High-Risk HIV Behaviors in District of Columbia

District of Columbia

Human immunodeficiency virus (HIV) attacks the body’s immune system. HIV is a chronic, lifelong condition. An estimated 1.2 million people are living with HIV in the United States. The virus spreads when certain bodily fluids of a person who has HIV enter the bloodstream of someone without HIV. The most common ways HIV is spread are unprotected sex and sharing needles with someone who has HIV. 

People who are HIV positive may experience HIV-related stigma. Nearly 8 in 10 HIV patients report feeling internalized HIV-related stigma, meaning they experience negative feelings such as shame, guilt or worthlessness. Experiencing HIV-related stigma is associated with adverse health outcomes like depression. People with HIV can also experience discrimination — for example, being ostracized by their peers or denied care by a health care professional. 

Untreated HIV can lead to acquired immunodeficiency syndrome (AIDS). By the time AIDS occurs, a person’s immune system has been severely damaged and they are more likely to develop infections and cancers. While there is no vaccine or cure for HIV or AIDS, medical therapies can help manage the symptoms. 

HIV can infect anyone regardless of age, gender, sexual orientation or race/ethnicity. However, certain behaviors like unprotected sex and needle/syringe sharing put some groups at higher risk than others. 

According to America’s Health Rankings data, populations with a higher percentage of high-risk HIV behaviors include:

• Men compared with women.
• Adults ages 18-44 compared with adults ages 45 and older.
• Multiracial adults compared with Asian and white adults.
• Adults with annual household incomes less than $75,000 compared with adults with an income of $75,000 or more.
• Adults living in metropolitan areas compared with adults in non-metropolitan areas. 
• LGBQ+ adults compared with straight adults.
• Adults who have difficulty with cognition compared with adults without a disability.
• Adults who have not served compared with those who have served in the U.S. armed forces. 

HIV infection is preventable. There are steps people can take to lower their risk of being infected with HIV, including:

• Taking preventive medications such as pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP). 
• Making sure to use a condom correctly (external or internal condom) whenever engaging in sexual activity. Combining condom use with medication is recommended when a sexual partner is HIV-positive, as condoms do not eliminate risk even when used correctly.
• Abstaining from sex. 

Not engaging in injection drug use is the safest way to avoid HIV infection from drug use, but if that is not possible, the risk of infection can be lowered by:

• Using only clean, sterile needles and not sharing needles with anyone.
• Avoiding coming into contact with other people’s blood.
• Disposing of needles appropriately after every use. 

Many communities have started implementing syringe service programs, such as needle exchanges. These programs provide safe disposal of used syringes and access to new sterile needles, as well as connections to resources such as substance use disorder treatment programs and treatment care for HIV. Studies indicate that needle and syringe programs have been effective at reducing new cases of HIV.

People who are diagnosed with HIV should start taking medicine to treat it as soon as possible. The medicine used to treat HIV is called antiretroviral therapy (ART) and it works by reducing the amount of virus in the body. ART can decrease the amount of virus in the body so much that it becomes undetectable. At that point, the person effectively has no risk of transmitting HIV to someone who is HIV-negative through sex. 

The Centers for Disease Control and Prevention has a tool to help people find HIV prevention services in their area, including condoms, HIV testing, PrEP and PEP. 

Healthy People 2030 has multiple goals related to sexually transmitted infections, including:

• Reducing the number of new HIV infections.
• Increasing knowledge of HIV status.

Further, the U.S. Department of Health and Human Services is working on an initiative to reduce new HIV infections.

Abdul-Quader, Abu S., Jonathan Feelemyer, Shilpa Modi, Ellen S. Stein, Alya Briceno, Salaam Semaan, Tara Horvath, Gail E. Kennedy, and Don C. Des Jarlais. “Effectiveness of Structural-Level Needle/Syringe Programs to Reduce HCV and HIV Infection Among People Who Inject Drugs: A Systematic Review.” AIDS and Behavior 17, no. 9 (November 2013): 2878–92. https://doi.org/10.1007/s10461-013-0593-y.

Rueda, Sergio, Sanjana Mitra, Shiyi Chen, David Gogolishvili, Jason Globerman, Lori Chambers, Mike Wilson, et al. “Examining the Associations between HIV-Related Stigma and Health Outcomes in People Living with HIV/AIDS: A Series of Meta-Analyses.” BMJ Open 6, no. 7 (July 2016): e011453. https://doi.org/10.1136/bmjopen-2016-011453.