Tag Archives: Needle Exchange Programs

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.

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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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A Case of Northern Overexposure

By: Marcus J. Hopkins, Blogger

The face of Hepatitis C (HCV) continues to change, as the State of Alaska Section of Epidemiology is reporting – nay, warning – of yet another example of rapid increase in HCV rates among people aged 18-29 (State of Alaska, 2016). Of the 1,486 cases of HCV reported in 2015, the aforementioned age group represented 459 of those cases – roughly 31% – putting them on par with people aged 30-49 (461, roughly 31%). The remaining cases in 2015 were seen in people aged 50 or older.

This data conforms to national trends in HCV. While the majority of cases tend to occur within the 50+ age range, the fastest rate of increase continues to exist amongst the young, largely driven by opioid prescription drug and heroin abuse. Injection Drug Use (IDU) is consistently pegged as the largest driver of new infections, and the problem continues to grow and more people are being prescribed addictive prescription opioid drugs for pain management for injuries that may not necessitate them.

While opioid and heroin IDU is a growing problem, Alaska has long been utilizing Harm Reductions methods to attempt to mitigate the harm to IDUs. Four Syringe Exchange Programs (SEPs) are currently operating in Alaska in four cities: Anchorage, Fairbanks, Homer, and Juneau. Only once of these cities – Juneau – is present in the hardest hit region of the state, where the rate of infection for 18-29-year-olds saw a 490% increase from 2011-2015. Of further concern is that no SEP programs are operative in other parts of the state, which means that people in those areas are least likely to receive IDU support services.

The State of Alaska is quick to state that these data should not be considered the final word on HCV infections for 2015; many people who are infected with HCV are not diagnosed until years after the initial infection (Juneau Empire, 2016).

In similar news, Clark County in Indiana has become the sixth county in the state to qualify for permission to open an SEP under a 2015 emergency law that allows states to open an approved exchange if the state’s health commissioner declares a public health emergency in the county (. This was in response to a massive outbreak of HIV and HCV in southern Scott County in late-2014/early-2015 related to IDU.

While Clark County has received approval for the opening of an SEP, it spent a full eight months attempting to work out issues with its initial application. The primary issue, according to County Health Commissioner Kevin Burke, was that state officials didn’t support how the SEP would have been funded. Funding for the program was and will be provided by the Los Angeles-based AIDS Healthcare Foundation (AHF), which has garnered both high praise and sharp criticism in its approach to negotiating contracts with states and counties. After the problematic funding models were hammered out, a second application was submitted and approved.
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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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Carolina on My Mind

By: Marcus J. Hopkins, Blogger

Every year, legislatures around the United States pass legislation that is a mixture of good and bad, and this year, North Carolina’s bill, H972, is no exception.

First and foremost, H972’s primary function is to codify into law that recordings made by law enforcement agencies are not public record, and therefore are not subject to Freedom of Information Act (FOIA) or public records requests. This portion of the bill – which makes up two-thirds of the document, itself – is the likeliest portion of the bill to head immediately to court. It is not, however, within the context of the purposes of HEAL Blog to comment either on the legality or constitutionality of this section, and we will therefore move on to the next.

For our purposes, the final two pages of the bill authorize the establishment of state-sanctioned needle exchange programs in the state of North Carolina. This is a fantastic step forward in a state hard hit by the ravages of opioid prescription drug and heroin abuse. Injection drug users (IDUs) represent an ever-increasing percentage of new HIV and Hepatitis C (HCV) infections in the United State, and syringe exchange programs as a measure of harm reduction have largely shown to be effective in preventing the spread of disease by reducing the likelihood that IDUs will share needles.

Image promoting needle exchange for IDUs

According to the Centers for Disease Control and Prevention (CDC), injection drug use accounted for a full 6% of new HIV infection in adults and adolescents in 2014. That number is likely to rise considerably for the year 2015, with the recent spate of widespread infection in rural and suburban areas in Indiana, Kentucky, Ohio, West Virginia, and Massachusetts.

Indiana’s well-publicized example of the risk of HIV and HCV exposure via injection drug use was so vast, it inspired a usually vehemently opposed conservative legislature to agree to pass emergency permission to establish state-sanctioned syringe exchange programs in the hardest hit areas of the state. Similar circumstances prompted certain areas in Kentucky and West Virginia – areas where syringe exchanges have been long needed, but never funded – to establish localized syringe exchange programs in some of the most impacted areas.

While North Carolina’s legislature should be lauded for their passage of Needle Exchange provisions, there is some concern that its inclusion in a bill designed to make secret the recordings of law enforcements agencies and the constitutional concerns that raises may prompt the governor to veto the bill. If that occurs, it is hoped that the tireless advocacy efforts of NC State Senator Stan Bingham and State Representative John Faircloth – both Republicans – will find their way back into another bill, as this issue is vitally important to preventing the further spread of HIV and HCV in North Carolina and beyond.
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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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Appalachian Syringe

By: Marcus J. Hopkins, Blogger

If the heroin epidemic of the 1970s taught us anything, it’s that heroin use mostly affects the inner city minority communities, so white people who live outside of those cities don’t have anything to worry about, right?

Wrong. Much to the chagrin of anti-drug propagandists, this narrative was then, and is now, entirely false. One of the biggest fallacies of America’s drug policy is the fact that most of the prevention-based legislative efforts have been based off of similar false narratives, shoddy “science (most of which is relegated to stereotyping drug users), and a desire to punish, rather than prevent.

The latter – punishment over prevention – is a recurring theme in American drug politics, and that is arguably best reflected in how our states approach the issue of syringe exchanges. Despite the Appalachian Region (including AL, GA, KY, MD, MS, NY, NC, OH, PA, SC, TN, VA, & WV) having some of the highest rates of opioid prescriptions per 100 people, the highest rates of Hepatitis B and C, and some of the highest opioid-related overdoses in the nation, there has been little political will to enter into the scientifically uncontroversial, but politically controversial, business of syringe exchanges.

droppedimage

Photo Source: Bathroom Sketch

The premise behind syringe exchanges is this – we understand that people are going to use injection drugs; providing them with a safe way and place to exchange used needles for clean ones helps to stem the spread of virulent diseases that often run rampant within these communities. Sadly, the punishment-based approach to dealing with drug abuse operates off the premise that drug abusers know the risks of their bad habits, and if they’re stupid enough to use injection drugs, they deserve whatever health consequences come their way. Not only is that premise callous, it is also costly.

In the past few years, some states have begun to learn this lesson the hard way – Scott County, Indiana’s 2015 epidemic of IDU-related HIV and HCV, for example – and have begun to recognize that the conventional approach to dealing with the opioid and heroin epidemics has been largely unsuccessful. Rather than quelling the epidemic, the punitive approach to coping with addiction has simply driven it underground where it cannot be effectively monitored, diagnosed, or treated. This has helped to create a dangerous breeding ground for the spread of disease as a result of IDU that was largely thought to have ended in the 1990s.

Thankfully, several states’ law enforcement communities and local governments have recognized that the punitive approach to this problem has not brought about satisfactory results, and have come to be some of the most ardent supporters of both syringe exchange programs and rehabilitative and recovery services – two measures that research indicates as being the most effective tools in stemming the spread of preventable IDU-related disease exposure. These programs also offer support staff who are there to engage participants in confronting their problems with addiction, as well as helping to provide linkage to other important social services, such as housing and healthcare.

While we clearly have a long way to go in providing addiction and recovery services to the underserved communities in Appalachia, there are positive strides being made and steps being taken, although this is happening mostly on the local level. The best way to extend these programs to hard to reach communities is to advocate for their inclusion in state-level legislative initiatives, and doing that will require advocates to demonstrate how these programs help to save states money in these times of economic uncertainty. When faced with empirical and quantitative evidence, even the most fiscally conservative debt hawk can’t deny that these measure save not only lives, but precious resources.
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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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