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A cluster of new HIV infections in North Seattle has health officials worried that it’s unknowingly being spread by homeless addicts.

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Eight new cases have been identified among people described as being homeless, heterosexual, and drug users. Public Health said several of the people reported exchanging sex for money or drugs.

Doctors say the cluster is unusual and suggests that HIV could be gaining inroads into the heterosexual population through dirty needles.

“This cluster is unusual and worrying, suggesting that we are seeing an increase in HIV among heterosexuals who inject drugs, and that HIV could be gaining inroads into the heterosexual population through injection drug use,” Dr. Matthew Golden, MD, Director of Public Health’s HIV/STD Program said in a . “Changes in drug use patterns, with greater mixing between heroin users and people who inject methamphetamine, may be putting more people at risk for HIV.”

An average of 10 heterosexual people who use injection drugs are diagnosed with the disease in King County each year, according to Public Health. So far, there have already been 19 in 2018.

Public Health says it is alerting healthcare providers and urging them to increase HIV testing and prevention counseling, increasing outreach and testing programs, providing case management for individuals newly-identified with infections, and continuing to assure access to sterile injection equipment and condoms.

“The most effective way to prevent HIV transmission in the community is to identify people with HIV, link them to medical care and ensure that they are treated,” Dr. Jeff Duchin, Health Officer for Public Health – Seattle & King County said in a news release. “Medications for HIV suppress the infection, safeguarding the health of infected persons and preventing HIV transmission.”

Public Health says homelessness is a contributing factor for communicable diseases and HIV. The homeless have poor access to health care, have a high prevalence of injection drug use, and face behavioral health challenges.