San Antonio HIV cases on the rise, city called ‘hot spot’

San Antonio HIV

San Antonio HIV cases are on the rise. Last year the city had 338 new diagnoses and the CDC identified it as the largest ‘hot spot’ in the U.S.

A “hot spot” represents a transmission cluster of cases where the virus in the infected individuals is of a genetically similar strain. This means that the virus is spread within a population before it mutates. 

There are 16 such clusters in Texas. Six of those are in San Antonio, including one that includes 27 confirmed cases of HIV. In 2018, there were 338 new HIV diagnoses in the Alamo City. 

Across the U.S., 48 counties account for more than 50 percent of new HIV cases. More than 50 percent of those cases were acquired through male-to-male sexual contact. 

In Texas, the counties with the most HIV cases tend to be clustered around large urban areas and points of transit. 

The Texas Department of State Health Services found that  HIV is common in Cameron and Hidalgo counties — the heart of the Rio Grande Valley. 

HIV is also prevalent in Greater Houston and the Dallas-Fort Worth Metroplex. In Central Texas HIV diagnoses follow I-35, with Bell County in the North and Bexar County in the South. 

San Antonio HIV is worse for minority LGBTQ youth

In Bexar County,  infection rates are trending up in young LGBTQ people, especially Hispanic and Black men. The DSHS found that new HIV diagnoses amongst gay Hispanic men increased from 31.7 percent in 2008 to 40.5 percent in 2017.  

Bexar County and San Antonio’s various health officials and AIDS organizations have spent the last two years trying to combat the disease. 

One of the ways that state agencies and NGOs are working to stop the spread of HIV is by getting the word out about PrEP and PEP. 

Pre-Exposure Prophylaxis, or PrEP, is a class of antiretroviral prophylactic drugs that can reduce the risk of catching HIV by 51 percent. Post-Exposure Prophylaxis, or PEP, is a course of antiretroviral drugs taken within 72-hours of being exposed to HIV. 

“PrEP is a critical strategy to addressing HIV,” Chris Van Dusen, DHSH’s director of media relations. said. Because PrEP is seen as such a key component in controlling the spread of HIV, DSHS is using funds from a one-year federal grant to raise the drug’s profile in Texas. 

One way the state agency is educating gay men about PrEP is through peer-to-peer technical assistance. 

The initiative trains peer counselors to provide “supportive services to promote medication adherence” as well as “answer questions and help troubleshoot issues and concerns,” according to DSHS documents.  

In 2018, DSHS funded three local health departments and five community-based organizations to provide PrEP services. One organization that provides PrEP counseling is Legacy Community Health in Houston. 

HIV stigma is alive and well

When it comes to counseling one of Legacy’s main struggles is fighting the stigma that still surrounds HIV. 

“There have been considerable advancements in prevention, [but] many people are unaware of their options and some forego medical consultation all together because of the stigma,” James Lee, Legacy’s  Government Relations Manager, said.

Despite decades of education, the ignorance and stigma surrounding HIV remain a daily reality.  Oddly, ignorance of HIV is more pronounced in younger generations than in older.   

A recent study from the Prevention Access Campaign and the pharmaceutical company Merck found that 41 percent of people 18-22 years old are either not at all informed or somewhat informed about HIV. 

The percentage of people without information about HIV drops to 23 percent for people between the ages of 23 and 36 years-old.  However, 30 percent of HIV-negative millennials would prefer not to interact with someone with HIV. 

Additionally, One in three Black and Latinx millennials reported avoiding shaking hands, sharing drinks or eating utensils with someone with HIV. And 28 percent of HIV-negative millennials won’t hug a person with HIV. 

To counteract the negative stigma surrounding HIV the San Antonio AIDS Foundation (SAAF) utilizes patient navigators. These trained counselors help individuals who have opted into HIV testing, learn about PrEP and PEP. 

The navigators also connect patients with other San Antonio organizations that can offer medications. Along with information DSHS also provides funding for at least one PrEP prescription for about 1,700 people.  

The prescriptions are offered through the existing STD clinic structure in Fort Worth, Houston, and San Antonio, according to Van Dusen. Despite the advances that have been made over the last few years, the fight against HIV is never really over.  

In this past legislative session, Legacy helped lobby lawmakers to get HIV-positive patients classified as a protected class for Medicaid beneficiaries, Lee said. 

“During the [next] legislative session, we hope to focus on the issue of coverage for HIV testing and expanding access to testing at large,” he added. 

Houston chemical plant explosion ‘high priority violator’

Chemical plant explosion
An explosion and fire at a chemical plant in Port Neches on Nov. 27, 2019.
CASEY PORTER via REUTERS

BY KIAH COLLIER

Another Houston chemical plant explosion. The Port Neches chemical plant where two explosions and an ongoing fire prompted widespread mandatory evacuations on  Nov. 25 has a years-long history of state and federal environmental violations.

The facility owned by Houston-based Texas Petroleum Chemicals, or TPC Group, which manufactures highly flammable 1,3 butadiene, has been considered a high priority violator by the U.S. Environmental Protection Agency for more than two years, and been out of compliance with federal clean air laws since the agency’s last inspection in August 2017. State data shows the facility has reported spewing more air pollution than allowed by its government-issued permits five times this year, including hundreds of pounds of butadiene.

Though the exact cause of the fire and explosions, which injured several workers and residents, is still unknown, local emergency response officials said it had been traced to a processing unit that produces the colorless gas, which is used to make rubber and plastics and is a known human carcinogen. The first explosion took place around 1 a.m. on Wednesday, Nov. 25.

The second occurred that afternoon, prompting mandatory evacuations within a four-mile radius of the plant in Port Neches, Groves, Nederland and northern Port Arthur. For most of the next 48 hours, approximately 50,000 people were forced out of their homes.

Together, the EPA and the Texas Commission on Environmental Quality, the state’s environmental regulatory agency, have fined TPC for air emissions violations more than half a dozen times in the past five years after finding many of the missteps preventable.

But environmental and consumer advocacy groups on Wednesday said that those penalties — which add up to less than $200,000 — are nowhere near enough to deter a company that brings in billions of dollars a year from taking corrective actions.

“When you look at all these facilities and their compliance histories, it’s like a rap sheet,” said Elena Craft, senior director for climate and health at the Environmental Defense Fund. “And of course we see many times these bad actors that continue to have violations and ultimately this can lead to the kind of major disasters like the explosion last night.”

Houston chemical plant explosion, latest in a long line

There have been multiple, major fires and explosions at Texas chemical plants in recent years that have resulted in injuries and deaths, particularly in the Houston area.

Some of this year’s headline grabbing explosions and fires included the March 17 fire at Intercontinental Terminals Co.’s Deer Park facility.

The ITC fire burned for three days and pumped enough black smoke into the atmosphere that the plume could be seen in Downtown Houston, 20 miles away. As high-profile as the ITC fire became, it wasn’t the Houston-are’s worst industrial accident of the year.

In August, an explosion at an ExxonMobil plant Baytown plant injured 66 people.  Like with Port Neches, many of the facilities that caught fire this year had long histories of repeat violations.

A 2017 investigation by The Texas Tribune found that the TCEQ, which is responsible for administering federal clean air laws, fined fewer than 1 percent of so-called “emissions events” — when a facility emits more air pollution than is allowed by its permits — in 2016. When it did fine companies, those penalties often make up a sliver of revenues and profits — and the commission often waives a portion of them if the companies agree to address the underlying issue in a timely manner.

The two fines TCEQ handed down to TPC Group this year were for $13,688 and $7,500, but the agency agreed to defer one-third of the amount.

The EPA, TCEQ and TPC Group didn’t respond to requests for comment.

In an incident update posted to its website Wednesday morning, TPC, which celebrated its 75th birthday this year, said it “sincerely remains focused on protecting the safety of responders and the public and minimizing any impact to the environment.”

In a written statement, Catherine Fraser of Environment Texas said “Disasters like these are terrifying and unacceptable, and the TCEQ and EPA need to take much tougher enforcement actions and strengthen safety regulations, like the Chemical Disaster Rule, to build safer and healthier communities.”

The Port Neches incident comes a week after the EPA gutted the so-called Chemical Disaster Rule. A series of safety regulations enacted in the waning days of  the Obama administration.

Although the rules weren’t adopted until 2017, they were proposed after the West Fertilizer Company explosion in West, Texas. In 2013, an arsonist set fire to the plant.

Within 20 minutes, the flames hit an unknown amount of ammonium nitrate. The explosion hit with the force of about 10 tons of TNT and left a 93 foot crater.

The fireball killed 15 people, injured another 160 people, and destroyed 150 buildings. The resulting rules changest strengthened a decades-old EPA program designed to prevent and mitigate chemical disasters.

The Chemical Disaster Rule would have required companies to study ways to avoid incidents by using better technology or less risky chemicals, be more transparent about what types of chemicals they store on site to aid first responders in case of an incident — and to do third-party audits and root-cause analyses afterwards if one were to occur.

As authorities investigate the cause of the Nov. 25 Houston chemical plant explosion, it’s difficult to say whether the Port Neches incident could have been prevented if the rule had been in effect.

But Heather McTeer Toney, who was a regional administrator for the EPA under the Obama administration, said, “what we can say with all certainty is that rules like this are critical to ensuring that we’re at least aware and are doing everything that we can to prevent these types of explosions.”

This article first appeared on the Texas Tribune. Click here to read it in its original form.