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As HIV Transmission Among People Who Inject Drugs Increases, So Does The Need For Action

Earlier this month, public health officials in Multnomah County, Oregon reported that the state was experiencing its most substantial HIV outbreak in years and that it was occurring primarily among people who inject drugs. The outbreak in Multnomah County, which includes the city of Portland, has seen 42 people who either inject drugs or who have sex with people who inject drugs contract HIV in the last 18 months. As has been the case in similar injection drug use centered HIV outbreaks, like the one that has impacted people who inject drugs in northeastern Massachusetts, this spike in new HIV infections among people who inject drugs in Oregon has disproportionately impacted those who are at risk for or are experiencing homelessness, with more than half of the 42 newly diagnosed individuals experiencing unstable housing.

Health officials in Multnomah County are still unsure if this recent uptick in HIV transmission among people who inject drugs will be predictive of future increases in HIV incidence in the area. For the 5 years prior to 2018, rates of HIV transmission had been declining, but this recent outbreak has undone all of that progress with the number of new diagnoses in the last 18 months almost doubling the combined totals from 2016 and 2017. And, while HIV diagnoses have been trending downward, rates of other sexually transmitted and bloodborne infections like hepatitis C, syphilis, and gonorrhea have been rising for a number of years.

At this point in the life cycles of the overdose and HIV epidemics in the United States, the capacity of public health officials and advocates for HIV and drug user health to be shocked has all but worn out. For years now—well in advance of the injection drug use fueled HIV outbreak in Scott County, Indiana in 2015—the harm reductionists, clinicians, and epidemiologists who have been facing these dual crises in their work have been very clear and consistent in their recommendations and warnings: the failure of federal, state and local governments to prioritize public health spending on evidence-based interventions like syringe services programs, easily accessible mediation-assisted treatment for opioid use disorders, increased naloxone distribution, and safer consumption sites would lead to increasingly frequent HIV outbreaks among people who inject drugs.

Fortunately for the people of Portland, Multnomah County has an established adequately funded syringe services program and the exclusion of needles and syringes from the state’s drug paraphernalia laws. However, just weeks before news of the HIV outbreak was released, Multnomah County officials were looking to cut nearly $200,000 from the county’s syringe services program budget. In the end, that funding was not cut, but it was only extended for another year, leaving the program’s future on less than solid ground.

Meanwhile, in West Virginia, a less encouraging response to the HIV and overdose crises has been taking place. As detailed in a recent article in Mother Jones, another Scott County is brewing and the willingness of some elected officials to embrace best practices has been disturbingly absent. In 2018, the syringe services program in the state’s capital, Charleston, was suspended by the Kanawha-Charleston Health Department after opposition from Charleston’s Mayor and increased restrictions imposed on the clinic that went against best practices, like requiring government issued photo ID from participants and only distributing retractable syringes, made its continued operation untenable.

Before it’s closure, the Kanawha-Charleston Health Department’s syringe services program was serving more than 400 people who inject drugs each week and was viewed by the drug using community as a valuable resource that genuinely cared about the people they worked with. Now, it appears as if many of the people who inject drugs in the Charleston area have been forced to go back to harmful injecting practices that could lead to a major HIV outbreak in the region.

In a recent qualitative study of program participants by researchers at Johns Hopkins University, one person who injects drugs recounted the terrifying new reality of using drugs when syringe services programs aren’t readily accessible:

“It’s an epidemic [syringe sharing]. That’s how bad it’s getting. I mean, you’ve got four or five people sharing a needle, and then they’ll throw it down on the ground and maybe somebody else come along and they pick it up and they think burning it with a lighter will sterilize it. Well, that’s not so. And then the next thing you know, four or five people use that needle. One needle will probably do 15 people.”

The Kanawha-Charleston Health Department syringe services program was one of 62 organizations that were awarded funding by the Syringe Access Fund that is managed by AIDS United. In 2018, AU wrote a letter urging officials in the city of Charleston to remove the newly imposed barriers to service that they had implemented so that the people who inject drugs who hailed from as many as 192 different zip codes could access this life saving program.

AIDS United will continue to fight for the implementation of best practices around providing health care for people who inject drugs in West Virginia and all across the country. Please check back in with AIDS United’s policy update for more on this issue.

Posted By: AIDS United, Policy Department - Friday, June 28, 2019

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