With public health experts laser-focused on clamping down COVID-19 infections, the nation's ongoing HIV epidemic has faded into the background. Now, some experts are voicing concern that a silent HIV outbreak may be brewing.
"What we are seeing reminds us of the 80s and I am worried that the pandemic might set everyone back," said Jasmine Budnella, a drug-policy coordinator at Voices of Community Activists and Leaders-New York (VOCAL-NY), which provides services for ending the drug war, homelessness and other issues affecting the poor.
In recent years, the United States has implemented programs that have helped level off the rate of new HIV infections, primarily through needle exchange programs that distribute clean needles to people who inject drugs and by distributing new medicines capable of stopping the spread of the virus.
Now, with the COVID-19 pandemic raging, many cities and local health departments have diverted personnel and resources to combatting the current pandemic. That means needle exchange programs have shut down, and many free HIV clinics have closed their doors.
"People have been reusing and sharing needles, sharpening old needles with rocks, or cleaning them with bleach and then injecting because they are unable to access new and clean supplies," said Budnella.
The ability to get syringes to those who need them has always been a challenge because of the lack of resources and stigma associated with drug use, said Sheila Vakharia, the deputy director in the department of research and academic engagement at the Drug Policy Alliance.
It's become nearly impossible for the people who previously relied on these programs to seek help. According to Vakharia, many have resorted to sharing syringes or cleaning them without proper supplies, which could increase the spread of blood borne infections like HIV.
In Ohio alone, over 50% of needle exchange sites have closed their doors; the remainder experiencing cuts in funding, according to advocates.
Although politically controversial, studies show that needle exchange programs can dramatically decrease the transmission of HIV.
Many of these clinics - which advocates call "harm reduction" programs - not only distribute clean needles but also offer free HIV testing and distribute lifesaving HIV treatment and prevention medication.
When one such clinic shut down in West Virginia, the community witnessed a staggering seven-fold increase in the number of new HIV cases.
People who need these services might be forced to go to one designated urgent care clinic in the city, said Cyndee Clay, the executive director at HIPS, a needle exchange center in Washington, D.C.
"Under a public health emergency like COVID-19, over the past month we have seen a significant drop-off in people's ability to stay connected to us because we're not allowed to provide the wraparound services that have made us successful," said Clay. "Under these circumstances, it's frustrating and it means people are going to die. And that's a really heavy thing to think about."
Needle exchange programs across the nation are rushing to find new ways to continue serving the most vulnerable and keep people engaged.
The Atlanta Harm Reduction Coalition now provides mail-in HIV testing to curtail the expected rise of HIV cases as well as adhere to social distancing policies. Dr. Mojgan Zare, the executive director of the Atlanta Harm Reduction Coalition, said the clinic has been able to use videoconferencing to reach some patients, but not everyone can access those services.
Mail orders are being used to provide needles and syringes. Next Pro is an organization that mails syringes to people in need to provide the freedom of accessibility, but this won't help people who are homeless.
Vocal-NY has attempted to overcome the strain the pandemic has caused on needle exchange programs by implementing secondary exchange, which Budnella explains as a method of community outreach where IV drug users are given more supplies than they need so they distribute them locally within their community.
Paula Santiago, an outreach and peer education manager for VOCAL-NY, has allowed her co-workers to stay home during the pandemic while she ventures to communities on her own.
"I am out there more than ever," she said.
But despite her greatest efforts, "we are going to see an outburst in HIV transmission because of people sharing syringes," she explained. "I'm hearing it from participants that people are sharing that there aren't enough syringes because programs are closing or reducing services, and that [HIV] is definitely a concern of mine."
Budnell said she hopes public health leaders will learn from this experience.
"In the moment of COVID, everybody is seeing it slamming in our faces that we need back up systems in place to avoid the circumstance we are experiencing now," said Budnell.
Lily Nedda Dastmalchi, D.O., M.A., is an internal medicine resident physician at The George Washington University and a contributor to the ABC News Medical Unit.