By: Marcus J. Hopkins, Blogger
One of the most frequent drums HEAL Blog likes to bang is that epidemics do not occur in siloes. As we learned in Scott County, Indiana, an uptick in new HIV and Hepatitis C (HCV) cases was largely the result of the Injection Drug Use (IDU) of the now-removed-from-the-market prescription opioid drug, Opana. The HIV community has been banging this drum since the 1980s; unfortunately, the politics around IDU were such that Syringe Services Programs (SSPs, or needle exchanges) simply weren’t a politically feasible reality in most of the United States. In other parts of the country, like San Francisco, underground exchanges began in the late-80s, and legalization was relatively quick to follow.
San Francisco’s first underground needle exchange – Prevention Point – began in 1988 when a group of friends realized that something needed to be done to stop the spread of HIV among People Who Inject Drugs (PWIDs). Against California law, the organizers and volunteers went to great lengths to provide sterile syringes to PWIDs and also partnered with researchers, collecting data to document the positive health benefits programs like theirs could achieve (San Francisco AIDS Foundation, n.d.). Prevention Point operated for four years underground until 1992, when then-mayor Frank Jordan declared a public health emergency in the city of San Francisco and committed $138,000 to Prevention Point. This bold step went a long way to ensuring that SSPs were legalized within the state of California.
Fast-forward to 2018, and again, IDU is again a serious issue in San Francisco. This time, however, the San Francisco Department of Public Health is leading the charge using a variety of integrated initiatives involving:
opioid overdose prevention, education, and the distribution of Naloxone [an opioid overdose reversal drug]; access to and distribution of [sterile] syringes; prevention, screening, and treatment of HIV and HCV; alcohol prevention; and the creation of a Harm Reduction training institute (Chaverneff, 2018).
This multi-pronged approach to dealing with these intertwined epidemics using community-based methods, including peer education and testing models that have proven effective in other settings around the world.
More importantly, their model also includes taking HCV treatment outside of traditional healthcare settings, and helps to provide treatment at an Opiate Treatment Outpatient Program (at University of California San Francisco), at the San Francisco County Jail, at the SF AIDS Foundation Syringe Exchange program, at Magnet (a gay men’s sexual health clinic), at shelters, and in street settings (mobile setups). Of these, the most notable success was that the 10 patients who began HCV therapy in shelters all completed treatment; conversely, less than half of the 100 inmates who began HCV therapy completed treatment (Burk, 2018).
This model has been working for San Francisco, and it has the potential to work around the country, as well.
- Burk, K. (2018). Overdose, Hepatitis C, and Drug User Health: SFDPH’s Response to Overlapping Public Health Crises. San Francisco, CA: San Francisco Department of Public Health: Population Health Division: Community Health Equity and Promotion Branch. Retrieved from: http://www.nationalacademies.org/hmd/~/media/Files/Activity%20Files/PublicHealth/Opioid-Workshop/Burk-Katie.pdf
- Chaverneff, F. (2018, April 17). How the City of San Francisco Is Tackling the Intertwined HIV/HCV and Opioid Epidemics. New York, NY: Clinical Pain Advisor: Opioid Addiction. Retrieved from: https://www.clinicalpainadvisor.com/opioid-addiction/opioid-epidemic-opioid-crisis-public-health-hcv-hiv/article/758665/
- San Francisco AIDS Foundation. (n.d.). History of Health: Needle Exchange in San Francisco. San Francisco, CA: San Francisco AIDS Foundation: Client Services. Retrieved from: http://sfaf.org/client-services/syringe-access/history-of-needle-exchange.html
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.