Pubdate: Fri, 06 Jan 2017
Source: Morning Call (Allentown, PA)
Copyright: 2017 The Morning Call Inc.
Contact: http://drugsense.org/url/DReo9M8z
Website: http://www.mcall.com/
Details: http://www.mapinc.org/media/275
Author: Jim Karczewski (Post-Tribune)

NEEDLE EXCHANGES COULD STEM HIV OUTBREAK

[photo] Dr. Deepak Ariga holds a needle favored by drug users in Hammond
on April 9, 2015. (Jim Karczewski, Post-Tribune)

An HIV outbreak in Scott County, Ind., has infected 106 people. Can needle
exchanges stem the tide?

An HIV outbreak in Scott County, Ind., has infected 106 people thus far,
and despite reservations, Gov. Mike Pence green-lit a 30-day needle
exchange program to stem the tide.

But public health advocates say the exchange program should be extended to
really make an impact and expanded across the state as such programs have
been shown to be effective in stemming the tide of HIV and hepatitis C
infection among IV drug users.

The Indiana House took a step in that direction recently when it approved
a measure that would allow counties with high rates of hepatitis C to
create needle exchange programs. Hepatitis C can be an indicator of needle
sharing and HIV infection.

Needle exchanges work by allowing drug users to trade in used syringes for
sterile hypodermic needles and associated paraphernalia.

But Pence has not indicated support of the measure and admitted to
reticence in authorizing the program in Scott County, citing his long-held
beliefs about drug policy.

Rep. Charlie Brown, D-Gary, said the measure didn't specifically mention
HIV in order to soften the votes in lockstep against such a measure. Brown
said it's hard for lawmakers to support a measure that could be viewed as
supporting a drug habit.

More than 100 people in southeastern Indiana have tested positive for HIV
in an outbreak linked to the sharing of intravenous needles, and officials
said Friday they're trying to combat unfounded fears among drug users that
they could be arrested if they take part in a needle-exchange program
created...

More than 100 people in southeastern Indiana have tested positive for HIV
in an outbreak linked to the sharing of intravenous needles, and officials
said Friday they're trying to combat unfounded fears among drug users that
they could be arrested if they take part in a needle-exchange program
created... (Tribune wire reports)

"Without a doubt, the governor is adamantly opposed because he
automatically associates the program with getting more people to abuse
drugs, but it's been proven in many, many studies that this is a means of
preventing HIV," Brown said.

Brown supports expanding needle exchanges to Lake and Marion counties, as
well as other areas across the state with high numbers of HIV patients.
According to the Indiana Department of Health, as of April 1, Lake County
has 1,160 patients living with HIV/AIDS and 16 cases have been newly
reported since Jan. 1. Marion County has around 4,700 cases of HIV/AIDS,
according to the health department.

A legislative panel has approved a measure that would allow high-risk
counties to create needle exchange programs following an HIV outbreak in
southern Indiana.

Health officials say 81 people who either live in Scott County or have
ties to it have tested positive for HIV. Indiana prohibits needle...

A legislative panel has approved a measure that would allow high-risk
counties to create needle exchange programs following an HIV outbreak in
southern Indiana.

Health officials say 81 people who either live in Scott County or have
ties to it have tested positive for HIV. Indiana prohibits needle...
(Tribune wire reports)

"It's amazing to find out that Scott County has less than 6,000 folks,"
Brown said. "I'm certainly not putting down need for the services, but
look at Lake and Marion counties, where there are thousands of documented
cases and a strong possibility of a larger number of cases. They're
denying a proven method of minimizing outbreaks.

"I think it's paralysis of analysis with the governor saying he will not
support needle exchange programs. We have an epidemic in Scott County and
possible spillover. People need help."

Dr. Deepak Ariga, an assistant professor of medicine at Indiana University
Northwest, said the length of the current needle exchange in Scott County
and the proposed legislation don't go far enough in truly addressing the
problem.

"Thirty days is way too short," Ariga said. "But it is a good starting
point for the state as well the nation to have real discussion on the
benefits of needle exchanges."

One thing that is important to note, Ariga said, is that numerous studies
have shown that needle exchange programs do not result in higher rates of
drug abuse in communities.

"The Centers for Disease Control, the National Institute of Drug Abuse,
WHO, most agencies -- in study after study -- show that needle exchange
programs definitely do decrease the rate of HIV infections and also all of
the studies show that needle exchange programs do not promote risky
behavior or increase rates of IV drug use," he said.

Needle exchange programs are rare in the United States, with few states
allowing them due to the stigma of drugs and federal funding prohibitions.
Most states categorize syringes as drug paraphernalia, which means it's
illegal to buy or own without a prescription. Under Indiana law, needle
exchange programs are illegal. Since 1989, the federal government has
banned public funding of needle exchange programs.

All of the Scott County infections are linked to needle sharing, mostly
through people injecting a liquefied form of the prescriptions painkiller
Opana. Ariga said addicts started using Opana once oxycodone was
reformulated to turn into goo when water was added.

HIV is most efficiently transmitted via blood, Ariga said. While
transmission rates among gay and heterosexual couples has decreased quite
a bit in recent years, Hepatitis C infections among IV drug users have
gone up 75 percent since 2010, which is worrisome data for those trying to
prevent HIV outbreaks, he said.

While taxpayer money isn't allowed to go toward needle exchange programs,
those who are infected with HIV disproportionately require public
assistance, Ariga said.

"Some of these people may not even have access to health care to begin
with," Ariga said. "Per IV drug user per year, needle exchanges cost a
couple hundred or at most $1,000 annually, but the cost to treat someone
with HIV is more than a half million dollars over a lifetime. A lot of HIV
patients are on public aid, so the money to pay for their care is coming
from taxpayers.

"So the economic argument outweighs any kind of so-called moral one."

Planned Parenthood of Indiana and Kentucky spokesperson Tammy Lieber said
that, anecdotally, several health centers have reported an uptick in
people getting tested and requesting information on HIV, but there's no
specific data at this point.

The outbreak also has raised questions about whether the state's public
health infrastructure is adequate. Scott County's Planned Parenthood
clinic -- which didn't offer abortions but did HIV testing -- was forced
to close in early 2013 due to federal funding cuts.

"The fact that Scott County -- the center of the HIV epidemic -- was
without a testing facility until a few weeks ago is a glaring example of
the kind of public health crisis that results when prevention and testing
are left unfunded," Planned Parenthood said in a statement.

"We applaud the state's public health officials in acting to address this
epidemic, but we also encourage our legislators to adequately fund public
health efforts to protect all Hoosiers from future health crises from HIV
and other devastating outcomes."

Between April 20-25, several locations will offer free HIV, gonorrhea and
chlamydia testing as part of Get Yourself Tested month. For more
information, visit ppink.org.

Though the outbreak is currently confined to Scott County, a mobile
society makes it easy for a disease like HIV to spread.

"No one is an island," Ariga said. "Just because it's in one county
doesn't mean it will stay there. With addicts, we see that they have
different social networks, and may go to another county or state for
drugs. If they have a car they can drive to another drug house."
- ---
MAP posted-by: