By: Marcus J. Hopkins, Blogger
Research published in The Lancet Global Health found that the U.S. lags behind other countries in terms of HIV and Hepatitis C (HCV) interventions in drug user populations. The study gathered and analyzed data from peer-reviewed, online, grey literature (government reports, issues papers, theses, dissertations, et cetera) databases, and disseminated data requests via social media and targeted E-mails to international experts (Larney, et al, 2017). The study found that just 93 of 179 countries with evidence of Injection Drug Use (IDU) have some form of needle or Syringe Services Programs (SSPs) available (Steptoe, 2017). This comes after previous reports indicating that the U.S. has fallen behind other first-world peers in the goal of eliminating HCV by 2030 (Kaltwasser, 2017).
SSPs are vital tools in the fight to end the spread of HCV and HIV amongst not only People Who Inject Drugs (PWID), but within the general population, as well. While HCV has been thought to be inefficiently transmitted via sexual intercourse, recent studies have shown an increased risk of sexually transmitted HCV if a patient is co-infected with another Sexually Transmitted Disease (STD) or HIV, has sex with multiple partners, or has rough sex (Centers for Disease Control and Prevention, 2017). This higher transmission risk is especially pronounced among Men who have Sex with Men (MSM).
SSPs are meant to serve as intervention points for PWID, providing not only syryinge exchange services, but access to basic health services such as HIV, STD, HCV, and HBV screening, some clinical services, referrals for disease and addiction treatment, counseling, and referrals for Medication Assisted Treatment (MAT) – currently the most effective method for treating opioid addiction. While many othern Western nations long ago saw the efficacy of these programs in preventing the spread of HIV/AIDS, STDs, and other blood borne illnesses, the U.S. has consistently dragged its feet in implementing this effective harm reduction measure across the nation.
Opposition to SSPs in the U.S. (and elsewhere) consistently rely upon fear-based messaging that imagines droves of drug peddling heroin addicts shambling into town like zombies, leaving in their wake a wasteland of used needles just waiting to be stepped on by unsuspecting children and white suburbanites. Recent HIV outbreaks in rural and suburban areas have convinced states and counties to begin allowing government-funded SSPs to open in areas previously thought unlikely to host such facilities. These are generally operated at and by county health departments and their employees, thought there are no standardized national guidelines on what data they must collect and report.
Other intervention points do exist within various healthcare settings – at routine checkups, visits to emergent care, et cetera – but PWID are a notoriously difficult population to integrate into traditional healthcare continua. Furthermore, few, if any, states have compulsory “opt-out” HCV screening regulations that require healthcare providers to screen for the disease in every setting. These measures would allow emergent care workers (for example) to screen from HCV once overdose victims regain consciousness and are able to provide informed denial of screening. Such compulsory screening would play a vital role in helping to eradicate HCV in the U.S…should it be implemented. Realistically, it likely won’t.
- Centers for Disease Control and Prevention. (2017, September 26). Sexual Transmission and Viral Hepatitis. Atlanta, GA: U.S. Department of Health and Human Services: Centers for Disease Control and Prevention: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention: Division of Viral Hepatitis. Retrieved from: https://www.cdc.gov/hepatitis/populations/stds.htm
- Kaltwasser, J. (2017, November 09). HCV 2020 Goals No Longer Feasible. Cranbury, NJ: Intellisphere, LLC: MD Magazine. Retrieved from: http://www.mdmag.com/medical-news/hcv-2020-goals-no-longer-feasible
- Larney, S., Peacock, A., Leung, J., Colledge, S., Hickman, M., Vickerman, P., . . . Degenhardt, L. (2017, October 23). Global, regional, and country-level coverage of interventions to prevent and manage HIV and hepatitis C among people who inject drugs: a systematic review. The Lancet Global Health, 5 (12), e1208-e1220. DOI: http://dx.doi.org/10.1016/S2214-109X(17)30373-X
- Steptoe, G. (2017, November 29). Lack of Interventions for Drug Users Contribute to Global Proliferation of HIV & HCV. Cranbury, NJ: Intellisphere, LLC: MD Magazine. Retrieved from: http://www.mdmag.com/medical-news/lack-of-interventions-for-drug-users-contribute-to-global-proliferation-of-hiv–hcv
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.