Tag Archives: People Who Inject Drugs

International Research Effort Shows U.S. Lags in Interventions

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

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).

Medical technician counting needles.

Photo Source: Daily Beast

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.

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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