Amanda Richards / Flickr

An HIV test.

Black women in some cities, including D.C., are five times more likely to contract HIV than the average black woman in the United States. That’s according to a recently released study conducted in six cities and funded by the National Institutes for Health.

Researchers focused on six HIV “hotspots:” D.C., Baltimore, New York City, Newark, N.J., Atlanta and Raleigh-Durham, N.C. In these communities, 24 black women in every 10,000 is infected with HIV annually. Nationally, the annual HIV-infection rate is 5 in every 10,000 black women.

The new data, which shows higher infection rates than previously thought, came as a surprise to scientists working in the field, including AIDS experts at Johns Hopkins University who assisted with the study.

“While we have always known that African Americans had a higher risk of HIV infection than other American racial groups, this study confirms it and underscores the severity of the national and local problem, especially in cities,” study site leader and professor Anne Rompalo is quoted as saying in a Johns Hopkins University press release.

More than 3 percent of D.C. residents are living with HIV or AIDS, according to the D.C. Department of Health [PDF]. Rates are highest in Wards 8, 6 and 5. In recent years, much attention in the field has been placed on young black gay and bisexual men, for whom HIV rates are rapidly rising. But this new study shows that infection rates are still high for black women.

The Los Angeles Times cites a number of reasons behind the high infection rate among black women, including a reluctance to get tested because of the stigma associated with having HIV, lacking health insurance and women not putting their own health concerns first.

Elahe Izadi / DCentric

Dentist Steven Myles shows how he is able to access a patient's medical records during appointments in Bread for the City's new dental clinic.

It’s been more than a decade since Florence Sandridge has been to a dentist. Now, the 80-year-old needs a plate put in her mouth.

“Usually the dentist is so expensive,” she said. That’s why last week she went to the ribbon-cutting of a free dental clinic for low-income D.C. residents.

The Bread for the City single-room clinic — with its green walls, new equipment and a couple of dentist chairs — fills a big gap. There are few options for low-income D.C. residents. Those on Medicare, Medicaid or signed up with D.C. Health Alliance receive some dental coverage. There are also a few other free dental clinics in the city — such as one run by nonprofit So Others Might Eat — and a mobile dental clinic that makes stops throughout the city. “But there just aren’t enough services,” said Kristin Valentine, Bread for the City’s development director. Dental care is consistently the most requested service among the Bread for the City’s clients.

Even those with dental coverage don’t regularly see a dentist; about half of low-income adults with coverage haven’t been to the dentist in at least a year, according to a Kaiser Family Foundation report. The reasons vary. Some have problems finding dentists who accept Medicaid. Out-of-pocket costs for those under private and public plans may be too expensive for families. Other issues keep low-income adults from getting dental care, such as lack of transportation, child care and work arrangements and cultural barriers, according to the Kaiser report.

Joan Carson, 56, is a Bread for the City client who serves on the nonprofit’s advisory board. She said it’s difficult to find dentists who accept Medicare and Medicaid. Another advisory board member and client, 54-year-old Deborah Branch, said she was thankful for the clinic, which has been a long time coming.

“A lot of people, especially older people, can’t afford [dental services], especially if you don’t have transportation,” Branch said. “It costs so much that they go without. They don’t have no other choice. What are they going to do?”

The dental clinic is part of a larger, nearly $7 million campaign to expand Bread for the City. A new medical clinic opened in late 2010 and the dental clinic is housed in one of its spare rooms. The cost to start the clinic and run it for a year comes to about $280,000, which came from a BlueCross BlueShield grant and private donations.

Bread for the City’s medical director Randi Abramson said the need for accessible dental care is “enormous.”

“There is a close relationship between dental health and overall health,” Abramson said. Problems can be serious, such as the untreated infection that caused the death of 12-year-old Prince George’s County boy in 2007. They can be minor as well; bad teeth can make it too difficult to eat fresh fruits and vegetables, contributing to other health issues over a long period of time.

“But then there’s this whole self-esteem issue,” Abramson added. Some people don’t want to smile, or feel ashamed of their teeth. That can even make it difficult to job hunt for those who feel self conscious about their appearance.

“They all can’t wait to get an appointment with a dentist,” she said of Bread for the City’s clients. “It’s not that they don’t want it or don’t understand how important it is.”

David McNew / Getty Images

We pondered yesterday whether lack of access to supermarkets is the major reason behind health inequality, in response to a survey showing most urban families were actually satisfied with their grocery options.

We asked readers: are food deserts really to blame, or do other factors loom larger? From the responses, it looks like prices and having time to prepare meals were also big concerns for families.

DCentric commenter molly_w wrote:

One thing I completely failed to appreciate until I became a mom was how hard it is for parents to find time to cook. I get home at 6, and my 4-year-old daughter needs to head upstairs and start her bedtime routine at 7:30. So I have 90 minutes a day to hang out with my child (never mind my husband), and I want to spend as little of it as possible fixing supper. (She doesn’t want me to spend it in the kitchen, either; she interrupts me every couple minutes with all sorts of invented needs — which only makes dinner prep take longer.) These days I’m all about frozen microwavable rice covered in something that came out of a crock pot, because I can get food on the table in about five minutes and have that time to hang out with my family. And I’m lucky in a lot of ways — I only work one job, I have a partner to help, we only have one kid.

In response to our post on the survey, Sylvia C. Brown, an ANC 7C04 commissioner, tweeted that saving money can come at the cost of saving time:

@DCntrc it still corroborates food deserts bcs it puts pressure on one--go to corner store save time but food price high +

February 1, 2012 9:37 am via UberSocial for BlackBerryReplyRetweetFavorite

@anc7c04

Sylvia C. Brown

Corner stores also don’t have the same variety of fresh fruits and vegetables as supermarkets do. There’s a local effort underway to address that problem, with nonprofit D.C. Central Kitchen delivering fresh produce to corner stores as part of its “Healthy Corners” initiative.

Also, simply having a supermarket in a community doesn’t translate into healthier eating habits, according to a study published in the Archives of Internal Medicine. Researchers said healthy food isn’t always visibly displayed in supermarkets and it can be expensive. So you could build it, and they may come, but what will they buy?

Adrian Clark / Flickr

It’s well documented that poverty and bad health have a strong connection. A team of researchers wondered if simply moving from a low income to middle class neighborhood could make a person healthier.

Turns out that it does, according to a new study published in the New England Journal of Medicine does. The U.S. Department of Housing and Urban Development researchers studied three groups. One group stayed in poor neighborhoods. Another group received rent subsidies to move into middle class neighborhoods. The third group received the same subsidies to help with rent, but remained in poor neighborhoods. The results: the group who moved to the middle class neighborhood were 5 percent less likely to be obese and show signs of diabetes. The people who stayed in the poor neighborhoods, even with the help of extra money, experienced no improvement in health.

From ScienceNOW:

The experiment clearly shows that the neighborhood effect is real, says Nicholas Christakis, a sociologist at Harvard Medical School in Boston who studies the effect of social ties on health, but the mechanisms remain murky. Is it the shops and restaurants, the parks and pools, he wonders, “or the people in a neighborhood that affect you most?” For example, Christakis says, the people who moved might have lost weight because safer streets and open spaces “allowed them to walk outside more, or because they saw thinner people around them, or both.”

Even if a neighborhood has plenty of recreational facilities and opportunities, it doesn’t mean people will take advantage of them. Research shows the fear of violence discourages people from being active outside. People are less likely to walk, bike or let their kids play outside. That rings true in D.C., where Ward 8, the ward with the most violent crime thus far this year, also has the lowest physical activity rate. We may have plenty of food deserts, but we also have our fair share of exercise deserts.

Flickr: NCinDC

Howard University Hospital

If you reside in Columbia Heights, Dupont Circle or Friendship Heights, chances are, you live near a practicing physician. For D.C. residents who make their home east of the river, it’s a very different situation, according to a recent article in the Washington Post, which focused on a potential shortage of doctors in this city. One part of the article stood out to us; when it comes to a lack of practicing physicians, certain areas in D.C.- have it much worse than others.

In Ward 3, for example, there is an abundance of physicians, with “literally hundreds of doctors to choose from,” said Michael Williams, chief of health-care operations for the nonprofit D.C. Primary Care Association. But he said only 90 doctors list a business address east of the Anacostia River.

The District has a “severe mal-distribution of physicians” rather than a shortage, given that roughly 23 percent of the population lives east of the river but only a tiny fraction of physicians have a business location there, he said.

The Post reported that there are 4,000 full- or part-time physicians in D.C. but it’s important to keep in mind those doctors are sometimes seeing patients who work in the city, but live in Maryland or Virginia. So doctors who maintain a practice in the city are treating patients from across the region, which for locals makes finding a doctor even more challenging.

Stephen Chernin / Getty Images

A young man inserts the Rapid HIV test swab into its tube.

The HIV infection rate for young black men who have sex with men is growing at an “alarming” rate.

That’s according to a report released this month by the Centers For Disease Control and Prevention. The CDC studied HIV infection rates from 2006 to 2009, and found that the rate increased by 48 percent for 13 to 29 year-old black men who have sex with men. Meanwhile, infection rates have remained relatively stable for all other groups.

Healthcare providers and organizers in D.C., where 3 percent of the population has HIV/AIDS, are seeing the trend. Justin Goforth is the director of community health at Whitman-Walker Health, a center offering medical, counseling and legal services to D.C.’s LGBT community.

“This is who we see come in every day that’s testing positive: young black gay men,” Goforth says.

Below are five factors contributing to higher infection rate among this group:

Most first sexual encounters are with older men

According to a D.C. and George Washington University study, the District’s young black gay men tend to have their first sexual encounters with “significantly” older men, who are the most likely group to already be infected with HIV — 31 percent of men of color over the age of 30 have the disease. Young white gay men, however, tend to have their first sexual encounters with other young men, who are less likely to be infected.

Older men tend to have resources and be established because they have finished school and have jobs, Goforth explains. Young men, however, are on much shakier ground, particularly if their families or communities have shunned them.

“The power dynamic is not with the young one to say, ‘Let’s use condoms,’ because the older man has the resources the young man needs,” Goforth says.

Discovering HIV-status and committing to care

Getting young black gay men to get HIV-tested is only half the battle; health workers also struggle with ensuring young men continue to get tested. The D.C. Department of Health recommends being tested twice a year. And then there’s getting those who do test positive stay on treatment plans, which can be a challenge for many young black gay men, Goforth says.

“They’ll come to a couple of appointments, maybe get started on meds, and then maybe we won’t see them for 10 months,” he says. “Then they’ll come back and say, ‘I didn’t want to deal with this. I didn’t take meds.’”

In response to treating “our most fragile clients with HIV,” Whitman-Walker Health has started a mentorship program called +1. Clients are matched with mentors in the same demographic group, and the pairs meet weekly outside of the clinic.

Homophobia

Homophobia, still an issue for society at large, creates unique challenges within the black community, where institutions such as the church are so important. Many young black gay clients are hesitant to come to the clinic or get tested because of the social implications; some fear being shunned in their communities or families.

Goforth relates the story of a young black teen he took under foster care, who tested positive for HIV at 16. A month later, his mother died. His grandparents rejected taking care of the teen because he was gay. Meanwhile, his HIV-infected sister, who was a drug addict, “is very welcome in their home,” Godforth says.

Despite the challenges, in the past couple of years Goforth has seen “a dedicated upswing in how the black churches want to be a part of this.”

“The black churches have really started to reach out to places like Whitman-Walker, saying ‘how can we help?’” he says. “That really should have been happening for 30 years, but I think that’s going to be a big game-changer.”

Historical healthcare disparities

There are documented disparities in healthcare for minority groups — racial minorities have poorer health and consistently get lower-quality treatment. This, and a history of medical experimentation on black people, has lead to distrust of the healthcare establishment among some in the black community.

“We need to work on better quality and access, and then we have to educate a whole community of people on what it means to access healthcare,” Goforth says.

D.C. is a small city

D.C. isn’t a large city, with a population of about 600,000 people. But it can feel even smaller when folks stay within their neighborhoods or social circles.

“If you have created the perfect storm for HIV and you’re in a very small, confined community, then the prevalence of HIV gets so high in that community that it almost becomes inevitable” for the rate to get so high, Goforth says. “… Everybody is one or two people removed from the person they date.”

Resources:

Us Helping Us, People Into Living: A D.C. organization providing case management and counseling to black gay men.

Where to get free condoms in D.C.

Information on HIV treatment for all, even the uninsured.

 Whitman-Walker Health programs .

Christopher Furlong / Getty Images

A new study shows that the disparity in care for D.C.’s black and white stroke patients isn’t due to institutional bias, but addressing the problem may involve “culturally tailored” outreach programs.

Georgetown University researchers found that African-American patients in the District were one-third less likely than white patients to receive tPA, the medicine needed to treat the most common type of stroke. Dr. Chelsea Kidwell, medical director of the Georgetown University Stroke Center, authored the study. WAMU reports:

Among the reasons African-Americans are not receiving tPA as often, Kidwell says, “is that the African-American population does not get to the hospital in time. They don’t call 911.”

Also, Kidwell says, African-American patients are more likely to have existing medical conditions, like high blood pressure, that would make tPA unsafe for them.

“[In] patients who do arrive in time and are eligible for treatment, there in fact is no racial disparity,” she says. “So our finding is important in showing that there’s no institutional or medical care bias in treating patients.”

About 75 percent of black stroke patients interviewed in the study called a friend or relative before calling 911. And nearly half of those who received delayed care reported it was because they didn’t think the symptoms were serious.

Flickr: Barjack

The tragic circumstances surrounding the April 7th shooting death of a popular H.D. Woodson High School student point to a challenge that many of D.C.’s kids face as they seek to have active, healthy lives.

Raheem Jackson, 16, was reportedly trying to buy a gun from someone who robbed and killed him instead. Washington Post columnist Courtland Milloy wrote that

… If true, he would not have been the first otherwise law-abiding youngster who felt the need to carry a firearm for protection.

A star basketball player at Woodson, he’d leave practice long after sundown and have anxious walks home in the dark. Many students have refused to participate in extracurricular school activities because it just isn’t safe to be out at night.

As noted by Homicide Watch D.C., Jackson had even written a poem about his scary walks home, which was published by his school newspaper The Insider:

Walking Benning Road at night is like
being scarred on your first fight.
It’s crazy. You are paranoid, cautions on every
turn. You hear a voice, turn around.
No one speaking a word.
walking through the dark street
you run away with a long distance scream.
You’re running from dark faces you’ve seen,
all the nightmares you have ever dreamed.
It’s just you facing reality as you get to your house
still in a daze, trying to figure out
what it’s like to
walk down Benning Road.

Jackson’s heartbreaking poem speaks volumes to the fear of violence many kids face head on so that they can participate in extracurricular activities. Fear of having the same unfortunate fate of Jackson also impedes people from being physically active. A recent study by Kaiser Permanente and the Prevention Institute found fear of violence stops people from taking advantage of recreational facilities and opportunities even if they are in their neighborhoods. The study found that “people who are afraid of violence walk and bike infrequently, avoid using neighborhood parks, and restrict their children’s outdoor play.” In other words, if you build it, they may not come if it feels too dangerous to walk there.

In D.C., the problem is even more pressing. Obesity rates are higher in Wards 6, 7 and 8 than elsewhere in the city. Ward 8, which has the highest homicide rate, also has the lowest physical activity rate. According to D.C.’s Overweight and Obesity Action Plan, 15 percent of all deaths in the District are a result of obesity. But in some parts of the District, the fear of getting shot while walking in your neighborhood can trump the more subtle reality of dying from an obesity-related illness.