Policy Updates: Hill Happenings and Administration Activities
Hill Happenings
Fiscal Year 2023 Appropriations
Lawmakers are making progress to advance a Fiscal Year 2023 (FY2023) spending bill. The US government is currently funded through a continuing resolution (CR) which temporarily extends Fiscal Year 2022 (FY2022) spending levels through December 16. With the midterm election results established, lawmakers are prioritizing passing a FY2023 funding package during the lame duck session, with top appropriators from both parties incentivized to secure a spending deal by year’s end. However, partisan battles over increasing the debt limit and the President’s emergency supplemental request for additional resources to tackle the COVID-19 pandemic and MPV response may derail that timeline, and threaten the possibility of a full-year CR.
On November 15, the White House requested that Congress allocate $10 billion in total funding for public health and other pressing issues through an emergency supplemental funding request. Notably, the request includes $750 million to combat hepatitis C virus and monkeypox (MPV). NASTAD will continue to monitor the appropriations process and advocate for the highest funding level on behalf of HIV and hepatitis programs.
Senate Advances Respect for Marriage Act
On November 29, the Senate passed the Respect for Marriage Act (H.R.8404), successfully advancing the landmark legislation to President Biden’s desk. The Respect for Marriage Act would provide statutory authority for same-sex and interracial marriages, whose legality are threatened following the Supreme Court’s decision on Dobbs vs. Jackson’s Women’s Health Organization, which undermined legal precedent to revoke certain constitutional protections including the right to an abortion, potentially having downstream effects on same-sex and interracial marriages. The House of Representatives passed the bill on July 19. President Biden is expected to sign the bill into law before the start of the 118th Congress in January 2023.
Lawmakers Introduce World AIDS Day Resolution
On December 1, World AIDS Day, lawmakers introduced a resolution (H.Res.1504/S.Res.856) in support of the goals of World AIDS Day. Senators Booker (D-NJ) and Sullivan (R-AK) and Representative Barbara Lee (D-CA-13) introduced the resolution, which encourage the US and the world to work to achieve the goal of zero new HIV transmissions, zero discrimination, and zero AIDS-related deaths. The Resolution recommitted the nation to ending the HIV epidemic in the United States and around the world by 2030. Additionally, Rep. Nikema Williams (D-GA-05) introduced legislation supporting continued investment to complete the development of an HIV vaccine (H.Res.1506), and a bill that would require coverage of STI testing without cost-sharing (H.R.9402).
NASTAD Calls on the Biden-Harris Administration to Fund Establish National PrEP Program
On November 29, NASTAD and key partners led a coalition of 6000 individuals and 300 organizations to call on Congress to establish a national PrEP program. The letter builds on months of advocacy from a large national coalition of HIV/AIDS advocacy organizations calling for federal fiscal year (FY) 2023 funding for a PrEP program that will increase access to medications, labs, and direct services for uninsured and underinsured individuals; expand a provider network including nonclinical sites and telePrEP; and create demand through both national and local campaigns. Additionally, the coalition called on President Biden to ensure that the program becomes a reality.
NASTAD Calls on Congress to Fund Sexual Health and Rights Programs in FY2023
On November 28, NASTAD joined a coalition of advocates and called on appropriators to robustly fund sexual health and wellness programs in the FY2023 appropriations package. The advocates highlighted the unprecedented crisis following the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, which left
millions of people without access to abortion care and will continue to wreak havoc on individuals and families across the country in the months and years to come. In addition to calling on Congress to increase funding for the international family planning programs, the Title X program, and the Teen Pregnancy Prevention Program, the coalition urged lawmakers to avoid issuing language that adds additional abortion restrictions in the funding package.
NASTAD Calls on the Senate to Pass the MAT ACT
On November 29, NASTAD joined a coalition of 200 organizations and urged the Senate to pass the bipartisan Mainstreaming Addiction Treatment Act (MAT Act) (S. 445, H.R. 1384) by the end of the legislative session. The MAT Act removes outdated barriers that prevent health care providers from prescribing a safe and effective treatment for opioid use disorder, known as buprenorphine. The House passed the MAT Act by an overwhelming bipartisan majority as part of the Restoring Hope for Mental Health and Well-Being Act of 2022 (H.R.7666).
Administration Activities
CDC Adopts WHO Recommendation to Rename Monkeypox to Mpox
On October 28, the CDC adopted “Mpox” as the term used to refer to monkeypox disease. The renaming supports the World Health Organization’s (WHO) recommendation to use “Mpox” after racist and stigmatizing language was observed as a result of the 2022 outbreak. Moving forward, U.S. federal public health agencies, including CDC, will adopt the Mpox name in correspondence with the medical community and the public. This change from the WHO will enhance the U.S. response to Mpox by using a less stigmatizing term. CDC encourages all partners to use the term Mpox in all documents, public facing communications, and correspondence.
CDC Observes World AIDS Day
On December 1, Centers for Disease Control and Prevention (CDC) observed World AIDS Day, a day to honor the millions of lives lost worldwide to AIDS-related illnesses and consciously renew our commitment to improving the lives of people with HIV and ensuring equitable access to prevention services for all who could benefit. This year’s theme—Putting Ourselves to the Test: Achieving Equity to End HIV—emphasizes accountability and action and highlights the importance of meeting people where they are with the services they need to stay healthy. This year, we observe World AIDS Day in the context of two other infectious disease threats—COVID-19 and mpox—that have further demonstrated the need for equitable access to prevention and treatment services across the United States. Click here to read a Dear Colleague Letter from the CDC Division of HIV Prevention on the significance of the 2022 World AIDS Day.
President Biden Issues Presidential Proclamation Honoring World AIDS Day
On December 1, President Biden issued a Proclamation on World AIDS Day, 2022, recommitting the nation to ending the HIV epidemic in the United States and around the world and rededicating ourselves to fighting the discrimination that too often keeps people with HIV from getting the services they need and living the full lives they deserve. The President urged the Governors of the United States and its Commonwealths and Territories, government officials, and the American people to join the HIV community in activities to remember those who have lost their lives to AIDS and to provide support, dignity, and compassion to people with HIV. Click here to read a White House fact sheet on the Biden-Harris Administration’s efforts to end HIV/AIDS at home and abroad.
US Public Health Service Commissioned Corps to Accept Applicants Living with HIV and/or Hepatitis
On World AIDS Day, the U.S. Public Health Service (USPHS) Commissioned Corps, a uniformed service of the Department of Health and Human Services (HHS), announced that it is changing its medical standards to accept future applicants living with chronic hepatitis B and Human Immunodeficiency Virus (HIV). The USPHS Commissioned Corps updated its medical accession standards, effective December 1, to no longer disqualify applicants with HIV who are on treatment with antiretroviral therapy (ART), who have an undetectable viral load, and show no evidence of impaired immunity. Additionally, applicants living with chronic hepatitis B who show low viral blood levels and no evidence of clinically significant liver damage will also no longer be medically disqualified for this condition. Advocates applauded HHS for removing the stigmatizing and medically unnecessary policy.
CDC Announces $3 billion to Improve Public Health Workforce and Infrastructure
On November 29, CDC awarded $3.2 billion to help state, local, and territorial jurisdictions across the U.S. strengthen their public health infrastructure. This first-of-its-kind funding provides awards directly to state, local, and territorial health departments to help them work towards ensuring that they have the people, services, and systems they need to promote and protect health in their communities. The $3.2 billion includes $3 billion from the American Rescue Plan Act of 2021 for 107 jurisdictions to recruit, retain, and train their workforce. CDC will also award a total of $140 million from the new Public Health Infrastructure and Capacity appropriation to jurisdictions to strengthen and revitalize their foundational capabilities. Lastly, national partners will be awarded $65 million to provide training, evaluation, and communication support to jurisdictions as they put the new funding to work.
Resources
NASTAD RFP: Strengthening Syringe Services Programs (SSP) through Direct Program Funding
- Webinar: Thursday, December 8, 3:30 – 5:00 PM ET
- Application Deadline: January 20, 2023
NASTAD and project partners, VOCAL-NY and the University of Washington (UW), are excited to announce a CDC-supported funding opportunity: Strengthening Syringe Services Programs (SSP) through Direct Program Funding. Please join us for a webinar on Thursday, December 8, 3:30 – 5:00 PM ET for an overview of the project and application technical assistance. This five-year project aims to strengthen the capacity of SSPs through direct program funding, provided through NASTAD, to continue serving as critically essential access points for core syringe and safer drug use supplies, overdose prevention information and materials, and a range of services for PWUDs such as adult vaccination services, HIV and viral hepatitis testing and linkage to care services, and referral and navigation efforts.
CDC MMWR: HIV Services and Outcomes During the COVID-19 Pandemic — United States, 2019–2021
“HIV service use decreased after the COVID-19 public health emergency declaration in March 2020… Innovative service delivery models for HIV testing and PrEP care are needed to ensure that these services are accessible during public health emergencies.”
AIDS United Webinar: Sex Work, Policy, and the Intersection of the Law: A Listening Session
- Date: December 14th, 2022 from 2:00 – 3:30 PM ET
This listening session will provide an opportunity for sex worker activists to discuss their experiences within the sex worker rights movement and the ways in which this work intersects with federal and state policy. In honor of International Day to End Violence Against Sex Workers*, AIDS United’s Harm Reduction and Policy teams will be hosting a listening session of sex work activists and harm reductionists, which will highlight the many ways structural inequality such as gender-based discrimination (i.e., misogyny, homophobia, transphobia), housing inequity, and drug user health stigma, are responsible for reproducing harmful conditions within the sex trade industry.
ASTHOConnects Webinar: Medicaid and Public Health Partnerships in Virginia
- Date: Tuesday, December 13 from 3:00 – 4:00 PM ET
NASTAD is excited to partner with ASTHO on this ASTHOConnects Webinar on Medicaid and Ryan White HIV/AIDs Program alignment in Virginia. Learn how state public health agencies can align with state Medicaid agencies to collaboratively advance the goals of the National Ending the HIV Initiative in this ASTHO webinar. Featured guests include the Virginia Department of Medical Assistance Services, the Virginia Department of Health Ryan White HIV/AIDs Program (RWHAP)/AIDs Drug Assistance Program (ADAP), and the University of Virginia.
CDC RFA: Public Health Crisis Response Cooperative Agreement
The CDC is activating CDC-RFA-TP22-2201 Public Health Crisis Response Cooperative Agreement to support state and local public health mpox response efforts. CDC will award up to $16 million to select jurisdictions on the approved but unfunded (ABU) list for CDC-RFA-TP22-2201. Funding will be prioritized for jurisdictions reporting the highest numbers of cases during October 2022. Funding is intended to address urgent needs and to implement monkeypox response related activities including efforts to increase vaccine accessibility and uptake, case and cluster investigation, surveillance, testing, communication, education, and outreach. Additional information, including supplemental funding guidance, is forthcoming. Applications are due February 12.
HRSA NOFO: Ending the HIV Epidemic - Primary Care HIV Prevention (PCHP)
- Application Deadline: January 17, 2023
- Applicant TA Webinar: Thursday, December 1 from 3:00 – 4:00 PM ET
HRSA released the fiscal year (FY) 2023 Ending the HIV Epidemic - Primary Care HIV Prevention (PCHP) notice of funding opportunity (NOFO, HRSA-23-025). HRSA will make approximately $50 million available for up to 140 health centers located in the targeted geographic locations where there are a substantial amount of new HIV infections.
FY 2023 PCHP will support expanding HIV prevention services that decrease the risk of HIV transmission in underserved communities. This funding will focus on increasing HIV testing, PrEP prescriptions, and linkage to HIV care and treatment. It is part of HHS’ Ending the HIV Epidemic in the U.S. initiative, which aims to reduce the number of new HIV infections in the U.S. by 90% by 2030. Health centers with service delivery sites in the targeted geographic locations that did not receive FY 2020, FY 2021, or FY 2022 PCHP funding, are eligible to apply. View the FY 2023 PCHP one-pager (PDF) for applicants. Visit the FY 2023 PCHP technical assistance (TA) webpage to access the NOFO, application aids, and other resource.
- Applicant TA Call: December 16, 2022
- Letter of Intent Due: December 19, 2022
- Application Deadline: February 9, 2023
The purpose of the CDC’s National Center for Injury Prevention and Control (NCIPC) Mentored Research Scientist Development Award (K01) is to provide support for an intensive, supervised (mentored) career development experience in substance use and/or overdose prevention research leading to research independence. NCIPC supports K01 grants to help ensure the availability of an adequate number of trained scientists to address critical public health research questions to prevent polydrug use and overdose. Applicants must propose a research project that aims to better understand and identify risk and protective factors related to polydrug initiation, use, escalation, and overdose. This could include, but is not limited to, co-use of opioids, stimulants, and/or cannabis, including co-use with or without the knowledge of the person who is using the drugs. Additionally, research can focus the examination of potential moderators of risk and protective factors for polydrug initiation, use and escalation; and/or can investigate the relationship between polydrug use and overdose.
CDC HAN Update: Update on Managing Monkeypox in Patients Receiving Therapeutics
“Monkeypox cases have declined since mid-August 2022 in the United States; however, new cases—including clinically severe cases—continue to occur. While there are currently no treatments specifically approved for monkeypox, therapeutics developed for patients with smallpox have been deployed during the current outbreak. This Health Alert Network (HAN) Health Update provides clinicians and public health officials with new information about managing monkeypox in patients requiring therapeutics.”
CDC NCHHSTP NOFO: PS-23-0009: Advancing Policy as a Public Health Intervention to Reduce Morbidity, Mortality, and Disparities in HIV, Viral Hepatitis, STDs, and Tuberculosis
The Center for Disease Control and Prevention’s (CDC) National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) is thrilled to announce a new funding opportunity. This two-component funding opportunity aims to strengthen the ability of leaders who make decisions in public health to identify and implement evidence-based policy interventions. The funding opportunity features two distinct components:
- Leverage legal epidemiology methods to examine laws and policies over time and perform critical analyses to understand the effect of laws and policies on health and economic outcomes.
- Provide robust legal and policy technical assistance (TA) to support leaders who make decisions in public health as they navigate complex issues unique to their jurisdiction and proactively create publicly accessible TA tools and resources.
Application Deadline: February 1, 2023
Job Postings
NASTAD RFP: NASTAD Media Training
- Application Deadline: January 9, 2023 at 5:00 pm
NASTAD seeks an experienced strategic communications/public relations partner to develop a comprehensive media training for a group of seven senior staff members. We are currently aiming to hold this training in-person at the NASTAD office on March 9, 2023. The office is located at 444 North Capitol Street, NW, Washington, DC 20001.
While this is a short-term project, our goal is to develop a long-term relationship with a public relations firm or professional. Because of the nature of our work, we would prefer contractors with experience in the public health and social justice fields, and who have worked with non-profit organizations. Total budget for this work is $12,500.
NASTAD RFP: Consultants for HIV Prevention Billing and Coding Guide
- RFP Issue Date: December 5, 2022
- RFP Closing Date: January 15, 2023
- Performance Period: February 1, 2023 – September 29, 2023
NASTAD is soliciting proposals from professionals with demonstrated expertise and experience in medical coding and billing and creation of HIV-related coding guides. The consultant will lead creation of a billing and coding guide for HIV Prevention, with a special emphasis on pre-exposure prophylaxis (PrEP). This work is funded by a cooperative agreement from the Centers for Disease Prevention and Control (CDC) and builds off of and updates a HIV Prevention billing and coding guide NASTAD created in 2018.
Boulder County AIDS Project – Boulder, Colorado
- Prevention Coordinator: The primary duties of this position are to provide HIV/HCV/STI testing, syringe access, and street outreach services, as well as outreach education at community partner locations and events. This position provides these services in collaboration with other Prevention Department staff and key community partners, as well as enters data into databases and completes monthly reports. This position reports directly to the Prevention Director, and attends staff, department, and community partner meetings.
- Bilingual Medical and Housing Case Manager: The focus of this position will be to ensure efficient delivery of quality medical case management services to clients who are living with HIV through assessment, planning, service procurement, delivery, coordination, and monitoring, ensuring all services are offered in an inclusive, respectful and professional manner. The Bilingual Medical and Housing Case Manager reports directly to the Care Services Director and is required to attend All Staff meetings, Care Services team meetings, Clinical Consultations, Finance Committee meetings and to keep all client data up to date for reporting purposes. Because this position manages confidential information for clients, the Bilingual Medical and Housing Case Manager must demonstrate the highest degree of professionalism.
HIV Care/Community Planner – Austin, TX
Under the general direction of the Planning Group manager, supports, directs, and monitors administrative agencies and other stakeholders engaged in HIV/STD care and prevention planning in Texas. Identifies technical assistance needs related to planning, monitoring compliance with program policies and directives, coordinates planning activities at the State, region, and local levels. Develops the state plan to address HIV/STD services and prevention needs as required by federal funders. Considerable latitude is required for the exercise of independent initiative, judgement, and action within the program. Experience in program and strategic planning, community engagement, group facilitation, and programmatic research preferred. Applications close December 2.
Harm Reduction Coordinator, State Opioid Response (SOR) Team – Washington, DC
This position will be responsible for the day-to-day management of one of the country’s largest naloxone (NARCAN®) programs, including working with over 150 community partners and pharmacies, coordinating and providing naloxone trainings, and ramping up fentanyl test strip distribution. An ideal candidate is familiar with social services/drug user health organizations in DC, trained and highly familiar with naloxone administration, able to manage relationships with diverse community stakeholders, and has proficiency with Microsoft Suite, especially Excel. Individuals with lived experience are encouraged to apply. Please note this is *NOT* a fully remote position—this position is expected to be in our NoMa office at minimum three days per week, plus attend occasional events and trainings in the community. Applications will be open until 11/30/2022. Salary range is Salary range is roughly $60-75K.
Florida Department of Health – Palm Beach County
To apply, please send resumes to Robert Scott, Robert.Scott@flhealth.gov. These are all $20/hr, in-office roles with possible remote flexibility.
- EHE Navigator: This position’s work will be actively guided by the Palm Beach County Ending the Epidemic (EHE) Plan, including the four pillars and their goals, objectives, strategies and activities. Incumbent will assist in the planning, coordination, implementation and monitoring of the goals, objectives, strategies and activities set forth in the Palm Beach County Ending the Epidemic (EHE) Plan, in collaboration with other Area 9 EHE funding recipients, to include, but not limited to: Palm Beach County, FoundCare, and Florida Community Health Centers.
- PrEP Navigator: This position’s work will be actively guided by the Palm Beach County Ending the Epidemic (EHE) Plan, including the four pillars and their goals, objectives, strategies and activities. Incumbent will link high-risk negative persons to available Pre-Exposure Prophylaxis (PrEP) and non-occupational Post Exposure Prophylaxis (nPEP) services with the goal of significantly reducing the number of new HIV infections among high-risk populations. Incumbent will assess and increase the knowledge, desirability, accessibility, and adherence of PrEP among referred high-risk individuals.
- Digital Media Manager: This position is responsible for developing and coordinating the area HIV digital media presence through multiple platforms. Developing digital marketing strategies, creating social media content, collaborating with community partner organizations, and creating new ad campaigns to advance Ending the HIV Epidemic (EHE) in Palm Beach County. Tracking data from digital campaigns to assist with EHE goals.
Executive Director, Hepatitis Education Project (HEP) – Seattle, WA (partially remote)
Reporting to a Board of Directors and in partnership with a staff of 19, the ED will lead the evolution of HEP as the organization reviews its impact to date and plans for the future in the fields of viral hepatitis and drug user health both locally and nationally.
Deputy Medical Director, HIV/STI/Viral Hepatitis/Harm Reduction – Nashville, TN
This position will serve as the Statewide Deputy Medical Director in the HIV/STI/Viral Hepatitis section. The position has cross-cutting responsibility in all program areas with potential for promotion in succession plans. Primary responsibilities include leadership and oversight of cross-cutting programs related to End the Syndemic Tennessee to tackle HIV, sexually transmitted infections, viral hepatitis and substance use disorder in an integrated manner with an outward-facing, community-engaged process.
Program Content and Training Specialist, Supporting Harm Reduction Programs (SHaRP) – University of Washington
This position is part of a cooperative agreement award from the Centers for Disease Control and Prevention to provide technical assistance about monitoring and evaluation to syringe services programs (SSPs) as part of the National Harm Reduction Technical Assistance Center. One of the primary projects of this award is to provide technical assistance (TA) to SSPs for monitoring and evaluation activities. The University of Washington is working in collaboration with the CDC, SAMHSA, NASTAD, the National Harm Reduction Coalition, and other TA partners to provide a suite of technical assistance support to individual programs.
Social Innovations Team Lead – Baltimore, MD
Baltimore City Health Department is seeking to fill the position of the Social Innovations Team Lead for the Bureau of Clinical Services and HIV/STI Prevention. The HIV/STI Social Innovations Team is a unique and visionary program at Baltimore City Health Department that utilizes a human-centered design approach to engage with the Baltimore community on issues related to HIV and Sexually Transmitted Infection (STI) prevention. The team creates innovative, original, and engaging programming to involve the community in the heart of the Health Department’s work.
Project Data Manager, Syringe Service Program – University of Washington
We are hiring for a Project Data Manager (Research Consultant) to work closely with the principal investigator, project coordinator, survey site staff, CDC personnel, and other support staff to enact all data-related components of Project NEXUS. This position will supervise the NEXUS data team, including two research assistants, lead data analysis, and be the main point of contact for the CDC data management team. They will also provide support for the Dave Purchase Memorial Survey and the National Harm Reduction TA Center as needed.
Communicable Disease Epidemiologist – Cheyenne, Wyoming
This position will serve as the Communicable Disease AIDS Drug Assistance Program (ADAP) Coordinator, Wyoming TB Controller, and Disease Intervention Specialist (DIS) for the Communicable Disease (CD) Treatment Program. Assist in outbreak response to ensure the safety of Wyoming residents; by interviewing cases for exposure information, updating news outlets on the progress of outbreak control, analyzing exposure data utilizing epidemiological and statistical methods.
Assistant Commissioner - Health Department – Baltimore, Maryland
The Baltimore City Health Department (BCHD) is seeking an Assistant Commissioner to lead the Bureau of Communicable Disease and Outbreak Control. This senior management position will lead a talented team responsible for communicable disease investigation, outbreak control and emergency preparedness programming. The incumbent will also be responsible for developing and implementing agency wide policies related to health department readiness to respond to public health emergencies. The incumbent will report directly to the Deputy Commissioner for BCHD’s Division of Population Health & Disease Prevention.
Open Positions – New York State
The New York State Department of Health, in partnership with Health Research, Inc, has various job openings, including some within the AIDS Institute. Please visit this link to learn about their current opportunities.
News Bulletin
Fauci bids farewell with a final plea: Get vaccinated
“Anthony Fauci, the president’s chief Covid-19 adviser, offered Americans one final warning as he prepares to leave government, ending a tumultuous turn in the national spotlight that earned him enduring affection from some and unrelenting hostility from others. “Please, for your own safety, for that of your family, get your updated Covid-19 shot as soon as you’re eligible to protect yourself, your family and your community,” Fauci said.”
Naloxone Startup Pursues FDA Approval for Over-the-Counter Swab
“A startup vying to produce one of the first over-the-counter overdose-reversal medications said it had submitted results to the Food and Drug Administration showing that its drug works more quickly than prescription-only versions. The randomized trial of 60 healthy volunteers evaluated naloxone absorption from Pocket Naloxone Corp.’s nasal swab versus a 4 milligram nasal-spray delivery and found 74% higher exposure 2.5 minutes after dosing and 19% higher exposure at 5 minutes. Naloxone works by blocking the effects of opioids. The FDA has encouraged pharmaceutical companies to apply for approval for over-the-counter versions of the drug to help confront a swelling overdose crisis from bootleg versions of the powerful opioid fentanyl. Pocket Naloxone said it plans to apply for new drug approval in the first half of 2023 and to request priority review.”
Biden administration prepares to end monkeypox emergency declaration
“The Biden administration is eyeing an end to its public health emergency declaration for mpox, a sign that officials believe they’ve brought the monthslong outbreak under control. Health officials are likely to issue a 60-day notice later this week for winding down the declaration, two people with knowledge of the matter told POLITICO. Such a move would put it on track to officially expire by Jan. 31.”
FDA Plans to Allow More Gay, Bisexual Men to Donate Blood
“Gay and bisexual men in monogamous relationships would be allowed to donate blood without abstaining from sex under guidelines being drafted by the Food and Drug Administration, people familiar with the plans said…The FDA plans to issue the new rules in coming months, the people familiar with the plans said. All potential donors would need to complete an individualized risk assessment, the people said. “
“The spike in wounds among people who use drugs in Philadelphia reflects the surge in the local supply of a compound called xylazine. A veterinary tranquilizer, xylazine, or “tranq,” exploded in recent years to the point that in 2021, it was found in more than 90% of heroin and fentanyl samples. With its ascendance has come a wave of wounds — sometimes called abscesses, lesions, or, in the words of one volunteer nurse here, something that looks like “it’s eating away your flesh from the inside out.” The city saw the number of emergency department visits for skin and soft tissue injuries quadruple between the beginning of 2019 and the end of 2021.”