State health officials declared yesterday a possible turning point in Maryland's fight against AIDS: a declining rate of new infections in the hardest-hit area of Baltimore.
The three-year decline was hailed because the area - a wide swath of West Baltimore riddled with poverty, crime and drug abuse - had been the only place in the state where the infection rate had been rising.
Liza Solomon, director of the Maryland AIDS Administration, said new cases of HIV infection dropped 24 percent from 1999 through 2001 after several years of increase.
At least some of the credit, she said, should go to stepped-up prevention efforts by her agency along with the city health department and a constellation of community groups. These include an expanded needle-exchange program, billboards and bus placards promoting testing and prevention, and new places where people can get tested and referred for treatment.
Since 1999, the peak year for infections there, the state has poured $1.5 million a year into prevention activities that targeted the area, while private groups had won another $1.5 million in grants from the federal government and other sources.
"This clearly says we can make a dent, that we can improve the health of our community," Solomon said at a news briefing. "A 24 percent decline is quite dramatic. It's not just a percentage - it translates into people's lives saved."
The rate of new infections declined from 209 cases per 100,000 residents in 1999 to 159 cases per 100,000 last year.
The intensified efforts began in 1999, when the AIDS Administration realized that the soaring rates of new infections in West Baltimore were distorting the state's HIV statistics, with new cases declining or leveling everywhere else.
In a section of West Baltimore defined by three contiguous zip codes - 21215, 21216 and 21217 - infections had jumped an average of 36 percent a year since 1994. That was the year the state began requiring doctors and labs to report all new cases of HIV infection.
The neighborhoods run along Park Heights Avenue, Liberty Heights Avenue and Reisterstown Road. The epidemic has been driven mainly by drug use and heterosexual activity that often involves at least one drug-using partner, Solomon said. A distant third is unprotected sex between men.
Why rates were rising there and nowhere else remains unclear, Solomon said. Drug use, poverty, low education levels and other conditions that give rise to AIDS run high in the neighborhoods, but many other neighborhoods share those problems.
A possible clue is that the area has few health-care facilities, she said. Other poor sections of the city are served by hospitals such as Johns Hopkins, the University of Maryland and Sinai, which offer testing, counseling and treatment. (Sinai is the closest hospital, but lies somewhat north of the worst-afflicted area).
Solomon noted, however, that the city and state still face a serious problem. Baltimore has the third-highest rate of new AIDS cases in the country, trailing New York and Miami. As a state, Maryland trails only the District of Columbia and New York. The onset of AIDS can lag the initial infection by more than 10 years.
Community activists greeted yesterday's announcement as a welcome indication that their efforts were paying off.
"It doesn't surprise me because there has been a concentrated effort over the last several years," said the Rev. Debra Hickman, director of Sisters Together and Reaching. "But I have a concern: We can't let up."
The group drives a van in which people can get tested for HIV and sexually transmitted diseases. Outreach workers also fan out and talk to residents about prevention.
Angelique Mason, director of Becoming a Responsible Teen, a prevention program at Southwestern High School, said teen-agers are beginning to understand the risk of unprotected sex and take precautions. Much more needs to be done, she says.
"The population we work with, they think they're immortal and [HIV] is not going to happen to them," said Mason, who works with the Payne Memorial AME Church. "We have to help them understand it can happen if they continue these practices."
News of progress should not undermine the state of emergency against AIDS declared Dec. 2 by Mayor Martin O'Malley, Solomon said.
"I'm not declaring victory over HIV and AIDS," she said. "We should not be sanguine right now. We have a lot of problems."