HIV outbreak among drug users accelerates in Boston

A syringe seen on a step outside Boston Medical Center, in the area known as Mass. and Cass, last fall.Craig F. Walker/Globe Staff

A Boston-based HIV outbreak among people who inject drugs may have accelerated during the past year, with nearly 60 new cases identified since last March, according to state data.

Since 2018, when state and city public health officials began tracking infections among intravenous drug users, the Boston cluster of cases now totals 171 cases, an increase of 58 identified cases since March 2021.

The state’s Department of Public Health linked the spike to the “persistent presence of fentanyl” in the drug supply, which is known to increase the frequency of injections, as well as the likelihood of users sharing unsterile needles. Officials said syringe-sharing and sexual behavior in close networks of opioid users were also among the factors associated with the outbreak.

State authorities said that people may have stopped using syringe service programs because of the COVID-19 pandemic and that there may have been new detections of prior HIV infections as drug users re-engage in disease screening as the pandemic eases.

In response to the outbreak, the Department of Public Health has convened local clinical and social service providers that aid hard-drug users to collect data, share strategies, and coordinate services. And the state continues to fund a city program that provides access to sterile syringes, distributes fentanyl test strips and the overdose-reversing drug naloxone, performs disease screenings, and refers people to treatment.

Additionally, state epidemiologists reach out to every new HIV case to help with entry into care and notify sexual partners.

But for some, it’s not enough.

“We’re not reaching out and providing people with the kind of help they need,” said Jim Stewart, a founding steering committee member for SIFMA Now!, a group that advocates for sites for safe consumption of drugs in the state. “It’s time to do something about it. ”

Specifically, Stewart, who is the director of the First Church Shelter in Cambridge, called the new HIV statistics the “clearest justification for providing people access to safe consumption facilities.” The city, he said, simply does not have safe spaces for people to use drugs.

Stewart said there are limited places in Boston where people can obtain harm reduction supplies, like clean syringes, tests for drugs to ensure people aren’t using a tainted supply, and material to address wounds caused by injections.

“These things need to be available across the city,” he said.

Brandon Marshall, an epidemiology professor at Brown University, said the numbers during the past year are “indeed very high, particularly when compared to historical statewide data.” Between 2010 and 2019, he said there was an average of about 60 new cases of HIV among people who inject drugs in the entire state of Massachusetts.

“The fact that we are seeing such a high number of cases in Boston alone is alarming and warrants more attention,” he said.

In a 2020 letter to local health care providers, city and state public health experts said between 2000 and 2014, the number of reported HIV infections in Massachusetts declined by about half overall and by 91 percent for people who inject drugs.

But that trend reversed starting in 2015 as a result of the opioid epidemic and the widespread introduction of fentanyl into the illicit drug supply, according to public health authorities.

In recent years, there was a large outbreak of HIV infection among injecting-drug users in the Lawrence and Lowell area. In 2018, federal disease-trackers counted 129 new cases of HIV among injecting-drug users in that area since the beginning of 2015.

A federal inquiry concluded that the outbreak resulted from the early arrival of fentanyl in northeastern Massachusetts and other factors. Homelessness and incarceration played an important role in the spread of the virus, by limiting access to treatment that suppresses it, according to a report released in 2018.

Leo Beletsky, a professor of law and health sciences at Northeastern University, thought the recent Boston numbers were likely to be “a huge underestimate” of the number of HIV cases among local people who inject drugs.

Local officials can do more to help mitigate the HIV problem in that at-risk population, said Beletsky, who called the HIV statistics “an indictment” of authorities who have not followed the science for solutions in this case. Beletsky said there should be more syringe exchange programs in the city and added that there should be a “full menu of scientifically based programs” to care for people who inject drugs.

Among the options should be safe consumption sites, but he added that such programs should not be considered a silver bullet. A bill that would establish a pilot program for at least two such sites in Massachusetts is in a joint committee of the Legislature, but advocates say it is unclear when or if it will be reported out of the committee.

”It’s a question of whether or not the state puts its money where the science is and it generally doesn’t,” he said.

Beletsky connected the HIV numbers among injecting-drug users and the city’s handling of the area known as Mass. and Cass, which for years was seen as the heart of the Boston’s opioid epidemic.

City crews cleared out scores of tents in the area around the intersection of Massachusetts Avenue and Melnea Cass Boulevard in January, the most aggressive and concerted effort in recent years to dismantle the unsanitary camps in what was considered an open air illicit drug market, move people off the streets, and place them into transitional housing.

Diffusing the concentration of homeless, said Beletsky, can make “it seem like things are better, but it further marginalizes and makes it harder for them to access services.” Such a move can also lead to upticks in overdoses and HIV infections, he said.

The city pushed back on any connection between the city’s approach to Mass. and Cass and the HIV outbreak. Jon Latino, a spokesman for the Boston Public Health Commission, said, “Based on what we are seeing on the ground, there is no evidence to suggest that the clearing of the tent encampments has spawned a sudden uptick in [injection drug use] HIV rates.”

And state statistics show that there were seven HIV cases in Boston among those who inject drugs reported to the Department of Public Health between the start of February and mid-March, which shows the bulk of the recent increase in reported cases preceded the tent clearing.

“The city has helped 179 residents find transitional and long-term housing, which is critical to supporting their recovery, as well as their general health and wellness,” Latino said in an e-mail.

Latino said for the city, “every option is on the table” to help people struggling with addiction.

“Expanding access to harm reduction services is a key component of our response to this crisis, but more work is needed to remove the stigma associated with it to encourage more people to use these life-saving services,” he said.

Felice J. Freyer of Globe staff contributed to this report.