Male homosexuality remains the principle means of transmission; about 10% of black men in their 40s are infected.
UPDATE 7/23/12 - Anal Sex is Main Cause of HIV Pandemic: Study
-- From "HIV/AIDS Rate in D.C. Hits 3%" by Jose Antonio Vargas and Darryl Fears, Washington Post Staff Writers 3/15/09
"Our rates are higher than West Africa," said Shannon L. Hader, director of the District's HIV/AIDS Administration, who once led the Federal Centers for Disease Control and Prevention's work in Zimbabwe. "They're on par with Uganda and some parts of Kenya."
Together, the reports offer a sobering assessment in a city that for years has stumbled in combating HIV and AIDS and is just beginning to regain its footing. A more accurate accounting of the crisis offers a chance to contain what is largely a preventable disease.
The District's report found a 22 percent increase in HIV and AIDS cases from the 12,428 reported at the end of 2006, touching every race and sex across population and neighborhoods, with an epidemic level in all but one of the eight wards. Black men, with an infection rate of nearly 7 percent, carry the weight of the disease, according to the report, which also underscores that the District's HIV and AIDS population is aging. Almost 1 in 10 residents between the ages of 40 and 49 has the virus.
Men having sex with men has remained the disease's leading mode of transmission. Heterosexual transmission and injection drug use closely follow, the report says. Three percent of black women carry the virus, partly a result of the increase in heterosexual transmissions.
Mayor Adrian M. Fenty (D) said he is aware that some advocates have called on elected officials and others to more aggressively and publicly address the crisis. He praised the city's recent efforts, however, and expressed his frustration about the struggle ahead.
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