Six years after city officials declared a "state of emergency" over Baltimore's AIDS problem, a commission is calling for stronger prevention efforts to reverse an epidemic that remains one of the nation's worst.
In a report released yesterday, the advisory panel said Baltimore is beset by rising infection rates among adults in their 20s. Meanwhile, African-Americans continue to bear the brunt of the disease, accounting for 90 percent of new HIV and AIDS cases.
"Baltimore as a whole is not doing well," said Dr. William Blattner, an epidemiologist who heads the Baltimore City Commission on HIV/AIDS Prevention and Treatment. "We need to have a strategic plan so we can move ourselves out of the top 10 in a coordinated way."
Blattner said he was disturbed by data showing that annual infections among people 20 to 29 had increased 10 percent between 2000 and 2006 - a trend that the school system could address through "age-appropriate" classes starting in grade school, he said.
Officials released the report at a town meeting last night at the Baltimore Urban League on Orchard Street.
A federal report indicates that metropolitan Baltimore has the second-highest rate of new AIDS cases in the nation, trailing only Miami. One positive trend: The rate fell from 40.1 new cases per 100,000 people in 2005 to 37.7 cases per 100,000 in 2006.
Almost 16,000 city residents - or about 2 percent of the population - were living with HIV infection or full-blown AIDS in September 2006, the last date for which there are good data. The rate of new infections has been declining by about 2 percent a year, according to the state AIDS Administration, but not as fast as many other cities that once had faster-growing epidemics.
In 2005, the commission said the city had failed to respond to an emergency declared three years earlier by then-Mayor Martin O'Malley. It found poor coordination between city agencies and no overall plan to stem the epidemic. The group also noted poor coordination between the city and state health departments.
Now, in its latest report, the panel lauds Mayor Sheila Dixon, Baltimore's health commissioner, Dr. Joshua M. Sharfstein, and state AIDS Administration Director Heather Hauck for demonstrating resolve to tackle the problem. But it found plenty of room for improvement.
It has called on the city to measure results of its prevention efforts, to ensure that people who test positive get treatment and to increase AIDS education in the public school system.
The group also recommended a citywide advertising campaign to raise HIV/AIDS awareness and programs to link homeless people with HIV to housing and treatment.
In an interview, Sharfstein said his top priority is developing a "coherent prevention plan," saying the city still lacks an inventory of what public and nonprofit agencies are doing and what they have accomplished.
All told, about 50 agencies are receiving almost $6 million in prevention grants from various sources, though primarily from the federal government.
The Health Department is devising a program called "HIV stat," which will ask agencies to report their activities on a quarterly basis. For example, nonprofits receiving grants for counseling and testing will indicate how many people they tested and how many people got into treatment.
Similarly, groups receiving education grants will be asked to report how many people have completed their programs.
"There's no public accounting," said Sharfstein, noting that one problem is the assortment of public and private agencies making grants. "If there were a single funding agency, it would be easier."
Sharfstein said the department is also planning new ways to grapple with high infection rates among people who trade sex to support their drug habits, a problem highlighted by a report in The Sun in November.
In January, the agency began dispatching vans staffed by outreach workers to neighborhoods known for prostitution. The workers have been counseling and testing women, and have referred several to treatment programs offering buprenorphine, a medication that blunts the craving for heroin.