Increase in HIV Cases Among IV Drug Users Raises Concerns in Massachusetts

By Paul Gaita 01/09/18

Black market fentanyl is believed to play a role in the uptick of HIV cases among people who inject drugs in the state.

gloved hands performing an HIV test

Health officials in Massachusetts have expressed concern over statistics which show that cases of HIV among people who inject drugs (PWID) have doubled in 2017. Though the actual number of new individuals diagnosed with HIV last year remains relatively small at just 78 cases—though that number is expected to rise—the increase has triggered fears that the opioid crisis has produced another dangerous development, and the array of programs and safety measures the state has long labored to provide PWID, including clean needle exchange, may not be enough to prevent an outbreak of HIV like the one in Scott County, Indiana, where 190 people were infected through shared needles in 2016.

Cases of HIV among PWID in Massachusetts dropped from 125 in 2005 to just 30 in 2014, reflecting the national decline in cases by 48% between 2008 and 2014—but as the Centers for Disease Control and Prevention (CDC) noted, the opioid epidemic in the United States has caused upticks among certain demographics, most notably non-urban areas with limited HIV prevention and treatment services, the homeless and prison populations and among individuals without health insurance for a period of 12 months or more. 

The increased numbers of HIV infections in Massachusetts have yet to be identified by any racial, social or financial demographic, but Dr. Alfred DeMaria, medical director of the Bureau of Infectious Disease and Laboratory Sciences at the Massachusetts Department of Public Health, opined that younger individuals who have been introduced to IV drug use through opioids may be among the most susceptible.

"Five years ago, the population of active injectors was skewing older," DeMaria told The Boston Globe. "Many of them were longer-term users [who] had learned sterile technique [and] knew how to clean syringes. A lot of the younger injectors don't have that history of safe injection."

While Massachusetts has 20 active needle exchange programs—up from six in 2015—Carl Sciortino, executive director of the AIDS Action Committee, said that many Massachusetts residents live some distance from these locations, which may prove problematic for the rising number of IV drug users in non-urban locations.

The flood of fentanyl into the black market has also exacerbated IV drug use; as the Globe noted, fentanyl produces a stronger but shorter-lasting euphoric effect than heroin, which often requires users to inject drugs more frequently, increasing the number of chances to contract a disease. The CDC has estimated that the chance for a person to contract HIV from sharing needles is approximately 1 in 63 per 10,000 exposures.

The state's public health officials plan a direct address for the situation. "It's a little early to say we have an epidemic on our hands, but we're primed for it. We're not waiting for it to get worse," said Dr. Jenifer L. Jaeger, interim medical director of the Boston Public Health Commission. Massachusetts established a number of projects that provide support, both financial and otherwise, to individuals with HIV that have allowed greater access to the antiretroviral drugs that have allowed those infected with the disease to live longer. At least two-thirds of the people living with HIV in the state had totally suppressed the virus by 2014, compared with national rates of only a third.

In the meantime, state officials note that opioid addiction in the state, which claims an estimated five individuals a day, remains an issue that needs greater focus. "We have a substance-use care system that's been underfunded for decades," said Dr. Jennifer Brody, director of HIV services for the Boston Health Care for the Homeless Program.

"Every day, I have patients, injecting drug users, desperately wanting to stop using, but who cannot find a treatment bed. Some might die, some might acquire or transmit HIV."

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.