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Health Advisory: Increase Testing to Prevent HIV

April 23, 2019

In King County, newly diagnosed HIV infections are increasing among people who inject drugs.

Pierce County data does not show this trend. Between 2014 and 2018, Pierce County had, on average, 6 newly diagnosed HIV infections each year among people who inject drugs. It is too early to evaluate 2019 data.

Healthcare providers should increase HIV testing among patients who recently injected drugs. Vigilant testing will help determine if transmission is spreading outside of King County.

Requested Actions

Detecting and treating acute HIV infection early reduces transmission and safeguards the health of people living with HIV. You don’t need special consent or counseling to perform HIV testing.

  1. Assess and evaluate patients for HIV risk factors.
    • Gather behavioral risk history, including injection drug use, transactional sex, methamphetamine use, unstable housing or homelessness. Take a comprehensive sexual history and drug use history.
    • Test asymptomatic people who inject drugs for HIV, hepatitis C and syphilis at least annually.
    • Test people who inject drugs and present with symptoms consistent with acute HIV infection (fever, fatigue, myalgia, headache, pharyngitis, adenopathy) for HIV.
  2. Promptly report new HIV infections to Tacoma-Pierce County Health Department. Provide risk history, clinical and demographic data.
  3. Connect to care those recently diagnosed or living with untreated HIV for evaluation, follow up and antiretroviral therapy. Help patients stay on treatment and remain in care. Washington Department of Health administers programs to help people at risk for HIV or living with HIV. For more information, call (877) 376-9316.
  4. Offer HIV pre-exposure prophylaxis (PrEP) to people who inject drugs or exchange sex.
  5. The Health Department can help notify HIV partners and refer to support services and insurance. Call us at (253) 798-3805.
  6. Help people who inject drugs get sterile injection equipment. See Tacoma Needle Exchange for locations.
  7. Provide information about substance misuse treatment programs, including medication-assisted treatment, to patients who are ready to reduce or stop drug use. Call Washington Recovery Help Hotline, (866) 789-1511, 24 hours a day.
  8. Educate people who inject drugs about the availability of naloxone to prevent overdose death. Naloxone can prevent death from opioid overdose. See Stop Overdose for more information, including where people can access Naloxone.


In King County, newly diagnosed HIV infections among heterosexual people who inject drugs increased from 7 in 2017 to 30 in 2018—a 328% increase. This appears to be like recent outbreaks in other areas of the United States. A similar increase in Snohomish County raises the concern that increases may occur in other parts of Washington.

To date, Washington Department of Health has not seen similar increases in other regions of the state. However, surveillance and analysis of the risk environment leads us to expect additional cases will occur. We are concerned that areas outside of King County are vulnerable to increases in HIV transmission among people who inject drugs.


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