WASHINGTON "Who's next for testing?" Nathalie Boittin asked on Tuesday in a crowded waiting room at the Whitman-Walker Clinic in northwest Washington.
A young black man rose and Boittin, a community health educator, led him to get tested for the AIDS virus.
Testing has spiked at this clinic and others in the U.S. capital since an official report this week showed that 3 percent of the city's residents are infected with HIV. Officials believe the true figure is even higher.
"There are a lot of people who don't know they are HIV positive because they don't want to know or are afraid to know," said Edward Harris, a 55-year-old man who gets care at the clinic.
With a large poor and minority population, the District of Columbia has struggled with HIV for decades. Its report on Monday showed the number of people with HIV infections rose 22 percent from 2006 to 2007.
"I think the true prevalence rate could be 30 to 50 percent higher," Dr. Shannon Hader, the city's HIV/AIDS Administration director, said in a telephone interview. Many people are likely infected without knowing it.
The report showed that 6.5 percent of the city's black men were infected. Overall, there were 15,120 HIV-infected people. Blacks make up 53 percent of the population of just over half a million people, but account for 76 percent of infections.
The U.S. Centers for Disease Control and Prevention said Washington has one of the most severe epidemics in the nation.
"It's an epidemic across all aspects of District life," Whitman-Walker Clinic CEO Donald Blanchon said. "It's not an epidemic of one group. It's not just gay or black."
Blanchon said people are being infected in three different ways, making it harder to target those at highest risk.
While sex between men was the top cause, accounting for 37 percent of cases, heterosexual sex led to 28 percent of cases and injection drug use to 18 percent, according to the report.
Hader said the city is stepping up its efforts. The city said it raised the number of people in its AIDS drug assistance program by 50 percent from 2007 to 2008, while the number of young people getting HIV tests doubled in the same period.
The city said it is one of two in the nation with a major condom distribution program, distributing 1.5 million in 2008.
"We want to make condoms widely available for free at a lot of easy-access points around the city," Hader said, including beauty parlors, barber shops, liquor stores and bars.
In 2007, the U.S. Congress, which under a special arrangement can control some of the district's operations, lifted a ban on a needle-exchange program, now under way.
"There's not a lack of qualified service providers or interesting or good programs in the city. But clearly it wasn't all coming together to satisfy the scale and the complexity of our needs here," Hader said.
The city also released survey data highlighting the fact that many heterosexuals do not use condoms and have multiple, overlapping sexual partners.
"At the end of the day, there's the need for individual responsibility. It doesn't matter who you are, where you live, where you come from, what your (sexual) orientation is," Blanchon said. "You need to practice safe sex."
(Editing by Alan Elsner and Maggie Fox)