HEALTH OFFICIALS have identified a growing cluster of 134 HIV cases primarily among homeless people who inject drugs in the Boston area, a worrying sign for health officials who several years ago were talking about a goal of eradicating new HIV cases in the state. 

“What we see is not only HIV transmission occurring, but the data indicates that we continue to see active clusters,” said state Sen. Julian Cyr, a Truro Democrat who chairs the Joint Committee on Mental Health, Substance Use, and Recovery. 

Since the height of the HIV/AIDS epidemic nationally in the 1990s, education, harm reduction efforts, and advances in medicine have significantly reduced the prevalence and toll of the disease.  

In Massachusetts in 2000, there were nearly 1,200 new cases of HIV diagnosed and more than 350 deaths. By 2007, the number of new cases dropped below 800 for the first time that decade and deaths dipped below 300. Between 2009 and 2013, the number of new cases diagnosed each year hovered around 700, and that number dropped to an average of 640 for the five-year period after that. Most cases since 2009 have been transmitted by sex between men. 

The worrying sign for public health officials today is a rise in cases attributed to drug use – a danger that had for years been steadily declining.  

According to the Department of Public Health, between 2000 and 2014 the number of reported HIV infections among people who inject drugs had dropped by 91 percent.  

However, as the opioid epidemic worsened, between 2016 and 2018, there was a large outbreak of cases among primarily homeless people who inject drugs in Lawrence and Lowell. 

Then in 2019, state officials began detecting a cluster in Boston among people who inject drugs and are homeless. The cluster appeared to be tied to the cases in Lawrence and Lowell. Dr. Jennifer Lo, medical director of the Boston Public Health Commission, said the cluster was fueled by the rise in fentanyl use, which requires users to inject more frequently, and more recently by the use of methamphetamines, which can lead to more risky behavior. 

While the cluster predated the start of the COVID-19 pandemic, advocates say the loss of services, like needle exchanges, has worsened the outbreak. In January and February of 2021, 13 new cases were diagnosed, with another four in March and 12 in April, according to the Department of Public Health. HIV testing numbers have also declined during the pandemic, according to DPH, likely because of the general disruption to health care providers and health care delivery. 

Carl Sciortino, a spokesman for Fenway Health, which specializes in care for the LGBTQ community including HIV/AIDS care, said once COVID gets a foothold in the population of homeless people who inject drugs, transmission can happen quickly, especially if people cannot access harm reduction services. During COVID, Sciortino said, drop-in centers that offered clean needles, nursing care, and other services closed. Although workers began conducting street outreach, that was less effective, especially when the police shut down homeless camps and forced people to move – making it harder to provide them with services. 

“When you have a community of people using drugs without access to sterile equipment, they’re going to share equipment, they’re going to share supplies,” Sciortino said. “Once HIV enters that population, it can spread like wildfire overnight.” 

Lo said the lack of testing means cases were not caught as quickly as they might have been pre-pandemic.

Boston Public Health Commission continued to distribute needles during the pandemic. But there were simply less services overall due to COVID, as providers were instructed to limit entry into programs and require COVID testing. “How do you prioritize which outbreak to address, which is the priority?” Lo said. 

Lo said the Boston Public Health Commission has been increasing its funding for HIV/AIDS services. It recently used a federal grant to start partnering with agencies that have people working on the streets to connect people who have HIV to care quickly. The commission is also trying to expand hours for recovery services, to make them available later at night.  

Sciortino said health care workers need to focus on engaging people at risk of HIV and getting them tested and treated. Between the opioid crisis and now COVID-19, he worries that much of the progress that was made in reducing HIV among drug users since 2014 was reversed.  We have a lot of work to do to turn it back around,” Sciortino said.