The opioid epidemic and a rising homeless population have helped fuel an HIV outbreak in North Seattle.

The spike in diagnoses of HIV has affected heterosexual homeless men using drugs intravenously and homeless women who are sex workers in North Seattle, according to Public Health – Seattle & King County. Since January 2018, 17 people have contracted HIV in the cluster. The cases are connected to a strain of HIV that 26 people have been diagnosed with going back to 2008.

Across King County, from 2017 to 2018, HIV diagnoses have risen threefold for heterosexuals who inject drugs.

The rapid increase of the infection rate is likely the coupling of a growing homeless population and the exploding opioid epidemic, said Dr. Matthew Golden, director of Public Health’s HIV/STD program.

“What we have is a growing population at risk,” he said.

The HIV strain showing up in this population worries public-health officials because homeless drug users are often hard to reach and connect with medical care and prevention programs. Public Health began working with medical providers, social-services agencies and others in the North Seattle cluster last summer when the outbreak was identified.

On-the-spot HIV testing has been expanded in the area of North Seattle around Aurora Avenue, as has the distribution of clean needles. Despite King County’s large needle-exchange program, it wasn’t reaching people in this area and added to the virus’ spread, said Golden.

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A rising rate among heterosexual men and women goes against past patterns of infection in King County, where the group most impacted was men who have sex with other men, and it runs counter to the declining number of HIV cases nationally. King County’s needle-exchange program is partly to credit for HIV rates traditionally being low for heterosexuals in the county, Golden said.

“At the end of the day we need to do a better job,” Golden said. “We need to do a better job addressing homelessness and the opioid problem.”

Another factor working against the people in the North Seattle cluster was a lack of focus on HIV spreading among heterosexuals, and catching up to women in the sex trade who don’t access traditional medical services, said Dr. Shireesha Dhanireddy. Through her role as the medical director of Harborview Medical Center’s Madison Clinic, Dhanireddy works with the North Seattle clinic S.H.E. (Safe Healthy and Empowered), a clinic that provides services such as family planning, vaccinations and testing for sexually transmitted diseases for women who are homeless, who use drugs, or who are sex workers.

“The sheer number of obstacles these women face and have to face on a daily basis, on top of the stigma, on top of the abuse, the rape, and the assaults, it is just overwhelming,” Dhanireddy said.

The rising number of homeless heterosexuals contracting HIV isn’t isolated to Seattle. Outbreaks have cropped up in Cincinnati, in Scout County, Indiana, and in the Lowell and Lawrence areas of Massachusetts, Golden said.

Infectious diseases have been hitting Seattle’s homeless population hard. Public Health – Seattle & King County issued advisories last year for outbreaks of rare diseases such as shigella and Bartonella quintana, known as “trench fever” when it spread among World War I soldiers.

On Thursday King County public-health officials said a local homeless man was diagnosed and hospitalized with the hepatitis A virus. Hepatitis A is not common but highly contagious. People who are homeless, people who use drugs intravenously, and men who have sex with men are at greater risk of contracting the virus.