The reports began in the beginning of 2018.
An outbreak of new HIV/AIDS diagnoses sprang up in Seattle. By September, Public Health – Seattle & King County found more than 10 new cases concentrated among heterosexual people injecting drugs. That’s more than the department receives in an average year.
Seattle and King County have had success in controlling and treating this disease, which attacks the body’s immune system. The area has seen the rate of new infections drop by half, and advancements in treatment mean that the virus is no longer the death sentence it once was.
That is, of course, if patients can receive the treatment that they need. But people experiencing homelessness often have difficulty receiving adequate health care, something that is especially critical to people living with HIV.
“A person who was stably virally suppressed and not having any trouble might see a doctor twice a year,” said Dr. Matthew Golden, director of the Seattle & King County HIV/STD program.
People with less stable living conditions may need to be seen more often, if only to ensure that they’re keeping up with their medications. That can be made more difficult by circumstances that impact homeless people, such as transportation problems or the loss of life-saving drugs in encampment sweeps or theft.
But the disease is spreading, in part because of the use of drugs including methamphetamine and heroin, and also because of changes in sex work, Golden said.
Backpage, a site where people could advertise sex work, was shut down by federal authorities in April. News outlets reported that this pushed sex workers back onto the street, where their trade holds more dangers.
The newest outbreak occurred among heterosexual drug users, which is unusual, Golden said. That’s a problem for public health officials because there are more people who fall into that category.
“As the population grows, our vulnerability increases,” Golden said. “If there are more people having these hardships, that’s going to be harder for the population, and more people for something bad to happen.”
“As the population grows, our vulnerability increases.”
HIV is a reportable disease, meaning that it is tracked when someone tests positive for the illness. Most cases are discovered through interactions with the health care system. In this case public health workers conducted direct outreach in order to find new cases and get people into care.
One quarter of the people in the recent outbreak were found through this method, Golden said.
According to a 2017 King County HIV/AIDS epidemiology report, there were an estimated 6,798 King County residents and 12,395 Washington state residents living with an HIV infection in 2016. The department estimated that 11 percent of King County residents living with HIV who are in medical care had experienced homelessness in the past year.
Modern treatments for HIV/AIDS are very effective, as is a medication called pre-exposure prophylaxis, better known as PrEP, which has been shown to reduce the risk of HIV infection in high-risk populations by as much as 92 percent. However, PrEP is considerably less effective when taken inconsistently, complicating that method of prevention for homeless people.
Dr. Carrie Horwitch has been treating patients with HIV/AIDS since 1993. Modern medications are much easier to take and the body tolerates them better, Horwitch said.
“We should have, in my opinion, no death from HIV/AIDS,” Horwitch said.
Horwitch, who practices at Virginia Mason Medical Center, says there is likely enough availability of treatment in the area, and that barriers to care are often social determinents such as lack of transportation, lack of insurance or lack of housing.
“The biggest thing I would emphasize is that HIV is absolutely treatable and mostly preventable infection that requires access to care and coverage,” Horwitch said.
“The biggest thing I would emphasize is that HIV is absolutely treatable and mostly preventable infection that requires access to care and coverage.”
King County is lucky insofar as accessing treatment for this chronic illness is easier here than in other places. In 2017, public health officials announced that the county was one of the first in the country to meet a major milestone set by the World Health Organization: get 90 percent of residents infected with HIV knowledge of their infection status, 90 percent on HIV retroviral treatment and 90 percent virally surpressed.
People experiencing homelessness and living with HIV have options. Local programs can help get them into housing, and assist with transportation and food, Golden said.
“Nobody goes without HIV care in this state because they are uninsured or poor,” Golden said.
“We treat everyone.”
Ashley Archibald is a Staff Reporter covering local government, policy and equity. Have a story idea? She can be can reached at ashleya (at) realchangenews (dot) org. Follow Ashley on Twitter @AshleyA_RC
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