Hennepin County is the midst of a new HIV outbreak fueled by the COVID-19 pandemic and the continuing synthetic opioid crisis.
The most recent county statistics show 54 people have tested positive for HIV in the past two years from intravenous drug use or sexual transmission. In a typical year, the county averages less than three people who contract the virus.
The population impacted most by the outbreak is homeless people living in encampments who inject opioids or spread HIV through sexual transmission, county officials say. Ramsey and St. Louis counties have also recorded sizable HIV outbreaks of nearly 15 cases each.
Hennepin County workers have been aggressively addressing the issue after the state Department of Health first discovered the outbreak and alerted officials in January 2020. Even with preventive measures such as syringe exchanges, on-site testing and outreach programs, the outbreak has proved challenging to contain.
"It's a complex population," said Stephanie Abel, manager for clinical services for Hennepin County's public health department. "You have a person with an HIV diagnosis who might also have a substance use problem, mental illness and lack of housing."
Hennepin County's outbreak is especially concerning when compared to those in other parts of the country. Kanawha County in West Virginia, which includes Charleston, had at least 35 cases in 2020. New York City, with a population of 8 million, recorded 36 HIV cases tied to intravenous drug use in 2019.
"Whenever we see a higher number of cases reported than expected, that is significant and concerning for us," said Allison LaPointe, senior epidemiologist for the state Health Department's HIV section.
"While this outbreak does not compare with levels of new cases occurring in the early years of the HIV epidemic, it is one of the largest since the annual number of new cases stabilized over the past 20 years," she said.
Can lead to AIDS
HIV is a virus that attacks the body's immune system. If left untreated, it can lead to AIDS, which interferes with the body's ability to fight infections. There is no cure for HIV, but it can be controlled with strict adherence to antiretroviral therapy.
Hennepin and Ramsey counties have eight diagnosed cases so far this year. Each positive test result must be reported to the state Department of Health, along with demographic information.
A disease intervention specialist from state or local public health will try to reach the diagnosed person for a full interview, asking about risk factors and contacts. The state is now getting assistance from the Centers for Disease Control and Prevention with data analysis that detects outbreaks.
St. Louis County had an HIV outbreak declared in February, but the state had been working with local health providers for months before the notice. The county was also informed about an increase in syphilis cases.
Hennepin and Ramsey counties had an outbreak of 16 HIV cases in December 2018, but the total spiked to 68 last month. As more cases were reported, the state discovered a population pattern of homeless people in encampments who inject drugs.
"When we shared the HIV outbreak information with the general community, they are surprised," said Christine Jones, manager for the state Health Department's HIV section. "They think it's one of those things that was under control."
Hennepin County is one of 52 jurisdictions in the country that receives federal funding through the Ryan White HIV/Aids Program, which provides services to help low-income people living with the virus. The $6 million annual grant allows the county to work with 17 different organizations and the HIV care clinic at Hennepin Healthcare. The county recently received $80,000 from Minneapolis to house people who are homeless and have HIV.
"When the county bought hotels for the homeless who might be vulnerable to COVID-19, it allowed outreach workers to connect and test people who might also have HIV," said Jonathan Hanft, the manager of Hennepin County's Ryan White program.
Before the outbreak, the county already had an established HIV and drug harm prevention program. It has sites that provide more than 100,000 free syringes and take used syringes for exchange. It also offers a daily medication to prevent HIV infection for people at risk of contracting the virus and targeted outreach and testing at homeless encampments. Before COVID-19, clinics passed out about 50,000 syringes.
"Building trust and relationships is key with outreach and getting people whatever services they may need," said Sarah Jane Keaveny, a registered nurse with Hennepin County's Health Care for the Homeless program. "It may be straight up offering a $5 gift card to take a test or asking if I can get them a burger."
There is no typical response when workers interact with clients, Keaveny said. Some are angry about the stigma around HIV and others question the necessity of testing, she said. Then there are people who won't even deal with the issue, she said.
"COVID-19 and HIV have put an unprecedented strain on the health care system," Keaveny said. "The county's response has been robust and compelling. Nobody could have predicted what has happened in the last two years."
Communities of color
Much of the focus of HIV and drug prevention is aimed at communities of color, who suffer a high rate of substance abuse problems, according to county numbers. Some workers in the field said they believe drug and alcohol programs deserve more funding.
"I firmly believe in the health of drug users," said Marissa Bonnie, a care coordinator at Southside Harm Reduction Services in Minneapolis. "Drug users have human rights."
With the record number of fentanyl overdoses and deaths in Minnesota last year, the HIV outbreak will remain a priority public health issue, she said. Mobile medicine programs, low barriers to care and culturally specific treatment services will be important initiatives to contain the future spread of the virus.
"I see folks that I've known for years," Bonnie said. "If I can engage with them, I can tell them why care is so important. And most don't refuse help."
David Chanen • 612-673-4465