Rapid HIV testing and clean needles – key to containing the epidemic – are just starting to emerge in needed capacities in the city, and sources fear that apathy may prevent the response from being taken as seriously as it is. it should be.
âI’m so angry I can’t take it,â said Sue Purchase, director of Harm Reduction Sisters at Duluth, of the state’s response so far. “It was preventable, and they watched the statistics climb and did nothing.”
The Minnesota Department of Health announced the HIV epidemic in March, starting with 13 cases within a 30-mile radius of Duluth. The number has since risen to 17, with 16 cases in St. Louis County and one in Lake County.
The multitude of cases recorded during the outbreak is linked to those first diagnosed in September 2019. The virus would normally appear in zero to five people per year in the area concentrated around Duluth.
But half a dozen sources interviewed for this report tell a chilling story. They describe cases that first appear in the population of people who inject drugs and then spread to include the sexual partners of some of these people.
And although the epidemic is concentrated among people who are homeless and men who have sex with men, it has not been limited to these groups. People at work who use injectables and spouses who are unaware of their partner’s drug use or promiscuity are at increased risk of contracting HIV during the epidemic.
âPeople who inject themselves cut many different types of tissue,â said Dr. Harmony Tyner, a physician at St. Luke’s Infectious Disease Associates. “It has the potential to become a pretty big problem.”
Harmony Tyner (2021 document photo)
People who trade sex for housing and other needs are also at high risk during the current epidemic.
HIV is spread through sex or through contact with contaminated blood. And syringe sharing, one of the riskiest behaviors associated with HIV transmission, is endemic locally, with desperate people sometimes using and sharing the same bacteria-laden syringe for weeks, sources said. Some people resort to sharpening the tips of needles on matchbooks.
Purchase meets people on their terms, wherever they go. It distributes 45,000 clean needles per month from its Honda sedan to people in 10 counties surrounding Duluth. It may sound like a lot, but it’s only part of what she’s done in the past, as needle swaps – swapping contaminated syringes for new ones – suffered during the COVID-19 pandemic.
âI can’t meet the need,â Purchase said. “I’m maybe down in half of what I was doing on average 80,000 per month.”
Sue Purchase sits in the back of her car filled with harm reduction supplies, including new needles for people who inject drugs. (Tyler Schank / dossier 2019 / News Tribune)
Mary McCarthy is the executive director of the state’s Rural Aids Action Network. He has an office in downtown Duluth that offers needle exchanges and, soon, rapid HIV testing. She and others have suggested the outbreak is deeper and has more cases than is currently known.
âIt’s a great role model for meeting people where they are, but the challenge is we probably haven’t found everyone,â McCarthy said. âThat’s a lot of geography to cover.
A Minnesota Department of Health official said the state is on top of the epidemic and sympathizes with frontline workers who, she explained, often see things in real time d ‘in a way that may give the impression that the response has been slow.
âOne of our concerns is that when we see this number of cases in a concentrated area, it can spread quite quickly,â said Christine Jones, manager of STD / HIV / TB programs at the Minnesota Department of Health. âTo scale up our response to HIV, we are getting a lot more training to get people to do more testing, and a lot of harm reduction supplies are available. “
“Young people don’t know”
Because rapid tests are only starting to appear on the streets and in the windows of advocacy agencies, people who have tested positive locally have done so in hospitals.
Left untreated, HIV can profoundly suppress an individual’s immune system over time. But that’s no longer the death sentence it was when HIV first arrived in the early 1980s, first plaguing the gay community. There are now powerful and effective drugs that can make the viral load undetectable and support normal lives in people with HIV.
âThe vast majority of the people I care for (HIV positive) are older people who are well controlled,â said Tyner of St. Luke’s. “But one of the challenges with this particular epidemic is that the lives of those involved tend to be chaotic, and to be treated effectively they need medication every day.”
HIV can become resistant to drugs when not taken as prescribed, she added.
It is feared that some people with HIV may not find out about their disease and continue to transmit the disease. Statistically, one in five people with HIV don’t know, Tyner said. Acquiring HIV can cause flu-like symptoms, but after that it can take years for a person’s health to deteriorate.
Due to the epidemic, it is recommended that people belonging to high-risk groups get tested for HIV now and continue to do so regularly.
âOnce a person knows, they tend to change their behaviors,â Tyner said. “Only a sociopath doesn’t.”
One of the biggest obstacles encountered during the epidemic is the general lack of knowledge about HIV and other sexually transmitted diseases. Earlier this week, the state’s health department announced an outbreak of syphilis in Duluth, with cases in St. Louis County dropping from 12 in 2019 to 28 in 2020 and 24 so far in 2021. Syphilis is spread through sexual contact.
âConcerns about HIV have subsided a bit,â said McCarthy, of the Rural Aids Action Network. “I don’t know if it’s apathy or a lack of understanding in general.”
Kathy Hermes is an HIV educator at the Center for Changing Lives in Duluth, serving homeless 13-24 year olds. She agrees that awareness is low.
âYoung people in general are not aware just like adults are not,â Hermes said. “When I make my pitch about the free tests, there isn’t a lot of interest until I tell them I’m going to give them a $ 20 gift card.”
To help with Duluth’s response, the Minneapolis-based Indigenous Peoples Task Force is using his expertise. So far, there is no evidence that the local indigenous population has been disproportionately affected by the epidemic, said Calvin Hylton, head of HIV programs for the group.
He pointed out that the COVID-19 pandemic created the environment that allowed HIV to thrive.
âResources are often slow in coming in a normal environment,â Hylton said. “Then you add to that the emergence of a global pandemic, which has caught everyone’s attention.”
While there have not yet been any cases among young adults served by the Center for Changing Lives, the specter of HIV looms over its mission.
âIt makes me sweat to think about when this is happening,â Hermes said. âCOVID has exacerbated this on several levels. People are quite isolated both informally and one-on-one. “
‘The tip of the iceberg’
Despite the frustrations over the collective response to the epidemic, things are falling into place.
In Duluth, the state has brought together what it calls the HOPE group, or HIV Outbreak Partner Engagement, which brings together HIV agencies at the same table. The group met online this week to further define its response.
State HIV official Jones reported that $ 150,000 in harm reduction supplies, including clean needles and HIV test kits, has been ordered for outbreaks in Duluth and the Twin Cities , where HIV epidemics in Hennepin and Ramsey counties were announced last year.
Rapid test kits come in the form of a saliva swab or finger prick, and training to administer the tests includes lessons on how to compassionately educate someone who is HIV positive.
âFirst and foremost, we put them in immediate contact with care,â Jones said. “We help them let their partners know that they have been exposed, and we will do so anonymously.”
By informing partners and collecting data from the individual, the state is able to better understand the spread of the disease. As of yet, there is no link between the Twin Cities and Duluth epidemics. But at a time when HIV cases are declining globally in the state, epidemics illustrate how paying so much attention, even rightly, to the COVID-19 response has had consequences.
âCOVID was our number one priority,â said Rillis Eklund, St. Louis County disease response specialist. âWe started off slower than most people would have liked with the HIV epidemic. ”
The county is ordering large syringe disposal boxes to be deployed throughout the community. The containers will look more like postal letter boxes than the smaller units found in public washrooms.
And the state gave a grant of $ 168,000 over 18 months to the Harm Reduction Sisters, so they could expand their ability to meet people where they are.
âI tell every person I meet that there is an epidemic,â Purchase said. ” It’s horrible. This is just the tip of the iceberg.
A federal law prohibits federal spending on syringes used in needle trade. This is indicative of the controversial nature of harm reduction work. Although it aims to reduce the impact of high-risk activities, many people misjudge it and blame the victims.
âPeople are so terrified,â Purchase said. “They already face incarceration, alienation and isolation in many ways.”
In St. Luke’s, Tyner noted his ability to prescribe pre-exposure prophylaxis, or PrEP, a harm reduction drug that, taken daily, can prevent HIV from appearing in people with high-risk behaviors.
âIf I know someone or their partner is injecting drugs and they are ready and able to take drugs, I will prescribe it 100%,â Tyner said.
HIV drugs are expensive, and the shock of the sticker can be a barrier to treatment. But the doctor said there are ways to get the drugs for free. She encouraged anyone concerned about their HIV status to seek treatment at the hospital.
âWe need people to be tested,â Tyner said. âIf you think you might be at risk, we can help. “