Surge of HIV in Indiana Shows Value of Syringe Exchange

Amid growing evidence that HIV and hepatitis C are on the rise among people who inject drugs (PWID) in some parts of the United States, amfAR, The Foundation for AIDS Research, today released a new brief that underscores the importance of syringe service programs (SSPs) as a highly effective tool in the fight against the spread of each of these preventable infections. Despite an overwhelming body of scientific evidence demonstrating their effectiveness, however, the U.S. Government continues to prohibit the use of federal funds for SSPs.

"The new cases of HIV and hepatitis C among injecting drug users in Indiana and Kentucky could have been prevented if syringe service programs were in place," said amfAR Chief Executive Officer Kevin Robert Frost. "For too long, government officials have refused to acknowledge the proven public health benefits of syringe service programs in spite of the scientific evidence."

At least eight percent of the estimated 50,000 new HIV infections in the U.S. each year occur among injecting drug users. And according the Centers for Disease Control and Prevention (CDC), about one quarter of all people with HIV are also infected with hepatitis C.

Syringe service programs help curb the spread of blood-borne diseases such as HIV and hepatitis C by providing access to sterile syringes. By facilitating the safe disposal of contaminated syringes, SSPs also reduce the risk of needle-stick injuries among law enforcement officers and the public. They also provide preventive health services such as HIV testing and form vital bridges to drug treatment and overdose prevention.

More than 200 SSPs are currently operating in 34 states in the U.S. and are supported primarily through publicly allocated funds from state and local governments. But a Congressional ban in effect since 1988 prohibits the use of federal funds to support SSPs, thus preventing state and local jurisdictions from spending their federal public health allocations on these programs.

The CDC has recently issued warnings over the spikes in HIV or hepatitis C diagnoses among people who inject drugs in rural Indiana and Kentucky. This has prompted state and local officials in both states to implement SSPs to help reduce any further transmission. Prior to the disease outbreaks in either state, Kentucky had no SSPs statewide, and Indiana had only one.

According to amfAR's brief, "Preventing HIV and Hepatitis C Among People Who Inject Drugs: Public Funding for Syringe Services Programs Makes the Difference," a recent study by researchers at Beth Israel Medical Center in New York City found that states with laws that allowed SSPs, provided public funding for them, and permitted over-the-counter sales of syringes had either declining HIV cases among drug users from 1985 through 2012 (if diagnoses were high) or never witnessed a rise in HIV infections among PWID in the first place (if diagnoses were low).

Furthermore, SSPs have been shown not only to save lives, but also to save millions of dollars in HIV treatment costs. Estimates show that expanding the availability of syringe service programs to cover just 10 percent of injections would avert nearly 500 new HIV infections annually. An expansion of that size would cost approximately $64 million while saving an estimated $193 million in treatment costs averted.

A stark reminder of the effectiveness of comprehensive drug treatment is a comparison of the number of HIV infections between New York City and Scott County, Indiana (the location of the latest HIV outbreak among PWID). The number of new HIV diagnoses in Scott County, Indiana in the first three months of 2015 alone (population 24,000) is nearly double the number of new HIV diagnoses among the estimated 100,000 people who inject drugs in New York City of the last calendar year of available data from the NYC Department of Health.

A likely factor in the discrepancy is the expansion of SSPs in New York City in the early 1990s contributed to a dramatic reduction in new HIV infections among PWIDs, declining from 54 percent of the City's HIV cases in 1990 to 13 percent in 2001.

"We are witnessing a changing landscape of injection drug use in America as it shifts from largely urban areas to more rural localities. Unless we adopt sound public health policies that have proven to work in urban areas, we may see spikes in HIV and hepatitis C diagnoses in less populated areas of the country," said Greg Millett, amfAR Vice President and Director of Public Policy. "Following the best available science and eliminating restrictions on how states can use federal funds is imperative to advance public health practice."