By: Marcus J. Hopkins, Blogger
The HEAL Blog covers the expansion of Syringe Exchange programs as an effective and proven method of Harm Reduction to prevent the spread of HIV and Hepatitis C (HCV). While there have been some notable successes over the past few years, especially in states where rural transmission of both HIV and HCV is increasing, the stark reality is that these areas largely lack access to the Syringe Exchange programs that could help to stanch the spread of deadly diseases that are easily spread through sharing and reusing needles.
A new report from the Centers for Disease Control and Prevention (CDC), decreases in HIV diagnoses in People Who Inject Drugs (PWIDs) indicate success in HIV prevention. However, emerging behavioral and demographic trends could reverse this success (Wejner, et al, 2016). In terms of demographics of PWIDs, both African-Americans and Hispanic populations have seen consistent and rapid downward trends in all three areas: HIV diagnoses among PWIDs, those who shared syringes to inject drugs, and people who reported injecting drugs for the first time. Whites, but urban and non-urban, however, did not fare well in these measures.
In both Urban and Non-Urban settings, new HIV diagnoses amongst white PWIDs saw a slight increase; the same is true of whites who shared syringes to inject drugs; whites made up over 50% of people who reporting injecting drugs for the first time. This shouldn’t come as a big shock to those who have been following drug usage trends – the abuse of opioid prescription drugs and heroin in rural and suburban areas has spiked significantly, over the past twenty years, as we have covered in previous posts – areas where the population tends to skew heavily to the White.
While Syringe Exchange Programs (SEPs) have grown more common in urban areas, people living in largely rural states, rural areas, and suburban areas have again fared poorly in this regard. A 2015 report from the CDC surveyed 153 SEP directors (out of the then 204, in March 2014), and found that only 9% of SEPs were in Suburban areas and only 20% in Rural areas (Des Jarlais, et al., 2015). The areas hardest hit by the increase in PWIDs – the Northeast, South, and Midwest – had a total of 11 SEPs in Rural areas; the West, by comparison, had 18 in Rural areas. While this data is from 2013, and more SEPs have been opened, it is difficult to get a definitive count of the number of operative SEPs.
From a health emergency perspective, we have a White HIV crisis brewing in rural and suburban America. Beyond the issues related to PWIDs, there is also the increase risk of sexual transmission from PWIDs to those who do not inject drugs. Whites have consistently represented the largest number of new infections, since the beginning of the epidemic (not to be confused with the disproportionate rate of infection amongst minority groups), and for the first time in 2014, White PWIDs had more HIV diagnoses than any other racial or ethnic population in the country (Sun, 2016). State and Federal laws – especially in rural states – continue to present barriers to establishing and funding SEPs in areas that are the hardest hit.
One of the most frustrating aspects of reporting healthcare statistics is the reporting lag; the references used in this post present data that is at least two years old. This problem exists because of the time it takes for states to finalize data, in addition to the time it takes for peer reviewing before publication. While there were 204 operating SEPs in the U.S. in 2013/2014, it’s now 2016, and we could use some updated numbers.
- Des Jarlais, D.C., Nugent, A., Solberg, A., Feelemeyer, J., et al. (2015, December 11). Syringe Service Programs for Persons Who Inject Drugs in Urban, Suburban, and Rural Areas — United States, 2013 [MMWR 2016; 64(48): 1337-1341]. Atlanta, GA: Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report. Retrieved from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6448a3.htm
- Sun, L. (2016, November 29). White, rural drug users lack needle exchange programs to prevent HIV infections. Washington, DC: The Washington Post: To Your Health. Retrieved from: https://www.washingtonpost.com/news/to-your-health/wp/2016/11/29/white-rural-drug-users-lack-needle-exchange-programs-to-prevent-hiv-infections/?utm_term – comments
- Wejnert, C, Hess, K, Hall, I, et al. (2016, December 02). Vital Signs: Trends in HIV Diagnoses, Risk Behaviors, and Prevention Among Persons Who Inject Drugs — United States [MMWR 2016; 65:1336-1342]. Atlanta, GA: Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report. Retreved from: https://www.cdc.gov/mmwr/volumes/65/wr/mm6547e1.htm?s_cid=mm6547e1_e
Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.