The outbreak of HIV among injecting drug users in Lawrence and Lowell has affected many more people than originally thought, resulting from the early arrival of fentanyl in northeastern Massachusetts and other factors, a nationwide study
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Homelessness and detention played a major role in the spread of the virus, by restricting access to treatment that repressed it, according to the eight-page report released Wednesday. Other factors included a decline in HIV testing and, in practice, sexual or drug-sharing partners of infected people.
The number of 129 cases is "a very large outbreak of these infections in this population," said Kevin Cranston, director of the Department of Infectious Diseases and Laboratory Science of the State Department of Health.
"Now we really understand the scale of this problem," said Cranston, noting that for many years, the transmission of the virus among drug users in Massachusetts was low.
The increase in HIV cases was first observed in 2016 in Lawrence, a sign that overdoses are not the only fatal consequence of the opioid epidemic.
As HIV numbers continued to grow and a similar cluster was discovered in Lowell, the Massachusetts Department of Public Health last summer called specialists from the US Centers for Disease Control and Prevention. About 19 CDC employees came alternately to the state over a five-week period ending June 1.
Using sophisticated molecular techniques and field-based interviews in the affected cities, the CDC was able to clarify the extent of the outbreak.
Fentanyl, a potent synthetic opioid, was previously used in the northeastern part of the US to enter into illicit drug treatment, and the associated increase in deaths from overdose also increased there earlier. In the CDC report, Lawrence has been described as a "long-standing drug distribution hub" and "now a production site for illegal fentanyl," where the drug is much cheaper.
"What is different about this part of the state is the timing of the introduction of fentanyl, which has helped trigger the outbreak," Cranston said. As fentanyl forms a short-lived high, users tend to inject more frequently, increasing the likelihood of infection.
Asked whether he was worried about a similar outburst in another country, Cranston said that the authorities have long been concerned about this population, as with hepatitis C.
Now, however, the CDC Experts have provided the software and training that will enable state health officials to quickly identify future clusters or outbreaks.
The state has also stepped up its preventive efforts by expanding its network of syringe exchanges, 20 of which are now operational, including one that opened a few months after the outbreak broke out in Lawrence. Five other cities, including Lowell, as well as the cities on Martha's Vineyard, have recently approved the opening of such programs that provide searchers with clean needles and other services.
The state will also work to encourage health care providers, "We now need to remain vigilant and support those programs that help people prevent infections," Cranston said.
Dr. Christopher Bositis, head of the HIV program at the Greater Lawrence Family Health Center, said the findings did not identify anything unique to Lowell and Lawrence, but rather pointed to well-known societal mistakes.
In addition to the problems with fentanyl and homelessness, he mentioned limited access to effective treatment for addiction, especially in prisons and prisons.
"That could certainly happen in other places," said Bositis. "This is a significant problem that has been caused by several complex structural and societal issues, so do not think that there will be a simple answer.
" We have done our work for ourselves. "