Tag Archives: Iowa Department of Public Health

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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Hepatic in the Heartland

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

The Iowa Department of Public Health (IDPH) issued, this month, the state’s most recent epidemiological profile for Hepatitis C (HCV), and that profile isn’t looking good for people under the age of 30. Between 2010 and 2015, people between the ages of 18-30 have seen a 300% increase in new HCV infections (IDPH, 2017a). New HCV infections amongst all ages saw a 48.70% increase over that same period.

For nearly thirty years, the conventional wisdom has been that HCV is a Baby Boomer disease, and that, outside of the occasional People Who Inject Drugs (PWIDs), there is really no need to screen other groups for infection. What that preconceived notion failed to account for was a resurgence in popularity of heroin as the drug of choice and the resultant increase in Injection Drug Use (IDU). Moreover, the setting of heroin use has largely shifted away from being an urban problem that impacts mostly minority communities to one that’s plaguing suburban and rural areas where access to comprehensive healthcare and recovery services lags behind the more urban settings with which the heroin addiction has historically been associated.

The IDPH report indicates that IDU accounts for 68% of all new HCV infections, and that 55% of Iowans living with HCV live in one of six counties: Polk, Linn, Scott, Woodbury, Pottawattamie, and Black Hawk. Though these counties are among the most populous in Iowa, the state is, itself, relatively rural in comparison to its neighbors. In the IDPH HCV Fact Sheets, the increase in new infections amongst younger Iowans is specifically tied to IDU, indicating that ER visits for opioid and heroin overdoses increased 253% and 2,500%, respectively (IDPH, 2017b).

Randy Mayer, Chief of the IDPH Bureau of HIV, STD, and Hepatitis puts a positive spin on the report:

“These data indicate that Iowans are getting tested and referred to treatment by their medical providers. Everyone born between 1945 and 1965 and anyone who has ever injected non-prescription drugs, even once, should be tested for hepatitis C (Bunge, 2017).”

This is the first report by the IDPH to look at incidences of HCV in Iowa, and Mayer adds that, while this is the first attempt to pull together various data from around the state, the IDPH has been watching similar reports out of Appalachia, and as such paid additional attention to people under 30 (Shotwell, 2017).

This inaugural report from the IDPH does a lot of things “right,” my personal favorite being the use of APA citation, rather than MLA, allowing for in-text citations, rather than footnotes. Writing stylistic approach aside, the report does a fantastic job of indicating which areas Iowan medical professionals need to watch and where interventions most need to be made, as well as indicating that follow-up after treatment is necessary to avoid re-infection.

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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