and Latino men (9%) who have sex with men. Approximately 3% of newly diagnosed HIV cases in the District from 2015 through 2019 occurred within the transgender community — although this is most likely an underestimate, due to limitations of the data.
Slightly over 50% of all individuals living in the District diagnosed with HIV are 50 or older; however, newly diagnosed HIV cases tend to occur within younger age cohorts. From 2015 through 2019, approximately 34% of newly diagnosed HIV cases in the District occurred among those ages 20 to 29, with individuals ages 30 to 39 accounting for the second-largest proportion of newly diagnosed HIV cases (28%).
Geographically, the highest HIV burden and rates of new infection are observed in the eastern region of the District, comprising wards 5, 6, 7, and 8.
Of those diagnosed with HIV living in the District, there is evidence that approximately 80% are engaged in HIV care (reflected by their having at least one laboratory report with a CD4 or viral load measurement) in 2019, with 87% of those engaged in care having an undetectable viral load (less than 200 virus copies/mL) based on their last laboratory report during the year.
Of the 1,766 newly diagnosed HIV cases from 2015 through 2019, 88% were linked to care within 30 days of diagnosis and 60% had evidence of achieving viral suppression within 90 days of diagnosis. There is evidence of some variation among demographic groups in the level of engagement in HIV care. Even larger disparities are apparent when it comes to viral suppression among those engaged in care. Notably, 95% of white individuals living in the District diagnosed with HIV who were engaged in HIV care in 2019 had evidence of being virally suppressed based on their last documented laboratory report, compared with 72% of Black individuals and 68% of Latino individuals.
A similar disparity is also observed with regards to age. Approximately 90% of individuals living in the District diagnosed with HIV age 40 and over who have an HIV diagnoses and were engaged in HIV care in 2019 had evidence of being virally suppressed based on their last documented laboratory report, compared with 79% of individuals age 39 and younger.
While the total number of deaths among individuals diagnosed with HIV living in the District diagnosed with HIV declined slightly between 2016 and 2018 (from 314 to 277), the proportion of deaths attributable to HIV has remained relatively stable. Less than 30% of the deaths occurring from 2016 through 2018 among individuals diagnosed with HIV living in the District had HIV documented as the primary cause of death. The most prevalent documented primary causes of death among individuals living with HIV in the District are cancer, cardiovascular disease, and accidental death.
While we continue to document positive epidemiologic trends in HIV diagnosis, care engagement, viral suppression, and mortality within the District, challenges remain with regards to reducing inequities across the population in the risk and burden of infection.
Complete Epidemiology Profile: HAHSTA Annual Epidemiology & Surveillance Report 2020