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HIV and Injection Drug Use in the United States - Facts from the CDC

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HIV and Injection Drug Use in the United States - Facts from the CDC

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Injection Drug Use | HIV Risk and Prevention | HIV/AIDS | CDC

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This fact sheet provides data about HIV and AIDS among persons who inject drugs and discusses what CDC is doing to prevent HIV.

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Harm Reduction and Needle Exchange Programs - 

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Harm Reduction and Needle Exchange Programs - 

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Dr. Inaba discusses the continuing controversy around needle exchange programs and the need for more treatment opportunities as the best harm reduction strategy.

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Harm Reduction and Needle Exchange Programs

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http://www.cnsproductions.com/drugeducationblog/podcasts/126/ - Dr. Inaba discusses the continuing controversy around needle exchange programs and the need for more treatment opportunities as the best harm reduction strategy.

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Needle exchange programs are places where IV drug users can obtain clean syringes for free. Needle exchanges also often offer other services.

Why Were They Created?

The purpose of needle exchange programs is to reduce the transmission of HIV and other blood-borne diseases. Recent statistics show that one fifth of all HIV and HCV infections in the United States are due to IV drug use. IV drug users often share needles with others because they can't afford to buy new ones. Many needle exchange programs also offer education to help prevent the spread of illnesses like HIV and STD's.
Needle Exchange Programs in the US
What Services Do They Offer?

-HIV/AIDS education

-Condom distribution

-Access to drug rehabilitation centers

-HIV and STD testing

-Counseling

-Safe disposal of used syringes

-Other medical services

Addiction is not a choice!

Call 866-205-3108 to speak with an Addiction Advisor.

Needle Exchange Program Facts

87% of needle exchange programs offer HIV testing and counseling, 65% offer hepatitis C counseling and testing, 55% offered sexually transmitted disease screening, and 31% offered tuberculosis screening; 89% provided referrals to substance abuse treatment" (from Drug War Facts).

As long ago as 1997, The N.I.H. stated, "individuals in areas with needle exchange programs have an increased likelihood of entering drug treatment programs."

In 2008, needle exchange programs reported exchanging just over twenty-nine million syringes.

Studies show needle exchange programs have led to a 30% decrease in HIV infection, and an 80% decrease in risky sexual behavior.

These needle exchange program facts and statistics pretty accurately answer the question "do needle exchange programs really work?" Yes, yes they do.
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What's With all the Controversy?

Many feel these programs shouldn't exist and that drug users should be punished to prevent drug use. People against needle exchanges argue this would provide more incentive for quitting.

Whether a program condones or prevents drug use, they're helping the fight against HIV and STD's. Addicts will find a way to get high and needle exchange programs offer harm reduction during active addiction. Those using these programs have less risk of contracting a blood-borne disease and, upon getting sober, will better be able to live as productive members of society.

Needle exchange programs often try to get addicts to stop using. Information about treatment centers and other services to help quit are available. Many in the depths of drug use don't know the path to recovery. Needle exchange programs offer information on what to do and where to seek help.

Do Needle Exchange Programs Really Work?

Those who don't understand the disease of addiction say that addicts must deal with the consequences of their decision to use dirty needles. Contrary to public opinion, these programs actually help cut down on public health costs. Taxpayer costs increase with the increase of infections.

In some states, there are laws against possessing needles without a prescription and individuals carrying syringes may even be arrested for possessing drug paraphernalia. By 2006, forty-eight states have authorized needle exchange programs and allow the purchase of needles without a prescription. As of 2012, needle exchange programs can be found in almost thirty-five states.

There hasn't been any increases in drug use, or more frequent drug injection, in these states. Crime statistics have NOT shown any higher risks of crime from needle exchange programs.

You draw your own conclusion.
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Do Needle Exchange Programs Really Work? | True Facts

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Needle exchange programs are places where IV drug users can obtain clean syringes for free. Needle exchanges also often offer other services. The purpose of needle exchange programs is to reduce the transmission of HIV and other blood-borne diseases. Recent statistics show that one fifth of all HIV and HCV infections in the United States are due to IV drug use.

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It's no secret that heroin use is on the rise in the U.S. Data from the Substance Abuse and Mental Health Services Administration (SAMHSA) found that heroin use has soared in recent years, from 373,000 yearly users in 2007 to 669,000 in 2012.

This has also led to a sharp increase in new HIV and Hepatitis C infections among these intravenous drug users, leading more government officials to ponder how to address this growing crisis.

Officials Praise the Programs

Michael Botticelli, Director of the Office of National Drug Control Policy, has praised needle exchange programs as a way to reduce new infections.

Users who visit these centers can exchange used needles for sterile ones, but may not use drugs on site. The North American Syringe Network reports that there are 200 of these programs across 33 states and the District of Columbia offering support.

"They've been demonstrated to reduce not only infectious disease but also create an opportunity for people to get the care and provide a transition into treatment for people in the community," said Botticelli.

A Look at the Pros and Cons

Some of the pros for these programs are fairly clear. They include the following:

Reducing the risk of contaminated needles being shared

Reducing the risk of law enforcement officers becoming infected by accidental needle sticks

Many of the needle exchange centers offer free HIV testing and counseling

Some programs will also assist those seeking help for their drug problem to get into treatment programs, support groups or other local services

On the flip side, those opposed to needle exchange programs cite the following:

The programs promote drugs by offering needles to help a person use

The apparent "acceptance" of IV drug use will lead to higher rates of drug abuse

Many of these programs are being funded with taxpayer dollars

Some reports indicate the HIV rate increases as a result of needle exchange programs

Locals often feel unsafe due to the constant influx of addicts

A Look at the Numbers

But contrary to the criticisms, studies show these programs can generally help to improve the situations of thousands of IV drug abusers. In fact, data indicates that addicts involved in these programs are actually more likely to attend long-term rehab than those who don't. European countries who have similar community programs, including Switzerland, Brazil and Norway, have seen a reduction in new cases of HIV contraction and the overall spread of AIDS.

Needle exchange programs can ultimately serve as a solid middle ground for people who aren't fully ready to stop using yet, but are aware of the danger they face with continued heroin use. This population has a strong likelihood of eventually entering treatment.

Taking away the positive stepping stones like needle exchange programs would likely exacerbate what has already becoming an opiate epidemic of monstrous proportions.

Additional Reading: Why is Opiate Addiction So Hard to Treat?.

Image Source: commons.wikimedia.org, pixabay.com

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The Pros and Cons of Needle Exchange Programs

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It's no secret that heroin use is on the rise in the U.S. Data from the Substance Abuse and Mental Health Services Administration (SAMHSA) found that heroin use has soared in recent years, from 373,000 yearly users in 2007 to 669,000 in 2012.

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ACLU - A Major Advocate for Needle Exchange Programs

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ACLU - A Major Advocate for Needle Exchange Programs

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Injection Drug Use and Infectious Disease Make Needle Exchange Programs Imperative:

There are an estimated 350,000 regular injection drug users in America - all at increased risk of contracting and spreading fatal blood-borne diseases. 1

Approximately 950,000 U.S. residents are living with HIV/AIDS. 2

More than a quarter of AIDS cases in the U.S. among people age 13 or older are directly linked to injection drug use. 3

When mother-to-child HIV transmission is taken into account, roughly 35 percent of all AIDS infections can be related to injection drug use. 4

An estimated 61 percent of AIDS cases among women are due to injection drug use or sexual contact with someone infected with HIV through injection drug use. 5

Over half of HIV infections in children result from injection drug by a parent. 6

AIDS is the second leading cause of death among African American women and third leading cause of death among African American men. 7

Injection drug users are also at serious risk of contracting Hepatitis B and Hepatitis C. Hepatitis B infects between 140,000 and 320,000 people every year and kills between 5,000 and 6,000 people in the U.S. Hepatitis C infects about 36,000 people in the U.S. every year, killing 8,000 to 10,000 of those infected. 8

Needle Exchange Programs by the Numbers:

There are approximately 185 needle exchange programs (NEP) operating nationwide. 9

A national survey of NEPs found that in addition to exchanging sterile syringes for contaminated ones, 97 percent of programs provide a range of public health services, including referral to substance abuse treatment, prevention education for sexually transmitted diseases, HIV counseling and testing, tuberculosis screening, and primary health care. 10

It costs an average city about $160,000 to run an NEP (about $20 per user per year), whereas one syringe-infected AIDS patient will require upwards of $120,000 per year in public health expenditures. 11

Federal law forbids use of federal funds to support needle exchanges - nonetheless, exchanges operate in 38 states. 12

Needle Exchange Programs Promote Public Safety:

In 2002, NEPs reported removing nearly 25 million used syringes from communities. 13

According to the Centers for Disease Control, the one-time use of sterile syringes remains the most effective way to limit HIV transmission associated with injection drug use. 14

A study by the National Institutes of Health found that NEPs "show a reduction in risk behaviors as high as 80 percent in injecting drug users..." 15

NEP participants have been found five times more likely to enter drug treatment than those who had never used an exchange. 16

NEPs throughout the country have reduced HIV transmission rates by one-third to two-fifths. 17

An analyses of a New York State-approved NEP found that during a 12-month period, an estimated 87 HIV infections were averted as a direct result of the use of needle exchange. 18

Injection drug users who are afraid of being arrested while carrying drug paraphernalia are 1.74 times more likely to share syringes, and 2.08 times more likely to share injection supplies than other users. 19

Sources:

1. Substance Abuse and Mental Health Services Administration's (SAMHSA) 2003 National Survey on Drug Use & Health

2. National Institute of Allergy and Infectious Diseases: HIV/AIDS Statistics

3. Centers for Disease Control and Prevention (CDC): AIDS cases by exposure category

4. CDC: Drug Associated HIV Transmission

5. CDC: HIV Surveillance Report

6. CDC: HIV Surveillance Report

8. National Institute of Allergy and Infectious Diseases: Hepatitus fact sheets

9. Drug Policy Alliance

10. Paone D, Clark J, Shi Q, Purchase D, Des Jarlais DC. Syringe exchange in the United States, 1996: A national profile. Am J Public Health 1999 Jan; 89(l):43-6.

11. Syringe Exchange in the United States: 1995 Update, HIV Capsule Report, United States Conference of Mayors, February 1996

12. Vogt RL, Breda MC, Des Jarlais DC, et al. Hawaii's statewide syringe exchange program. American Journal of Public Health. 1998;88:1403-1404.

13. Morbidity and Mortality Weekly Report 2005;54(27):673-6.

14. CDC: Drug-associated HIV transmission continues in the U.S. 2002.

15. National Institutes of Health: Interventions to Prevent HIV Risk Behaviors. 1997 February 11-13;15(2):1-41.

16. Hagan H, et al. Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors. J Subst Abuse Treat 2000; 19(3):247-52.

17. National Institutes of Health: Interventions to Prevent HIV Risk Behaviors. 1997 February 11-13;15(2):1-41.

18. Laufer FN. Cost-effectiveness of syringe exchange as an HIV prevention Strategy. J Acquir Immune Defic Syndr 2001;28(3):273-8.

19. Blumenthal, R.N., Collateral damage in the war on drugs: HIV risk behaviors among injection drug users. International Journal of Drug Policy 10 (1999) 25-38.

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Needle Exchange Programs Promote Public Safety

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Fact Sheet on Needle Exchange ProgramsInjection Drug Use and Infectious Disease Make Needle Exchange Programs Imperative:There are an estimated 350,000 regular injection drug users in America - all at increased risk of contracting and spreading fatal blood-borne diseases. 1 Approximately 950,000 U.S. residents are living with HIV/AIDS. 2

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Needle
 and syringe programmes (NSPs) for HIV prevention - International Aspects

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Needle
 and syringe programmes (NSPs) for HIV prevention - International Aspects

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Needle and syringe programmes provide access to sterile needles and syringes to reduce transmission of HIV and other blood borne viruses from sharing injecting equipment

Needle and syringe programmes can be provided through fixed sites, mobile sites, outreach services, vending machines and pharmacies

Global coverage remains inadequate. Only 12 countries are providing the WHO-recommended 200 clean needles per person who injects per year

Criminalisation, legal restrictions on those under 18, and stigma and discrimination are key barriers to effective needle and syringe programmes

Funding for needle and syringe programmes is inadequate, largely due to lack of political support

Explore this page to find out more about how needle and syringe programmes are delivered, coverage of programmes across geographical regions, and barriers to accessing these programmes.

Needle and syringe programmes (NSPs) are a type of harm reduction initiative that provide clean needles and syringes to people who inject drugs (sometimes referred to as PWID) to reduce transmission of HIV and other blood borne viruses (such as hepatitis B and C). The World Health Organization (WHO) recommends providing 200 sterile needles and syringes per drug injector per year, in order to effectively tackle HIV transmission via this route. 1

Many programmes supply other equipment to prepare and consume drugs such as filters, mixing containers and sterile water. The majority are run by drug services or pharmacies and operate from a range of fixed, mobile and outreach sites. 2

Programmes aim primarily to reduce the transmission of HIV and other blood-borne viruses caused by the sharing of injecting equipment. Many also work to reduce other harms associated with injecting drug use by providing:

advice on safer injecting practices

advice on minimising the harm done by drugs

advice on how to avoid and manage an overdose

information on the safe handling and disposal of injecting equipment

referrals to HIV testing and treatment services

help to stop injecting drugs, including access to drug treatment (such as opioid substitution therapy) and encouragement to switch to safer drug taking practices

other health and welfare services (including condom provision).

NSPs substantially and cost effectively reduce the spread of HIV among PWID and do so without evidence of exacerbating injecting drug use at either the individual or societal level. 4

Fixed sites

Fixed sites are typically located where the drugs are bought and sold openly. They are normally converted shops or offices and have a reception area for clients where they give out new, and receive used, injecting equipment.
At fixed sites, it is easier to offer additional services such as healthcare alongside testing and counselling for HIV and other blood-borne viruses. 5

Mobile programmes

Mobile programmes operate from a van or bus with needles and syringes distributed through a door or window. Some large mobile programmes act like fixed sites with testing and other healthcare services also available.
Others run in conjunction with fixed sites. In these instances, the fixed site is typically located in an area with high numbers of people who inject drugs with the mobile NSP focussing on harder to reach or smaller populations. 6

Mobile programmes can be more accessible than fixed sites and often face less opposition than fixed sites. 7

Outreach programmes

Outreach programmes take many forms including mobile units (such as a van or bus), backpacking services on the street or even home deliveries. 8

They typically operate where there is a shortage of funding for needle and syringe programmes. For example, it is the preferred method of delivery in Haryana, India, where a peer-led outreach programme provides one-to-one and group education sessions for people who inject drugs and has successfully reduced needle-sharing and other risky behaviour. 9

Some outreach programmes exist to complement fixed or mobile NSPs where injecting drug users are not engaging with established services. Outreach workers are tasked with encouraging people who inject drugs to use existing fixed or mobile sites. 10

Syringe vending machines

Countries including the Netherlands, Germany, Italy and Australia use syringe vending machines in addition to other forms of NSPs.

Syringe vending machines accept coins and tokens (distributed by outreach workers) in return for harm reduction packs. In Australia, these packs include several needles and syringes as well as alcohol swabs, cotton wool, sterile water and spoons. Others contain educational materials. 11

The machines are typically mounted on the outside walls of fixed sites. They are also installed in places where needles and syringes are hard to access. Most provide needles and syringes 24 hours a day, 7 days a week. 12

Pharmacies

Pharmacy-based NSPs operate in a number of ways. Some sell needles and syringes directly to people, while others exchange harm reduction kits for vouchers.

The main advantage of this delivery mode is that pharmacy networks are often already well established and located near to large groups of people who inject drugs. In addition, their opening hours are often more convenient than those at fixed sites. 13

However, they are very limited in low-income countries. Even where they do exist, some pharmacists are reluctant to sell needles and syringes or deal with their disposal. 14 Moreover, they rarely offer education and additional healthcare services. 15

In 2016, there were 158 countries worldwide that reported people who inject drugs, but just 90 of these countries implement needle and syringe programmes. Five countries (the Dominican Republic, Colombia, Jordan, Kenya and Senegal) introduced NSPs between 2012 and 2014. 16 However, since then there has been a halt in implementation.

Global NSP coverage remains inadequate. While 43% of countries with documented injecting drug use have no NSPs in place, only 12 countries provide at least 200 clean needles per person who injects per year as recommended by WHO. 17

Asia and the Pacific

A total of 17 countries in Asia implement NSPs. NSPs in Asia are delivered in a number of ways. In some places, fixed sites have been integrated with other facilities such as health clinics and pharmacies. Implementation of NSPs throughout the region has largely been undertaken by civil society organisations. 18

In Cambodia, Laos, Mongolia, the Philippines and Thailand, provision of NSP exists on a very small scale. Despite progress in some countries, Afghanistan, India and Thailand have reported a decline in the number of programmes since 2014. In Thailand the number of NSP sites has more than halved, dropping from 38 in 2014 to just 14 in 2016. This has been attributed to a reduction in funding. 19

NSP coverage is still too low to have a significant impact on HIV prevalence among injecting drug users in the region. A lack of human resources, inflexible hours and harsh drug policies are cited as barriers to NSP access. 20 21

In the Pacific (Oceania), Australia and New Zealand are the only countries that have figures on people who inject drugs, and both provide NSP services. In fact, they have one of the highest coverage rates in the world. Political support and public funding for harm reduction services has helped to keep HIV transmission from unsafe injecting very low. 22

Eastern Europe and Central Asia

All 29 countries and territories in Eastern Europe and Central Asia have NSPs, although there is a huge disparity in the number available in each country. For example, there are 1,667 in Ukraine but only two in Romania and four in Russia. 23 A report by the Eurasian Harm Reduction Network estimated that only 10% of people who inject drugs in Eastern Europe and 33% in Central Asia are able to access these services. 24

Since 2014, eight countries in the region have scaled up their NSP provision. However, Bulgaria, Kyrgyzstan, Romania, Slovakia and Slovenia have recorded a decrease. Coverage remains low across the region, and only Kyrgyzstan reported providing at least 200 needles per injecting drug user per year as recommended by WHO. 25

The political reaction to harm reduction services in the area continues to be hostile, forcing many services to close. This has severely affected Hungary, where its largest programme was shut down, reducing the number of clean needles available in the country by around 40%. 26

Inadequate financial support from national government remains the primary constraint to sustainable NSP services, with many governments providing no financial support. 27

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Western and Central Europe and North America

In Western Europe, NSPs operate in 19 of theout of 23 countries. In a few of these countries the annual number of syringes distributed per person who injects drugs per year approaches the WHO recommendation of 200. 28

NSPs in Western Europe use fixed sites, vending machines, outreach and mobile services. Syringes can also be bought without prescription in the majority of the countries in the region meaning pharmacies play a vital role in the provision of NSPs. 29

The number of NSPs has declined in Austria, Belgium, Finland, Germany, Luxembourg, and Norway, since 2014, with a large decrease in service provision in Portugal (from 1,270 to 590) and Spain (from 2,386 NSPs to 1,578). 30

Barriers to access in the region include under 18s being denied services, undocumented migrants not being reached, and rural areas having underdeveloped services. 31

NSPs are available in both the United States of America (USA) and Canada, but estimates of coverage are limited. Although the exact number of NSPs operating in Canada is not known, it is estimated that 94.5% of people who inject drugs used sterile injecting equipment at last injection. In the USA, 244 NSPs operate, a 25% increase since 2014, but still low given the population size. 32

Latin America

NSP services for people who inject drugs in Latin America is extremely limited. A 2010 review found The most recent data available suggest that only 2% of people who inject drugs are accessing NSP services in Latin America, with only 0.3 syringes distributed per person per year. 33

Of the 12 countries in the region that report injecting drug use, only six operate NSPs. Coverage has diminished since 2014, in some cases this decline is believed to mirror a declining number of people who inject drugs, for example, in Argentina, Brazil and Uruguay. 34

In the countries where NSP provision is available, many people who inject drugs are deterred from accessing services due to restricted opening hours, long waiting times, insufficient resources, criminalisation of drug use and inadequately trained service providers. 35

The Middle East and North Africa

Nine countries in the Middle East and North Africa (MENA) currently implement needle and syringe programmesNSPs. However, even where available, these services fall short of need. 36

Only in Iran, where unsafe injecting drug use continues to be the greatest contributor to HIV incidence, is NSP provision substantial, with 580 sites across the country. In 2015, 81.5% of people who inject drugs in Iran reported using sterile injecting equipment, 37

Coverage throughout MENA is thought to be extremely limited and remains too low to have a positive impact on the transmission of HIV and other blood-borne viruses. 38

Sub-Saharan Africa

NSP provision throughout sub-Saharan Africa is mostly limited to interventions by non-governmental organisations (NGOs), due to a lack of political and financial support from domestic governments. 39

Only five countries (of the 54 countries that make up the African Union) provide NSP services for people who inject drugs: Kenya, Mauritius, Senegal, South Africa and Tanzania. 40

In 2012, NSP services began being implemented in Kenya, with a combination of fixed sites and outreach services on offer. Prior to the inception of this service, an estimated 51.6% of people who inject drugs reported using sterile injecting equipment. In 2016 research found 88.8% of people reported using sterile needles. 41

Mauritius also has a high coverage in comparison to the rest of the region with 83.8% of people who inject drugs using sterile injecting equipment in 2013. 42

The Caribbean

Data regarding people who inject drugs in the Caribbean are sparse, with reliable data only available for Puerto Rico and the Dominican Republic. Aside from a pilot NSP in the US Virgin Islands, these are the only two countries in the region that have NSPs. 43

NSPs have been available in Puerto Rico since 2007, with six operating as of 2014. Between 2007 and 2011, they led to a 17.1% reduction in the number of HIV infections as a resulting of from unsafe injecting. 44 The Dominican Republic opened its first programme in 2012, and between June and December that year it distributed 4,000 new syringes. 45 In 2015, this service distributed nearly 14,500 syringes to people who inject drugs in the Dominican Republic. 46

Legal and social barriers
Criminalisation
In many countries worldwide, criminalisation of injecting drug use is a major barrier to NSP services.

Criminalisation of possession of illicit substances and injecting equipment often forces people who inject drugs to hide their equipment and engage in unsafe injecting practices, with many threatened, abused, extorted or arrested by the authorities. 47 One study from Northern Morocco reported that 87% of this group had experienced police violence. 48
Legal restrictions
Legal age restrictions for accessing NSPs in some countries prevent access to people who inject drugs under 18 years old, despite evidence that people now start injecting drugs at an earlier age. 49

Mandatory detention of injecting drug users in drug detention centres in countries such as China is also a barrier to accessing these services. 50
Stigma and discrimination
Even in places where it is legal to purchase needles and syringes, stigma, discrimination or disapproval from the community prevent many people who inject drugs from accessing NSP services. 51

They also experience stigma and discrimination from healthcare workers, or receive services that are not delivered in a culturally sensitive way. 52 53
Lack of political support and funding
In many countries, there is a lack of political will resulting in a shortfall of funding for the implementation of needle and syringe programmes. 54

For example, the USA has had a longstanding ban on the use of federal funds to purchase sterile syringes for injecting illegal drugs both domestically and internationally. 55 However, a 2016 amendment means that federal funds are now allowed to be used to support other facets of NSPs, such as human resources and syringe disposal. 56

In Canada, a lack of federal support means that NSPs are typically delivered by NGOs, civil society groups, provinces and territories, with service numbers varying dramatically between and within provinces. 57

Even in Europe, the region traditionally most supportive of harm reduction, a drop in government funding has resulted in service closures and uncertainty. 58 Bulgaria, Greece, Romania, Hungary and Poland have been particularly negatively affected. 59

International donor funding for the HIV response is in decline, and this problem is increasingly pronounced in middle-income countries where harm reduction is most needed. Services in many countries are having to close due to withdrawal of international funding with national governments failing to fill the funding vacuum. 60

For example, since 2015, the Global Fund has reduced its financial support to Russia by approximately 30%, which immediately resulted in a dramatic decrease in the coverage of already limited NSPs and harm reduction services, with the annual coverage of harm reduction services decreasing by over 60% between 2014 and 2015. Support is set to end entirely by 2018. 61

Physical and geographical barriers

In other places, access to NSPs is limited by geographical distance, particularly in remote and rural areas. A number of studies have shown that people who inject drugs who live in close proximity to programmes are more likely to use them. 62

Even where they are in reach, many sites have restricted opening hours, long waiting times, insufficient resources (including needle and syringe supplies) as well as inadequately trained medical personnel. 63 64 65
Photo credit: ©iStock.com/Dougall_Photography

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Needle and syringe programmes (NSPs) for HIV prevention

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Needle and syringe programmes provide access to sterile needles and syringes to reduce transmission of HIV and other blood borne viruses from sharing injecting equipment Needle and syringe programmes can be provided through fixed sites, mobile sites, outreach services, vending machines and pharmacies Global coverage remains inadequate.

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Needle-Exchange Programs Could Prevent HIV Outbreaks, Experts Say

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Needle-Exchange Programs Could Prevent HIV Outbreaks, Experts Say

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Offering programs that allow injection drug users to receive clean needles in a bid to avoid reuse and sharing could be one way to combat HIV outbreaks like the one in rural Indiana, two researchers argue in a paper released Wednesday.

In a new commentary published in the New England Journal of Medicine, Dr. Chris Beyrer, a Johns Hopkins Bloomberg School of Public Health professor, and Steffanie Strathdee, director of the Institute of Global Health at the University of California, San Diego, argue that Congress should immediately lift a ban on federal funding for needle-exchange programs.

As of June 10, 169 people living in Scott County, Indiana, had been diagnosed with HIV and more than 80% of them also had hepatitis C. The spread was traced to residents dissolving prescription painkillers and then injecting themselves. As TIME reported in June, some of the residents injected themselves up to 20 times a day, often sharing needles with others to do so. The U.S. Centers for Disease Control and Prevention even reported instances of three generations of family members passing needles around.

"There are going to be more of these outbreaks and what's urgently needed is a public health response before things get even worse," Beyrer said in a statement. "Now is the time to implement needle and syringe exchange programs, wherever they are needed. We can't put politics above public health. We have a cheap tool to prevent this."

The authors note that buying syringes over the counter is illegal without a prescription in 25 states and that in places where needle-exchange programs are legal, organizers cannot use federal funds. Indiana Governor Mike Pence has opposed needle exchanges, but allowed for them as an exception in the affected region. Still, the authors write that many programs are only open until 6 p.m. and ask for a lot of personal information that may deter people from seeking them out.

As America's drug-addiction problem has pushed deeper into rural white communities, the report's authors argue, America's approach needs to become more nimble. In addition to exchanges, other strategies like asking people about drug use during HIV screenings and considering the use of opioid replacement therapies could help the U.S. combat the growing health problem.
Read next: Why America Can't Kick Its Painkiller Problem

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Needle-Exchange Programs Could Prevent HIV Outbreaks, Experts Say

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Offering programs that allow injection drug users to receive clean needles in a bid to avoid reuse and sharing could be one way to combat HIV outbreaks like the one in rural Indiana, two researchers argue in a paper released Wednesday.