A new cluster of HIV cases in Boston and Worcester has public health officials scrambling to stop the outbreak before it spreads.
It's the start of something state officials and health care providers are determined to stop before it goes any further, posing a threat to years of considerable progress.
"We're not shocked to see that something like this has started to occur," Richard Baker, program director of the Victory Mobile Prevention Team, said. "Large populations have kind of gone complacent with HIV, not recognizing there is still risk of transmission."
Baker is on the front lines in the battle against new HIV cases, affecting mainly intravenous drug users.
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From what he's seen, an increase in the presence of fentanyl across the local drug market is a factor that can't be ignored.
“The nature of fentanyl, it’s a short and more intense high as compared to heroin, which is resulting in people having more frequent injection," Baker said. "Which ultimately leads to the likelihood sharing or reuse of needles."
From 2014 to 2018, the proportion of new HIV infection among intravenous drug users in the state grew from five percent to 14 percent.
Just last year, state and federal officials began probing an alarming cluster of HIV cases in Lawrence and Lowell.
Over the last three years, 157 new infections have been reported in those communities.
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Advocates are now actively working to prevent similar numbers in the state's two largest cities.
Kevin Koerner has been living with HIV for more than 30 years, and has lived through significant milestones in medicine since the once-grim diagnosis.
"I'm living proof that this disease isn't a death sentence anymore," Koerner said. "I just remember walking out of there in a daze. I didn't know when my life would end. I felt pretty soon it would."
But, Koerner is proof of a different outcome, and spends his days offering support to others who are HIV positive at the Boston Living Center.
He's hoping his story will encourage others to know their status in the ongoing fight against this disease.
"Testing makes all the difference," Koerner said. "Knowledge is power."
Health officials have activated a statewide advisory to healthcare providers and local boards of health, urging ramped up HIV testing among high-risk groups.
At least six new HIV cases have been reported in Boston since November. During the same period the previous year, there were no new HIV cases.