Between Promise and Performance: Leadership

Promise & Performance:
Leadership | Condom Distribution | HIV Testing | X-Pres

Leadership

The District of Columbia still does not have a Director for the HIV/AIDS Administration. For six months now, the HIV/AIDS Administration has been a ship without a captain. Mayor Adrian Fenty announced at the beginning of his term, that he would not reappoint Marsha Martin to the position. At that time, Gregg Pane, head of the Department of Health, appointed himself as interim leader.

Gregg Pane continues to split his time between his responsibilities as the head of the Department of Health and as the interim leader of the HIV/AIDS Administration. Both Pane and Fenty have referred to HIV/AIDS as the top health priority in the District, yet for six months now, we have settled for part-time leadership.

The Promise: On February 9th, the Washington Blade reported that: "he (Gregg Pane) said he and Fenty would name a new director of the administration in 30 to 60 days after Pane 'gets to the bottom' of what AIDS activists and health advocacy groups have said has been a problem-plagued agency for years."

The Performance: Gregg Pane failed to make good on this statement. Now, five months later, we are still waiting for a new Director. Adrian Fenty now bears the awkward distinction of being the only Mayor of DC without a full time Director of the HIV/AIDS Administration since the beginning of the epidemic.

Between Promise & Performance: Testing

Promise & Performance:
Leadership | Condom Distribution | HIV Testing | X-Pres

HIV Testing & Counseling

HIV testing is crucial in the District of Columbia. You can't treat HIV if you don't know you have it. One of the reasons DC has the highest HIV death rate, is that many folks don't get tested for HIV until years after they have become positive. They show up at a clinic or an emergency room and their HIV has progressed beyond the point at which current medications can be most effective.

The Promise: Former Department of Health HIV/AIDS Administration (HAA) Director Marsha Martin set the ambitious goal of having all DC residents tested for HIV between June 27th, 2006 and December 31st, 2006. This was based in part on the CDC's Revised Recommendations for HIV testing. Since that time HAA has failed to set any specific, measurable goals on HIV testing in the District.

The Performance: While HIV testing in the District did increase between June 27th, 2006 and December 31st, 2006, HAA did not come anywhere close to the ambitious goal of having everyone in DC know their HIV status. To make matters worse, many of the expensive HIV testing kits that were ordered had to be given away before their expiration or were simply thrown out.

Further, a number of experts are now challenging the revised CDC recommendations, the basis upon which this campaign is built, arguing that targetted HIV testing is much more effective than the CDC's 'mass testing' initiative.

I believe that in DC we need both a general testing campaign and smart, targetted HIV testing initiatives like the one conducted at DC Black Pride.

HAA's testing campaign failed to meet it's goal. Which means, quite frankly, that there are people out there in DC who won't find out their HIV status until it's too late. We will continue to have the highest HIV death rate until we can get our residents tested and into treatment sooner.

We desperately need leadership on this issue. HAA needs to set specific and measurable HIV testing goals and meet them.

Between Promise & Performance: X-Pres

Promise & Performance:
Leadership | Condom Distribution | HIV Testing | X-Pres

X-Pres

One of the most important things the DC Department of Health HIV/AIDS Administration (HAA) does is to make sure that the people living with HIV in DC get the services they need. In order to do that, HAA needs to make sure that the agencies and organizations they give money to actually provide the services they say they are providing. HAA is supposed to accomplish this through site visits, monthly reports, and by tracking the data entered into X-Pres. X-Pres is a computer program that (if it is working) allows organizations that receive HAA funds to enter information about their clients and the services they are providing.

The Promise: Over the years HAA has spent millions on a computer system that is supposed to accurately track the services being provided to people living with HIV/AIDS in the District.

The Performance: X-Pres is currently in a state of failure.

Last month I asked you to send me stories about your experience with X-pres and boy, did you. Here is what I learned.

• Agencies are not entering data into X-Pres because they have folks who have been waiting months to get trained. Those who have received training in the past year were very critical of the training they received.
• Agencies are not entering data into X-Pres because they have been waiting (in some cases six months or longer) for usable user-id's and passwords
• Most agencies that can enter data are not entering accurate information because they have one or more grant numbers that haven't been updated in the X-Pres system. So there is NO way that you can tell whether or not an agency is providing services under current HAA grants

The state of this system is shameful. What is more shameful, however, is that these problems have been brought to the attention of HAA time and time again; month after month; to no avail. I personally sent an e-mail back in May, hoping that the situation could be fixed and it wouldn't be necessary to blog about this. I'm still waiting to here back.

With so many problems with X-pres it is impossible to produce any useable data.

What are the demographics of people living with HIV who access services in the District? Which local AIDS Service Organizations did not meet their goals in providing service last month? Are women less likely than men to access health services in DC? How many people living with HIV accessed any services at all in the past three months?

If X-pres was working properly, getting this kind of data pulled would be a simple task, and it would be incredibly useful information for HAA and for our Ryan White Planning Council.

Once again, however, this is not the case.

Between Promise & Performance: Condoms

Promise & Performance:
Leadership | Condom Distribution | HIV Testing | X-Pres

Condom Distribution

Condom distribution is an essential service health departments provide, but for some time now, the DC Department of Health HIV/AIDS Administration (HAA) has fallen short.

The Promise: On two separate occassions, HAA has pledged to distribute a million condoms. The first of these pledges was made by Marsha Martin at the Washington Times Citizens Forum on HIV/AIDS on October 14th, 2006. Then when Dr. Gregg Pane took over responsibility for HAA He repeated the plan to distribute condoms in an article in the Examiner.

So they've been talking about this for about eight months. Surely, they've distributed a million condoms by now, right? After all the New York City Department launched a similar campaign around the same time, and they distribute anywhere from three to five million condoms each month

The Performance: DC Department of Health has not come close to distributing a million condoms. But what is even worse than that, is that they are misrepresenting how many condoms have actually been distributed.

When I hear the word 'distributed', I assume that this means condoms are available to folks who need them. When HAA uses the word 'distributed' they mean that boxes of condoms (and responsibility) has been passed on to other people.

And that's exactly where we are. In February HAA 'distributed' the first 250,000 condoms, but the vast majority of these condoms are sitting in boxes in closets, and hallways, and basements, and will not be made available to anyone anytime soon. If you don't believe me I will gladly take a film crew to show you box after box of 'distributed' condoms sitting in less than optimal storage conditions.

The biggest flaw with the HAA plan is that they gave 120,00 of these condoms to LifeGuard DC, an almost entirely volunteer effort. LifeGuard is a great group of volunteers, to be sure, I volunteered with them myself. But they were in no way equipped to handle this number of condoms. Up to this point, Lifeguard had successfully distributed around 8,000 condoms through two distributions points.

HAA didn't ask Lifeguard to double their volunteer effort, or triple it even. HAA gave them fourteen-times that number of condoms (120,000) with no financial assistance and no additional support and conveniently handed off responsibility declaring these condoms had been 'distributed' to the community.

Fast forward a few months later and it's no suprise that with no money and no support, the overworked and underappreciated LifeGuard volunteers haven't distributed anywhere near 120,000 condoms. Back in February, I wrote this post specifically to warn that relying too heavily on volunteers for this plan was a bad idea. Clearly, that was true. Lifeguard is not expected to continue distributing any condoms after August. The vast majority of these condoms are sitting in the basement of one of the volunteers.

Still the message HAA is giving the mainstream press is very, very different. HAA told the Washington post that 250,00 Condoms had been deployed in February of 2007. HAA continued to give exaggerated numbers at the DC Campaign to Prevent Teen Pregnancy Best Practices Coalition Meeting. We know better.

You can see the breakdown of where the first 250,000 condoms were 'distributed' here. A second batch of condoms arrived at HAA in March, but it's not clear where those were 'distributed'.

Bottom line, HAA has not reached this goal. To distribute a million condoms, HAA is going to need to come up with a plan that is more substantive that simply passing the buck to the Lifeguard volunteers.

New York City Department of Health successfully distributes between three and five million condoms each and every month through an effective network of hundreds of distribution points. Compare that to DC. Lifeguard has two distribution points. If you look at all the agencies that received condoms, HAA had maybe 20 distribution points total for this effort.

Distributing a million condoms in DC is a realistic and achievable goal. It is crucial to our efforts to prevent HIV in DC. But it is a goal that HAA has not yet met.