This December marks the 30th anniversary of World AIDS Day. The disease has killed as many as 41 million people worldwide, the mortality rate has decreased by more than 51 percent since its peak in 2004. Thanks to advances in medication and treatment, more than 80 percent of people who are HIV positive and accessing treatment are virally suppressed. This represents enormous progress.
But HIV is neither dead nor dormant. HIV had been declining in Massachusetts, but in 2017, communities in the Merrimack Valley, including Lowell, saw more than double the number of cases seen in 2016. That’s 52 new HIV diagnoses in just the last year.
Unsurprisingly, HIV in Massachusetts targets our most vulnerable populations. Over half of the patients diagnosed in 2017 were homeless. And communities of color are affected by HIV disproportionate to their representation in the population: Even though only 6 percent of the Massachusetts population is black and 10 percent is Latinx, 55 percent of the people living with HIV in Massachusetts are black or Latinx.
One reason for the spike is the opioid crisis. And in particular, the use of fentanyl, a potent opioid with a short high, which means it must be injected more frequently, prompting the spread of HIV among intravenous drug users. Between 2015 and the last summer, federal officials counted 129 cases of HIV linked to drug use just in the Merrimack Valley, a staggering increase. Over the last five to 10 years, there were between 30 and 60 new cases of HIV annually (in intravenous drug users) in the entire state.
Massachusetts’ experience has been reflected nationally.
The Centers for Disease Control (CDC), in response to a 40-fold increase in new cases of HIV infection among intravenous drug users in a small county in the Midwest, identified 220 counties in 26 states as vulnerable to HIV as a result of the opioid epidemic. Many of these counties have been characterized as “treatment deserts” -- places that lack community health resources, needle exchange programs or qualified health care professionals.
55 percent of the people living with HIV in Massachusetts are black or Latinx.
Despite the twin public health crises of HIV and opiate addiction, the Trump administration has reacted with apathy or outright hostility. In his fiscal year 2019 budget request, President Trump proposed to: cut the Ryan White HIV/AIDS program, which supports primary medical care, technical assistance, clinical training and essential support services for 52 percent of all Americans with HIV, by $58 million; slash the CDC’s HIV prevention programs by $40 million; and decrease funding for the AIDS Housing programs, which make grants to local communities, states and nonprofits for projects benefiting low-income Americans with HIV, by $26 million.
These decisions undermine the progress the United States has made in treating the HIV pandemic over the past two decades.
If communities ravaged by the opiate crisis are also forced to contend with a resurgence in HIV, their institutions and infrastructures will be further crippled. Public health across the country will suffer and the American people will bear the human, financial and social costs.
Despite the twin public health crises of HIV and opiate addiction, the Trump administration has reacted with apathy or outright hostility.
Massachusetts has been heralded as a leader in combating the opioid epidemic for effective, evidence-based practices, such as prescription monitoring, promoting the use of recovery coaches and restricting the length of new prescriptions. We can continue to promote innovative and life-saving policies here, even if the Trump administration refuses to act.
The commonwealth is well-positioned to reverse the startling resurgence of HIV by expanding access to HIV testing, treatment, education and needle exchanges. Notably, Lowell did not have state-authorized needle exchanges before the HIV outbreak. The Department of Public Health and Lowell Board of Health, in partnership with community outreach programs and local medical providers, have been working to educate residents about HIV and expand access to infectious disease testing, Narcan distribution and overdose education.
Public health experts have indicated that if this spike in HIV cases had occurred in a state with weaker HIV and hepatitis C surveillance systems, the outbreak could have been even more devastating.
But Massachusetts can do more. The commonwealth must continue to recognize the complex vectors of addiction — including housing instability, trauma, mental illness, race and poverty — and continue to treat the epidemic like a public health crisis rather than a criminal justice issue.