Public Health – Seattle & King County has been a leader in the work of diagnosing, treating and preventing new HIV infections. Our HIV Program staff offer critical services including clinical care for people living with HIV, to free testing, and HIV prevention support.
We do this at various sites, including the Sexual Health Clinic and the Max Clinic on the Harborview campus (a collaboration with the University of Washington) and Public Health’s needle exchange sites. We also partner with numerous community-based organizations to lead support services, medical care, case management, outreach and education to people living with HIV and those at risk of acquiring HIV.
Every year, our HIV Epidemiology Report provides a comprehensive look at how our community is doing in the fight against HIV. As described in the most recent report, we’ve made significant progress—including substantially curbing new HIV diagnoses and HIV-related deaths.
We sat down with Dr. Jen Balkus, Senior HIV/STI Epidemiologist at Public Health, to discuss the successes, challenges, and what’s next in our efforts to end the HIV epidemic in King County.
Q: How would you summarize the current state of the HIV epidemic in King County?
Dr. Balkus: We’ve made remarkable progress. We’ve seen a steady decline in new HIV diagnoses among men who have sex with men (MSM)—2023 had the lowest number of new HIV diagnoses in MSM since the HIV epidemic began in the 1980s. The proportions of people with HIV who know their HIV status and who are virally suppressed continue to be much higher than national estimates. Viral suppression refers to people who are on treatments for HIV that bring the level of HIV virus in their body so low that they cannot pass the virus to others. And, importantly, HIV-related deaths have declined significantly.
Q: What developments have made this progress possible?
Dr. Balkus: We’ve achieved this progress through a number of actions, including:
- Increased access to HIV testing.
- Connecting people living with HIV to treatments that allow them to lead long and healthy lives. These treatments can suppress the level of HIV virus in their body so low that they cannot pass the virus to others.
- Expanding access to pre-exposure prophylaxis (“PrEP”), a daily medication that nearly eliminates someone’s chances of getting infected with HIV.
Despite this progress, we also see areas where we could be doing better.
Q: What challenges remain?
Dr. Balkus: We need to do much better at reducing racial disparities in who is most impacted by HIV in King County. In 2023, 16% of new HIV diagnoses occurred in U.S.-born Black residents; only 5% of King County residents identify as Black and were born in the U.S. Latinx and American Indian/Alaska Native residents of King County also represent a higher percent of those newly diagnosed with HIV compared to their proportion of the overall population.
There are racial disparities both in who is currently living with HIV in King County, as well as in new HIV diagnoses. Black, Latinx and American Indian/Alaska Native residents represented 55% of new HIV diagnoses in 2022-2023, while these racial/ethnic groups make up just 19% of the King County population overall. There are also racial disparities in viral suppression.
Addressing these disparities requires targeted outreach and structural changes in healthcare access.
Q: What does targeted outreach and structural changes to address racial disparities in HIV care look like?
Dr. Balkus: First, we’re working closely with community organizations to provide culturally competent care that better meets the needs of Black, Indigenous and other residents of color. Second, we are working hard to expand PrEP access in Black and Latinx communities.
We are also working to reduce barriers to HIV testing and treatment. We recently launched two new low-barrier clinics in south King County. Compared to King County as a whole, south King County has a higher population of Black and Latinx residents, a higher proportion of new HIV diagnoses and, prior to these new clinics opening, few treatment resources for people living with HIV. In partnership with UW Harborview, we also opened a clinic in north Seattle that primarily serves people living homeless who may be at risk for HIV.
We know that addressing disparities requires more than just medical care—it involves tackling social determinants of health, including housing, stigma, and economic barriers.
Q: I understand we’ve recently seen more new HIV diagnoses in women. Why?
Dr. Balkus: While the number of new HIV diagnoses has remained stable overall, there was an increase in new HIV diagnoses among women in King County from 2022 to 2023. Some of this increase reflects immigration of people with HIV into the county. But there has also been an increase in HIV diagnoses among women born in the U.S. Many of these women are living homeless or use substances. While we still have a lot to learn about this population, I think what we’re seeing is a consequence of broader trends related to increasing poverty, homelessness, and substance use. It really underscores the critical role of social determinants of health as drivers of HIV transmission.
Q: What role does drug use play locally when it comes to HIV?
Dr. Balkus: Nationally, about one in ten people living with HIV became infected directly or indirectly through injection drug use, including from sharing injection equipment, having unprotected sex with a person who injects drugs, or transmission to infants born to people who inject drugs.
As injection drug use has gone down locally in recent years, the number of new HIV infections among people who inject drugs has also decreased. Only 9% of new HIV cases in King County in 2022-2023 were in people who inject drugs, compared to 17% in 2019.
While injection drug use has decreased, drug use overall has not declined and continues to impact the health and well-being of people at risk for and living with HIV. We’ve observed a sharp rise in deaths from drug overdoses among people living with HIV, particularly due to fentanyl. Fatal fentanyl overdoses have increased since 2017 both locally and nationally. In response, we’ve ramped up overdose prevention services at needle exchange programs, including distributing naloxone, overdose prevention training, distributing harm reduction supplies, and connecting people with drug treatment. We continue to work with community partners to better address the needs of people living with HIV who use drugs in order to prevent overdose.
Q: What are you doing to help connect people with PrEP?
Dr. Balkus: PrEP is a daily medication that nearly eliminates your chances of getting HIV if you are HIV-negative. It’s been a game changer in preventing new HIV infections. While anyone can take PrEP, we specifically promote this medication to people who meet certain criteria, including recent drug use, number of sex partners, or recent STI diagnosis. In King County, a number of community-based organizations help connect people to PrEP. We also directly provide PrEP to over 1,200 people in our Sexual Health Clinic.
Q: How well is PrEP promotion working for these communities?
Dr. Balkus: Among MSM in King County who meet these criteria, we estimate that 67% are currently using PrEP, up from 47% in 2019. That’s a huge step forward, but we still need to ensure that PrEP access is equitable across all populations, particularly among Black and Indigenous communities where uptake remains lower.
Q: What are the next steps for King County in the fight against HIV?
Dr. Balkus: We can improve how we help prevent new HIV infections and support those living with HIV in the following areas:
- Expand low barrier access to HIV care, including efforts to reach people who are not in care, link them to our low barrier clinics and, as needed, provide them with long-acting antiretroviral therapy (ART). This therapy is expensive and it’s not for everyone, but it is an important innovation and something that holds real promise as a means for increasing viral suppression. I think that this effort can play an important role in decreasing racial disparities in HIV treatment.
- Continue expanding PrEP access, especially in communities with lower uptake.
- Strengthen our response to the overdose crisis, which is increasingly impacting people with HIV.
- Improve housing and support services, recognizing that stable housing is critical for staying in HIV care.
King County has led the way in HIV prevention and care, but we still have work to do. Our goal is to make sure that everyone, regardless of race, gender, socioeconomic status, or country of birth, has access to the care and support they need.
Q: How is this work funded?
Dr. Balkus: Approximately 75% of the work of Public Health’s HIV Program is funded through federal dollars.
Major federal sources of funding include the Ending the HIV Epidemic in the US initiative, which aims to end the HIV epidemic in the United States by 2030, and the Ryan White Program, which supports treatment and care for low-income Americans living with HIV.
This funding makes lifesaving care available and reduces healthcare costs in the long run by preventing new HIV infections.
How to access HIV testing, treatment and care for HIV
If you or someone you know could benefit from PrEP, HIV testing, or treatment, visit Public Health’s Sexual Health Clinic to learn more about available resources and make an appointment.
Originally published May 14, 2025.