Use of Injection Drugs and Any Form of Methamphetamine in the Portland, OR Metro Area as a Driver of an HIV Time–Space Cluster: Clackamas, Multnomah, and Washington Counties, 2018–2020

• Published in: AIDS and behavior Vol. 26; no. 6; pp. 1717 - 1726
• Main Authors: Walters, Jaime, Busy, Lea, Hamel, Christopher, Junge, Kelsi, Menza, Timothy, Mitchell, Jaxon, Pinsent, Taylor, Toevs, Kim, Vines, Jennifer
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2022; Springer Nature B.V
• Subjects: Blood diseases; Clusters; Counties; Drug abuse; Health Psychology; Hepatitis C; HIV; HIV Infections - diagnosis; HIV Infections - epidemiology; Homeless people; Homelessness; Human immunodeficiency virus; Humans; Infections; Infectious Diseases; Intravenous drugs; Medicine; Medicine & Public Health; Methamphetamine; Metropolitan areas; Original Paper; Public Health; Risk-Taking; Sexually transmitted diseases; STD; Substance Abuse, Intravenous - complications; Substance Abuse, Intravenous - epidemiology; Syndemic; Syphilis; Time; Urban areas; Washington - epidemiology; Washington; Injection drug use; Surveillance; Epidemiology; HIV cluster investigation; Non-injection methamphetamine
• ISSN: 1090-7165; 1573-3254
• DOI: 10.1007/s10461-021-03522-3

We describe the response to detection of a time–space cluster of new HIV infection in the Portland, OR metro area among people who inject drugs (PWID) and/or people who use any form of methamphetamine. This time–space cluster took place in a region with a syndemic of homelessness and drug use. The investigation included new HIV diagnoses in 2018, 2019, and 2020 in Clackamas, Multnomah, and Washington Counties. Public health response included activating incident command, development and implementation of an enhanced interview tool, outreach testing, and stakeholder engagement. We identified 396 new cases of HIV infection, 116 (29%) of which met the cluster definition. Most cluster cases had no molecular relationships to previous cases. Persons responding to the enhanced interview tool reported behaviors associated with HIV acquisition. Field outreach testing did not identify any new HIV cases but did identify hepatitis C and syphilis infections. We show the importance of a robust public health response to a time–space cluster of new HIV infections in an urban area.