Monthly Archives: September 2017

Iowa Prison Systems Prepare for HIV & HCV Uptick

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

Iowa’s Department of Corrections (IDOC) has put in a request for additional funding for the 2019 fiscal year (FY19) in anticipation of potential upticks in new HIV and Hepatitis C (HCV) infections within Iowa’s jails, prisons, and youth correctional facilities as a result of increased abuse of prescription opioids and heroin. Jerome Greenfield, Health Services Administrator for IDOC, has requested an addition $1 million budget increase to accommodate increased pharmaceutical costs for the treatment of HIV and HCV (Pfannenstiel, 2017).

State Seal: Iowa Department of Corrections

Photo Source: IDOC

For each year from 2010 to 2015, between 12%-14% of Iowa’s incarcerated population tested positive for HCV, though these data account only for the individuals incarcerated at any given point in time, and do not account for the movement in and out of IDOC facilities (Iowa Department of Public Health, 2017). Of those entering into the IDOC system and who warranted screening, over 91% were screened for HCV in FY14, with a 5.6% testing positive; in 2015, over 78% were screened, and 4.5% tested positive. While the number of positive tests results decreased in 2015, that may be a result of fewer inmates being screened.

The budget request comes at a time when the state is grappling with a potential $75 million budget shortfall as a result of lower-than-expected revenue returns during the last fiscal year that ended June 30th, 2017. The IDOC, itself, suffered a $5.5 million budget cut in FY17, and a $1.6 million cut for FY18, making the likelihood of this request being fulfilled dubious, at best. For its part, IDOC officials believe that, should any more cuts be implemented, they will have to reduce staffing in order to deal with those losses. This means fewer correctional employees, which can create a hostile environment, leave inmate needs and concerns unmet, and foment distrust and enmity between inmates and correctional facility staff. As we saw in Delaware, earlier this year, this type of environment can lead to prisoners protesting and/or rioting (Oh, 2017).

Iowa’s also dealing with an explosion of new HCV diagnoses, which have more than quadrupled since 2009 among people between 18 and 30 (Carver-Kimm, 2017). For those from whom data were collected, over 51% reported Injection Drug Use (IDU) as a risk factor (Iowa Department of Public Health, 2017). The state is also making considerable inroads to combating the HCV epidemic within the state with seven local health departments and one Federally Qualified Health Center (FQHC) that administer HCV testing and Hepatitis A and B immunizations. These agencies, known as Counseling, Testing, and Referral (CTR) sites, are located in the state’s most populous counties, test only people who have ever injected drugs, and offer free HCV screening for anyone who reports having ever injected drugs.

In 2016, former Iowa Governor, Terry Branstad, signed a bill expanding access to Naloxone, a drug that reverses or blocks the effects of opioid medications. While advocates cheer the move as an excellent tool to save the lives of People Who Inject Drugs (PWID), they are also pushing the Iowa state legislature to legalize Syringe Services Programs (SSPs – Needle/Syringe Exchanges). Research consistently shows that SSPs lead to reduced rates of HIV, HCV, and HBV infections among PWID, as well as those who are sexually involved with PWID.

References:

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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.

 

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Hepatitis A: Extreme Sanitation Measures in San Diego

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

As a blog designed to talk about issues related to Viral Hepatitis and HIV, we do our best to stay focused on the topic of Hepatitis C (HCV). Recent developments in San Diego, CA, however, have captured our attention and merit coverage and discussion.

Since early 2017, the Public Health Services Division (PHSD) in the San Diego Health and Human Services Agency (HHSA) has been investigating a significant outbreak of the Hepatitis A (HAV) virus. As of September 12, 2017, there have been 421 confirmed cases of Acute HAV which have resulted in 292 hospitalizations (69%) and 16 deaths (3.8%). The majority of these cases have been within San Diego’s homeless and/or illicit drug user populations, although some cases have been neither (HHSA, 2017).

Hepatitis A Outbreak Spreads Beyond Homeless in San Diego

Photo Source: San Diego Informer

HAV is spread primarily by ingesting the virus by way of contact with objects, food, or drinks contaminated by feces or stool from an infected person, and the symptoms may include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and/or jaundice (yellowing of the skin or eyes). Moreover, HAV is very hardy and is able to live outside the human body for months, making it particularly easy to spread (CDC, 2016).

In response to this outbreak, San Diego has taken the unusually proactive step of implementing extreme health measures in order to combat the spread of HAV including the installation of 40 handwashing stations in areas with high concentrations of homeless people, sanitization efforts in those areas, holding 256 mass vaccination events and 109 “foot teams” of public health nurses who go into the aforementioned areas to offer vaccinations, distributing over 2,400 hygiene kits that include water, non-alcohol hand sanitizer, cleaning wipes, clinic location information, and plastic bags, and implementing street cleaning protocols that require sanitation department workers to power-wash streets and buildings with chlorine and bleach (Bever, 2017).

While these measures may seem extreme, the reality of combating an HAV outbreak once it’s already taken hold means that extraordinary steps must be taken. Despite the availability of HAV vaccinations since 1995, much of the homeless and indigent population either lack access to those healthcare resources, or are too old to have been vaccinated as children. During the mass vaccination events, county health officials have vaccinated 19,000 people, including 7,300 considered to be at-risk of contracting the disease (Warth, 2017). Additionally, the city has agreed to extend public toilet hours to 24/7 in order to allow homeless people access to the restrooms, rather than defecate in the open, whether others may come in contact (Montes, 2017).

While these proactive measures will certainly help to combat the spread, the most important step will be reaching, vaccinating, and educating hard-to-reach/hard-to-treat homeless, indigent, and/or illicit drug user populations in an effort to effect behavioral changes in order to prevent further spread of the disease. This means teaching proper handwashing techniques, proper hygiene, and proper sterilization of equipment used to partake in illicit drug use. San Diego, despite the dire circumstances it currently endures, is taking the right steps to ensure safer streets for their homeless population.

References:

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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.

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E-mail Undeliverable; HCV Patients Left in the Dark

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

It was a simple task: comb the Internet for a list of Hepatitis C (HCV) support groups in the U.S. with e-mail addresses as a point of contact, compile them into a spreadsheet, and contact each of them to invite them to access and distribute our free monthly HIV/HCV Co-Infection Watch report. Over a period of two weeks, I managed to gather information on 206 support groups with e-mail contact points, and this past week set about contacting each group with our information. Of the 206 e-mails I sent over two days, 63.1% of them were returned as “Undeliverable.” The rejected e-mails came back for a variety of reasons – closed/frozen accounts; full inboxes; hosts that no longer exist – and for each returned e-mail a problem became clearer: we have a support group problem.

E-mail undeliverable message

In collecting the data, I discovered that eleven states (DE, NE, NH, RI, SD, TN, UT, VT, WV, WI, WY) had no HCV support groups with e-mail addresses as points of contact (that I was able to locate). After compiling the data from the returned e-mails, another eleven states (AK, AR, CO, HI, ID, IL, LA, MN, NJ, OR, VA) had no HCV support groups with functioning e-mail addresses. This amounts to a total of twenty-two states without e-mail contacts for HCV support groups.

In all fairness, that doesn’t mean that there are no HCV support groups in those twenty-two states; just that there are no working e-mail addresses listed (that I could find in two weeks) for those states. Every state has at least one support group with a contact phone number, but because those were outside of the parameters of my assignment, they were not included in the data. Given that e-mail is arguably the most-used form of information gathering after searching websites, it creates a significant barrier to HCV patients gaining access to support services.

The paucity of support groups has largely been eliminated for HIV patients. After nearly forty years, many of the support systems are largely in place for patients living with HIV. This is in no small part a result of the tireless efforts of millions of people working to ensure that patients living with HIV have those support networks in place, should they choose or have the desire to use them. Typing “HIV Support Groups” into a Google search bar results in literally thousands of different options for support services; organizations by the hundreds list the various support groups for patients, family members, spouses, children, friends, neighbors, employers, employees…the list of groups is endless. This is not the case for HCV.

Beyond just support groups, lower-income HIV patients also enjoy (for lack of a better word) access to Ryan White programs that were designed to help patients living with HIV to afford the costs of medications, treatments, healthcare, and other costs of living with the disease. HCV patients, however, must rely upon manufacturer- or privately-funded Patient Assistance Programs (PAPs) that are not operated by either state or Federal agencies. Despite both the high cost of HCV medications and the efficacy of the Ryan White program in reducing the number of HIV-related deaths and increasing access and adherence to HIV treatment, there seems little appetite for either creating a similar program for, or opening up the Ryan White program to include HCV patients.

We must do better. In the modern Age of Technology, there is no good reason that HCV patients should have to muddle through incorrect or outdated contact information to access support groups. There is no reason for HCV patients to go without the types of services provided by doctor offices, hospitals, and clinics to HIV patients in accessing these support services. It is unconscionable for us, as one of the most advanced nations on the planet, to continue to fail the HCV community.

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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.

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Scott County and Indiana’s Steep Learning Curve on HIV and Hepatitis C

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

In early 2015, Scott County, Indiana was thrust into the global spotlight for an HIV outbreak among injection drug users abusing opioid prescription drugs and heroin (Hopkins, 2015). In a county that averaged a total of 5 new HIV infections each year, even doubling that number would’ve been a statistical anomaly. By the end of 2016, the county had 216 new HIV infections in the span of just two years, and of those, 95% were co-infected with Hepatitis C (HCV). So rare was the disease that county health department officials had never handled HIV cases, instead sending them all to the regional Sexually Transmitted Diseases Department in Clark County (May, 2016).

The outbreak in Scott County was, and still is, both instructive and reflective of several concurrent health crises faced by most of rural America. In one county, virtually every major health risk met in the middle: a prescription opioid addiction problem, the resultant heroin usage problem, and an access to comprehensive healthcare problem all walked into a bar, and out came one of the worst concentrated HIV epidemics in the U.S. in the past decade. Throw in a paucity of drug addiction, recovery, and Syringe Services Programs (SSPs), and you had the perfect case study for how outbreaks occur.

To be fair to Indiana’s legislature and then-Governor Mike Pence, the state responded intelligently to the crisis by legalizing for the first time SSPs…under certain previsions. Counties had to apply for approval, had to show that they had funding, and had to be located in a high-risk zone. Since Mike Pence’s departure from the state to swampier D.C. pastures, his replacement has actively attempted to ease those restrictions. Earlier this year, the Indiana General Assembly passed a bill allowing local governments to establish syringe or needle exchange programs without having to receive state approval (Rudavsky, 2017). His efforts have not, however, managed to convince everyone.

Map showing states with syringe exchange programs.

Source: HIV/HCV Co-Infection Watch

Madison County, for example, recently voted to remove all funding from their SSP, run by the county’s health department, and prohibited appropriations of funds for paying for both supplies and labor (Fentem, 2017). The ordinance, approved by five of the seven-person council, immediately shuttered the only operating SSP in the county, and was largely driven by stigma-based fears: discarded syringes were going to litter front lawns and public parks; drug addicts were going to wander over from neighboring counties, bringing their drug problems with them; “What about the innocent children?!” These well-worn excuses and arguments against the establishment and funding of SSPs have plagued the proven Harm Reduction measure since its inception. The fears are also unsupported by anything other than anecdotal evidence and hearsay, few assertions of which are backed up by any credible research or quantifiable proof.

Worse, still, is that the council members did nothing on their part to allay these fears. Council member Fred Reese is quoted as saying the following:

Some say if you don’t do the needle exchange, you’re going to have a spread of HIV, you’re going to have a spread of hepatitis C, but my concern is the innocents. I don’t want these needles out (Fentem).

This kind of statement on the part of an elected officials shows cowardice, rather than leadership. Part of the job of county councils is to do what’s in the best interests for everyone, rather than kowtowing to fear-based arguments that bear little resemblance to reality.

Clark County – where Scott County once sent its HIV cases for management – recently renewed their SSP for one year, after which it will be up for renewal in August 2018. About half of the program’s 150 participants have HCV, many of whom were diagnosed through the program (Beilman, 2017). Their hopes for the program include seeing a more balanced rate of return on needle collection. Of the nearly 16,000 needles distributed, the exchange collected almost 8,000 (Beilman).

In Boone County, where no SSP currently exists, Prosecutor Todd Meyer sent the following communique to county leaders:

A needle exchange program does not help in fighting the demand side, in fact, it will do the exact opposite by providing the users/addicts with the tools they need to continue to abuse illicit drugs…(Davis, 2017).

That this opinion was issued by a prosecutor should shock no one. Meyer’s position, however, is reflective of those espoused by [mostly Conservative] voters, legislators, and law enforcement officials, but again, bear little resemblance to reality. Instead, they rely upon fear and stigmatization, along with two terrifyingly short-sighted sentiments: “Not in my back yard!” and “It can’t happen here!” While Meyer contends that Boone County doesn’t have an HIV problem, now, let’s see if it has one in two years.

Back in Scott County, the SSP, run by the Scott County Health Department (SCHD), has another issue: it doesn’t keep track of HCV cases (de la Bastide & Filchak, 2017). For some reason, SCHD officials are only worried about their HIV problem. If that seems counterintuitive, that’s because it is. It was, in fact, a spike in new HCV cases that led to the discovery of the HIV epidemic. Additionally, with a 95% co-infection rate in the 216 HIV cases identified in the initial outbreak, as well as the more aggressive spread of HCV in the U.S. compared to HIV, it makes no sense, whatsoever, for the SCHD to fail to keep track of HCV.

The concurrent HIV and HCV outbreaks in Scott County, Indiana were just the beginning. Already, rural states and counties are beginning to see an uptick in new infections of both diseases as a result of Injection Drug Use (IDU). More concerning is the fact that most of those counties are deeply Conservative, which creates significant challenges for those hoping for proactive healthcare policies, rather than reactive cleanup measures. As for Scott County, there are several families with multiple generations infected with HIV, and very likely with HCV, as a result of prescription opioid and heroin abuse. Unfortunately for them, their county’s health department doesn’t see fit to track their issues.

Download the latest edition of the HIV/HCV Co-Infection Watch.

References:

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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.

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