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New city plan aimed at reducing HIV/AIDS infections by 25%

A group of Baltimore's health care leaders has crafted a plan to cut new cases of HIV infection by 25 percent by 2015, as part of an overall strategy to cope with a disease that has plagued the city for decades.

The plan, scheduled to be given to Mayor Stephanie Rawlings-Blake Tuesday, calls for attacking HIV/AIDS — which affects more than 13,000 city residents — at its earliest stages by limiting the transmission of the disease and pushing for more widespread testing. The goal is to cut the annual number of new diagnoses from 505 to 379 by 2015.

Among the recommendations are expanding needle-exchange programs, promoting testing in primary-care doctors' offices, and tapping churches to reach at-risk people for testing. The plan also calls for aggressive testing to reach the infected before they become sick, as well as targeting outreach to gay and sex clubs, schools, senior centers and prisons, where there is an increased risk for disease because of unprotected sex or drug use.

The plan's authors say millions more in funding is needed to significantly reduce infections, but they acknowledge that is unlikely given the city's and nation's fiscal situation. Instead, they expect government officials and community providers to stretch resources through better coordination of services. The city health department already plans to shift dollars to create a new high-level position overseeing the effort.

"One of the main barriers has been a lack of a road map, a strategic plan to guide the city's response and promote collaboration between the various city agencies, the state, community groups and citizens who are impacted," said Dr. William A. Blattner, chair of the City's Commission on HIV/AIDS Prevention and Treatment, which developed the plan.

"We need to better allocate our resources and get more people tested and treated," said Blattner, the associate director of the Institute of Human Virology at the University of Maryland School of Medicine.

Baltimore has been among the nation's top 10 cities for new HIV infections for the past decade, and HIV was declared an emergency by city leaders in 2002. The rate of infection has dipped somewhat recently, but by 2009 11/2 people a day were becoming infected.

In addition to lowering the number of new infections, the plan calls for increasing the number of people who know if they are infected, the newly diagnosed who get care within three months, and those who continue treatment.

The goals also include increasing the proportion of infected gay and bisexual men, African-Americans and Hispanics whose disease is controlled and unlikely to be spread.

The effort to reduce the rate of HIV infection reflects goals already included in a comprehensive health plan recently crafted by the Baltimore Health Department and aligns with a federal strategy to tackle new infections. The new plan was paid for by the Annie E. Casey Foundation.

Without new funds available for implementation, the commission, which includes academics, practitioners, government officials and advocates, will promote coordination of $6 million to $7 million in public dollars used on outreach and education annually, and about $20 million in federal money used on treatment.

Dr. Oxiris Barbot, the city health commissioner, said it's not realistic to expect new funding. But she expects savings from the effort by testing people before they develop costly symptoms or infect others. Lifetime costs for an HIV-infected person are about $355,000.

She plans to announce Tuesday that the money in her department will be shifted from disjointed HIV programs to fund the new assistant commissioner position in charge of the HIV strategy. That person will be responsible for handling the budget, coordinating with other agencies and community groups, and overseeing programs that address various health and social issues.

"If we're focusing outreach where transmission happens, we can reduce the overall [amount of infection in] the community and the overall risk," she said. "We must be smarter in the way we coordinate services."

For now, the costs and human toll remain high. By the end of 2009, there were 13,048 Baltimore residents living with HIV or AIDS, which included 505 new cases of HIV and 221 AIDS diagnoses, and 180 AIDS deaths in that year. (AIDS deaths peaked at 499 in 2003.)

According to the commission report, close to three-quarters of those new cases are found in nine city Zip codes that are home to just over 40 percent of the population. Disproportionate numbers of those infected with HIV are African-American and either drug abusers or men who have sex with men. And the report estimated one in five doesn't know about the infection.

That information will help groups such as Sisters Together and Reaching Inc., a community-based group that provides direct services and support to those with HIV, said the Rev. Debra Hickman, president and chief executive.

She said the organization will know where to steer a mobile unit that offers testing, and where to set up needle exchanges. Meanwhile, all of Baltimore's community groups, federally funded treatment centers and government offices will be on board with the same strategy — and won't duplicate efforts or leave gaps.

"We need to come together to strategize and determine what puts a community at risk," said Hickman, who helped work on the new HIV/AIDS plan. "There is substance abuse, homelessness, community sex work, poverty. There's a lot to cover and we'll be looking for ways to work in a more efficient and effective manner."

The mayor said the new plan was a "call to action."

Rawlings-Blake said, "It can change lives and change our city with a coordinated set of strategies, which can help those who are not infected stay HIV-free, improve the lives of those who are HIV-positive, and improve that provision of health care to the most at-risk populations."