Harm reductionists’ worst fears are coming to pass. A cluster of new HIV cases has sprouted in an Upstate county, increasingly among people who inject drugs, according to a state-published health advisory obtained by Filter. But the preventative measures recommended by the state’s Department of Health, like syringe service programs, are currently being undermined by Governor Andrew Cuomo’s failure to properly support contracted harm reduction organizations.
In the first nine months of 2020, Monroe County, home to the city of Rochester, recorded as many new HIV diagnoses (55) as it had in any of the previous four years. That means 2020—the year Gov. Cuomo hoped to “end the AIDS epidemic”—is on track to roll back progress in reducing the preventable transmission of the virus.
Monroe County’s number of new HIV diagnoses specifically among people who inject drugs began to increase in 2019, with 10 cases, compared with fewer than five in each year from 2013 through 2018. Like cases overall, injection drug users’ new diagnoses in 2020 so far have already reached 2019’s total. The Monroe County Department of Public Health did not respond to Filter’s request for comment.
Non-Hispanic Black and Hispanic upstaters have received the majority of new diagnoses in the Monroe County HIV cluster.
Already hit hardest by COVID-19, people of color—specifically non-Hispanic Black and Hispanic upstaters—have received the majority of new diagnoses in the Monroe County HIV cluster. National trends in recent years mirror this disparity. New York State Department of Health (DoH) spokesperson Erin Silk emphasized, though, that there is “likely no single demographic or transmission risk factor that explains the trend.”
Two other alarming public health issues are significantly impacting Black New Yorkers—in similar ways across the state, but far more severely in Monroe County.
Fatal overdoses among Black residents of Monroe County have been increasing since 2018, despite overall deaths trending downward since 2017. Filter was unable to obtain race-level data for such deaths in 2020. But drug-involved fatalities are spiking, from 47 in the first half of 2019 to 65 during the same time period this year. The 38 percent increase seems to have gotten underway in March and April, the period when Cuomo declared a state of emergency and instituted shelter-in-place orders.
New diagnoses of sexually transmitted infections (STI), particularly gonorrhea and chlamydia, are also surging in Monroe County, according to a July 14 health advisory, and it’s happening most commonly among Black people. Monroe County cases rose by 21 percent from 2018 to 2019, and 61 percent of cases in the latter year involved Black upstaters. Then in the first three months of 2020, the number of cases leaped even faster—up 75 percent from the equivalent period in 2019. The recent health advisory did not disclose the distribution of diagnoses by race for Q1 2020.
About one-third of people newly diagnosed with HIV in 2020 have previously been diagnosed with another STI, like gonorrhea and chlamydia.
The DoH recommends tried-and-true harm reduction services. Specifically, it advises organizations to “facilitate access to clean syringes and essential support services for people who inject drugs.” According to Silk, DoH has been “working closely with community providers, including the syringe exchange program, in the Monroe County area to make sure all have seen the health advisory, and discuss ways that providers increase outreach efforts in the area.” What appears to be Monroe County’s sole SSP, Trillium Health, did not respond to Filter’s request for comment.
A virtual community meeting is scheduled for October 30 “to follow-up on the health advisory and reiterate guidance on offering and performing HIV/STI testing, risk and drug use assessment, appropriate screening for HIV/STI in priority settings, treat promptly or link to care, collaborate and refer as needed to CBOs for support services such as PrEP and expedited partner therapy (EPT),” the spokesperson said.
But Governor Cuomo’s administration seems to be undermining the possibility of a robust response to the HIV cluster. Before COVID-19, the state was already failing to pay contractors on time, as the state Comptroller found. Now, some harm reduction organizations haven’t been paid for longer than usual, as Filter recently reported. And even if and when they do get paid, 20 percent of reimbursements will be withheld, per Cuomo’s July executive order suspending prompt payment regulations. His representatives did not respond to Filter’s inquiry.
Meanwhile, The Foundation for AIDS Research (amfAR), the organization contracted by the state to provide safer use equipment to SSPs, is apparently unable to keep harm reductionists properly stocked. The exact reason for the supply lapse is unclear, as amfAR didn’t respond to Filter’s request for comment.
Put together, the supply shortage and payment delays have left harm reductionists unable to sufficiently respond to the HIV cluster—or even to detect others that may be occurring.
“The fact of the matter is we don’t know whether there’s an HIV cluster in Onondaga County,” almost two hours east of Monroe County, Alessandra Miller, director of drug user health at Syracuse-based care provider, ACR Health, told Filter. “The only way that ACR would know about a cluster in our own community would be through outreach”—a program that conducted mobile rapid testing for HIV, hepatitis C and other STIs.
Miller believes the starved organizations may not be able to intervene until the problem has worsened.
But ACR’s outreach program “no longer exists,” Miller said. Its elimination was not even caused by COVID-19 austerity; the contract simply expired. Upstate suffers from “a lack of funding and presence of harm reduction agencies throughout the state,” she said. Miller added that ACR’s available resources for the area it covers, a single “health hub” clinic and three SSP sites, “[do] not provide a fraction of services that are adequately needed to address the need in these nine counties.”
Unable to meet participants where they’re at, a hallmark of harm reduction practice, Miller believes the starved organizations may not be able to intervene until the problem has worsened.
“Our population does not seek out healthcare. If I were to walk up to someone and say That infection looks really bad, You should go to the hospital, they would laugh,” she said. “We aren’t going to know until people call a rapid provider or get tested here. That’s what’s so frustrating: We just don’t know, and when we do, it will be a more significant problem.“
When combined, the novel problems caused by COVID-19—like the syringe shortages and a variety of exacerbated business-as-usual issues like limited contracts and payment delays—seem to be contributing to a crisis that on-the-ground experts could see coming a mile away.
“Of course there’s going to be an HIV [cluster],” Miller said, echoing a prediction also expressed to Filter by VOCAL-NY’s Jasmine Budnella, Housing Work’s Max Sepulveda and Harlem United’s Mary Brewster. “As long as people are injecting drugs—or anything—and these populations are flat-out not receiving these resources, there’s no ifs, ands, or buts about it.”
October 28, 2020 Update: Statements from Department of Health spokesperson Erin Silk have been added. Filter incorrectly described the HIV cluster as an “outbreak” two times in this article, and the language has since been corrected.