Building on lessons learned from a series of HIV outbreaks among people who inject drugs (PWID) over the past five years, the Centers for Disease Control and Prevention (CDC) has issued an advisory cautioning health departments and other groups servicing this population to be on their guard against such outbreaks during the COVID-19 pandemic.
Following many years of declines, HIV diagnosis rates increased by 11% nationally among PWID between 2016 and 2018, owing to the worsening opioid epidemic as well as the use of other substances by members of this demographic. The diagnosis rate increased even more steeply among PWID younger than 40 and those who are white.
The COVID-19 pandemic has only complicated the suite of services that PWID rely on to keep HIV negative, including those offered by syringe services programs.
The nation was put on notice that HIV could spread rapidly among PWID networks after more than 200 such individuals contracted the virus in a short period of time that peaked in 2015 in rural Scott County, Indiana. Recent research has found that there were numerous early warning signs that the state, then led by Mike Pence as governor, failed to heed, including an earlier outbreak of hepatitis C virus in this population.
Since then, several other communities, including those in rural and urban areas, have experienced similar, albeit smaller, outbreaks.
The outbreaks were driven by common factors. These include the nonsterile injection of drugs multiple times per day; the use of multiple substances, typically opioids with methamphetamine or cocaine; marginalizing circumstances, such as homelessness or unstable housing, recent incarceration or the exchange of sex for money or goods; and coinfection with hepatitis B or C viruses or other sexually transmitted infections.
Considering how COVID-19 has disrupted communities’ capacity to provide services to PWID in such marginalized circumstances, the CDC has provided a comprehensive list of recommendations to health departments, organizations that service PWID and clinical providers to help mitigate the risk of HIV outbreaks.
To read the CDC advisory, click here.