Between 2015 and 2018 there were 129 new HIV cases linked to drug use in two Massachusetts cities.
Fentanyl use in two Massachusetts cities is driving an HIV outbreak that officials say could be forecasting a national public health crisis.
Lawrence and Lowell Massachusetts, two cities along the New Hampshire border, have seen such a sharp spike in new HIV cases that the Centers for Disease Control and Prevention has become involved, according to.
Between 2015 and 2018 there were 129 new HIV cases linked to drug use diagnosed in the cities. In the four years prior to that there were only 41 new cases of HIV related to injecting drugs diagnosed annually in the entire state.
“This tells us we cannot rest on our laurels,” said Thomas Stopka, an infectious disease epidemiologist and assistant professor at Tufts University School of Medicine. “There are potentially other communities that are at great risk as well. HIV can and is raising its head again in places where risks align.”
In 2015, opioid injecting was linked to an HIV outbreak in rural Indiana. The risk factors in the Massachusetts outbreak are similar, but in an urban setting. One risk is pervasive fentanyl use. Because the synthetic opioid has a shorter half life than heroin, users inject more often. This means they have more opportunity to be exposed to dirty needles.
In addition, neither city had a needle exchange program before the outbreak, although both have since established exchanges. Finally, high rates of homelessness compound health risks, as does the fact that doctors don’t routinely screen for HIV, even among intravenous drug users.
“This may be forecasting what could conceivably happen around the country,” said Amy Nunn, executive director of the Rhode Island Public Health Institute.
This spring, epidemiologists from the CDC spent time in Lawrence and Lowell to try to establish why the outbreak was occurring. They presented their findings in a meeting on July 24.
“The most striking finding was the sheer number of cases,” said Stopka “[It] was substantially higher than what was seen in years prior.”
The number of new drug-related HIV cases “definitely caught a lot of folks’ attention and really spoke to the great need in terms of a response,” he said.
Most of the new cases were among white men ages 20-39, men like Mark, a 29-year-old who injected drugs before finding out that he was HIV positive.
“We all use,” Mark said. “We all know the other one has it. We don’t tell each other. People will lie right to your face about having it. It’s spreading around like wildfire.”
Stigma around HIV — even among drug users — keeps them from disclosing their status even if they know if. In addition, the draw of a high can cause people to put their health on the back burner, Mark said.
“People just don’t care,” he said. “When it comes down to it, if you’ve got a bag in your hand and somebody next to you’s got a dirty needle, you’re not going to run and find a clean one.”