As A&U reported in the June issue, the rise in HIV and hepatitis C (HCV) diagnoses in Scott County, Indiana, has put the state in crisis mode. The number of new HIV diagnoses in this rural county of 24,000 in the first three months of 2015 alone (population: 24,000) was nearly double the number of new HIV diagnoses among the estimated 100,000 people who inject drugs in New York City in all of 2014. And all of that increase in Scott County is from among people who inject drugs (PWID).
The drug of choice in Scott County is Opana, a form of Oxycodone that can be crushed and injected, but use of other injectable opiods like heroin is on the rise in rural America.
Though the HIV spike in Scott County is getting most of the national attention, hepatitis C is just as prevalent. Nearly nine in ten people who tested positive for HIV in the county were also diagnosed with the hepatitis C virus. That’s because syringes are a highly effective way of transmitting both HIV and HCV through a population very quickly.
In April, amfAR, the Foundation for AIDS Research, reacted to the Indiana outbreak by releasing a brief on the importance of syringe service programs (SSPs) in preventing the spread of these infections. The organization points out that, despite an overwhelming body of scientific evidence demonstrating their effectiveness, the federal government continues to prohibit the use of federal funds for SSPs.
That’s a huge problem, because there is little to no state funding for SSPs. Indiana’s governor Mike Pence approved a temporary needle exchange program in March, and in May the state legislature approved a year-long program, but only for that one county. On the date the legislature passed the law, nearly 200 people were participating in the needle-exchange program there, and nearly 20,000 clean needles had been distributed.
But Pence remains opposed to longer-term SSPs as a matter of public policy, as do many red-state governors.
Beth Meyerson, Co-Director of the Rural Center for AIDS/STD Prevention at Indiana University, tells A&U magazine that rural areas throughout the U.S. are vulnerable to spikes in HIV and HCV due to rampant opioid addiction, criminalization of IV drug use, and inadequate funding for prevention and treatment.
Greg Millet, vice president and director of public policy at amfAR, agrees. He told A&U that, while urban areas like Chicago and New York have strong needle exchange programs and active education programs for PWID, most of America does not.
“What we’re seeing is IV drug use is growing fast in rural America,” Millet says. “Big cities get it in terms of having needle exchange programs to prevent the spread of HIV and HCV. But without federal funding, it is up to the state or private funding to step in for the rural areas.”
The funding is there in Scott County, Indiana, now, but not in other rural counties across the U.S., including across the border in Kentucky—No. 1 in the nation with 4.1 hepatitis C cases per 100,000 residents, according to the CDC.
SSP advocates say needle-exchange programs became popular in the 1980s and have been crucial in drastically reducing HIV and hepatitis rates, but have faced opposition from law enforcement and lawmakers. More than 200 SSPs are currently operating in thirty-four states across the country. They’re funded primarily through state and local governments, with occasional help from foundations. But a Congressional ban passed in 1998 prohibits the use of federal funds to support SSPs and prevents state and local jurisdictions from spending their federal public health allocations on these programs.
The Obama administration lifted the ban on federal funding for exchange programs in late 2009, but 2011, Congress reinstated it as part of a last-minute budget deal.
The de-facto federal prohibition on needle exchange is costing lives needlessly, Millet says.
“Policy makers are not following science or data. And the science says these [SSP] programs save lives. We have seen that in urban areas.”
SSPs prevent new infections in several ways, Millet adds. These programs get people in for testing, and get linked to the healthcare system. In addition to needle disposal and exchange, there is often on-site medical care and counseling and referrals to drug counseling.
“Scott County is the harbinger of things to come,” Millet says. “States that have no sound health policy, no funding [for SSPs] and growing IV drug use is a combustible mix.”
Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles. His podcast on employment issues, “Labor Pains,” can be found at www.laborpainspodcast.com.