The opioid epidemic now brings one more worry for public health professionals in the city and at least one suburban county, as the number of new HIV diagnoses — which had been declining — has substantially increased among those who inject drugs.
“There is a new epidemic among people who use IV drugs,” said Jane Shull, chief executive officer of Philadelphia Fight Community Health Centers, which provides HIV primary care and education for low-income patients. “We have seen a lot of people in the health centers with new [HIV] infections.”
Thomas Farley, commissioner of Philadelphia’s Department of Public Health, said the increase “is something that definitely has us concerned.”
The overall number of new HIV cases has been on a steady decline since the mid-2000s. Currently, 19,199 Philadelphians are living with HIV. In 2017 there were 419 newly diagnosed HIV infections, according to the health department.
But from 2016 to 2018, the number of new diagnoses reported in people who inject drugs has nearly doubled to 59, a number that is sure to rise when all the data are finalized, said James Garrow, spokesperson for the Department of Public Health.
Farley said the department has increased testing in areas of the city where people inject drugs and is expanding the availability of clean syringes. HIV is being spread by those who are infected and share needles, he said.
The department is also expanding the use of PrEP, a daily pill that lowers the risk of getting the virus, he said.
“It is not easy,” Farley said. “They are not a population that tends to access medical care.”
A safe injection site in the city would have the added benefits of bringing more people into contact with health-care providers and help reduce the spread of HIV, he said.
Statewide, there was a 2 percent increase in HIV diagnoses among those who inject drugs from 2016 to 2017, according to the Pennsylvania Department of Health. The numbers for 2018 are not yet available, officials said.
New Jersey is seeing a similar trend. Newly diagnosed cases of HIV in people who inject drugs have nearly doubled, from 31 in 2016 to 61 cases in 2018, according to the state Department of Health.
Nationally, the number of new HIV diagnoses has leveled off at about 39,000 annually. But between 2016 and 2017, there was a jump in cases among those who inject drugs.
The increases in HIV cases for the second year in a row confirm what some experts already suspected. For the last three years, Sharita Flaherty, HIV program manager for the Bucks County Department of Health, kept a count of new cases of drug users diagnosed with HIV. In 2016, people who injected drugs accounted for 6 percent of new cases. In 2018, drug users accounted for 23 percent, she said.
“We had eight cases" in 2018, she said. “These are not massive numbers, but with respect to Bucks County, they are significant.”
Flaherty said the county has ramped up educational outreach to drug and alcohol rehabilitation centers and the Bucks County Correctional Facility to encourage testing and the use of PrEP and condoms.
Jose Benitez, executive director of Prevention Point, a nonprofit agency in Philadelphia that provides medical care and free syringes, said, “Everyone in the country is looking at whether we have a new outbreak.”
HIV education has been part of the group’s educational outreach all along, he said.
Benitez noted an explosion of people who moved from taking opioids in pill form to injecting the drugs, sometimes using as many as eight needles a day, he said.
“The proven way to avoid these kinds of infections is to have a very robust syringe services program,” Benitez said. “We are underfunded given the scope of what we are seeing.”
Needle exchanges remain illegal in Pennsylvania. Only Philadelphia and Pittsburgh currently have syringe programs.
“If history has everything to say about this, we have to start paying attention to it now,” said Benitez. “We don’t want to go back to where we were.”
The increase in new HIV infections among drug users comes after President Donald Trump called for a plan to halt the spread of HIV in the United States by 2030 in his State of the Union address.
The administration’s plan would be to focus on 48 counties, including Philadelphia, and seven states: Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma and South Carolina.
Local experts are optimistic that with the right resources, the goal is achievable, but share a growing concern that without sufficient funding and the possibility of cuts to the Affordable Care Act and other programs, the rates of infection could increase.
“We now have the tools that can have a big impact on HIV transmission,” said Pablo Tebas, a professor of infectious diseases and director of the AIDS clinical trial unit at Penn Medicine. The key is to provide the resources for drugs that are expensive, he said.
For PrEP, also known as Truvada, the cost to each patient can run about $20,000 a year — less than half the cost of treating a patient with HIV/AIDS, Tebas said.