EARTH FUTURE ACTION

America does poorly in comparison to the rest of the developed world in most areas of sexual health. What few people know is what a sexual health disaster is in the nation's capital.

It is perhaps symbolic of a society where people at the highest levels of American society are embroiled in the Epstein scandal, the largest child sex abuse scandal in modern history; even the President of the whole country is involved in this.

Unfortunately, it is not an isolated reality in Western society. The Catholic Church and some leading US evangelicals have had serious child abuse scandals. For example, in the boarding schools set up by U.S. and Canadian Christians, who forced their version of "civilization" on Native Americans, during this process, thousands of students were sexually molested and murdered.

Washington, D.C., has suffered from extraordinarily high rates of HIV and sexually transmitted infections for decades. An analysis of CDC data through 2013 found that the nation's capital had the country's highest diagnosis rates for HIV, syphilis, and gonorrhea. D.C.'s historical gonorrhea rates were so extreme that researchers used a separate scale for the District because its peak rate was more than three times higher than the peak among the 50 states.

There is an important limitation in examining exactly where D.C. stands today. The latest finalized CDC data allowing state-by-state comparisons of major STIs cover 2023. CDC has released provisional national STI statistics for 2024, but not finalized state and jurisdiction rankings. More recent local statistics are available from D.C. Health through the end of 2024.

HIV remains one of the most serious parts of D.C.'s STD problem despite substantial progress in reducing new diagnoses. Federal estimates for 2022—the latest available HIV incidence estimates—put D.C.'s rate of new HIV infections at 24.5 per 100,000 people, higher than the rate reported for any of the 50 states. These estimates include both diagnosed and undiagnosed new infections.

More recent HIV statistics demonstrate that the problem remains severe. At the end of 2024, 11,842 D.C. residents—approximately 1.7 percent of the population, or about one out of every 59 people—were living with diagnosed HIV. There were 192 new HIV diagnoses in 2024, an 86 percent decline from the 2007 peak of 1,374.

D.C. also had an HIV-related death rate of 7.8 per 100,000 in 2024. Mississippi had the highest rate among the 50 states at 3.3 per 100,000, but D.C.'s rate was more than twice as high. In other words, Mississippi ranked highest among the 50 states, but when D.C. is included, the District had a substantially higher per-capita rate. The CDC advises caution when comparing D.C. directly with states because of its much smaller population, but this does not change the reported rates.

D.C.'s unusually high rates are not limited to HIV. The latest finalized CDC data show that D.C. had higher rates of both gonorrhea and chlamydia than any of the 50 states in 2023. D.C. recorded 853.3 gonorrhea cases per 100,000 people, compared with 310.9 in Alaska, the highest-ranking state, and a national rate of 179.5. D.C.'s rate was therefore nearly five times the national rate.

D.C. also had a chlamydia rate of 1,228 cases per 100,000 in 2023. Louisiana, the highest-ranking state, had a rate of 792.4, while the national rate was 492.2. D.C.'s rate was approximately two and a half times the national rate.

Syphilis was not number one, but it remained exceptionally high. D.C.'s 2023 primary and secondary syphilis rate was 39.9 per 100,000, approximately two and a half times the national rate of 15.8. South Dakota had the highest rate among the states at 73.4.

More recent local data show that these diseases remain widespread. According to D.C. Health's latest annual surveillance report, the District recorded 6,956 chlamydia infections, 5,716 gonorrhea infections, 206 primary and secondary syphilis infections, and seven cases of congenital syphilis in 2024. These newer local figures cannot be used to determine D.C.'s national STI rankings because comparable finalized 2024 rankings have not yet been released.

D.C.'s exact current rankings will not be known until newer comparable national data are released. What the available evidence already makes clear, however, is that the problem has not disappeared. Despite significant progress against HIV and changes in individual disease rankings, Washington, D.C. continues to experience an extraordinarily high burden of sexually transmitted disease for a jurisdiction of its size.