The good news is use of syringe services programs (SSPs) has increased substantially during the past decade. But the bad news is most people who inject drugs (PWID) still don't always use sterile needles and, if they share needles and syringes, risk contracting or transmitting HIV, as well as hepatitis B and C viruses.
That's according to a recent CDC Vital Signs(www.cdc.gov) report and an accompanying article in the agency's Dec. 2 Morbidity and Mortality Weekly Report (MMWR).(www.cdc.gov)
According to a CDC press release,(www.cdc.gov) the analysis found that 54 percent of PWID reported in 2015 that they had used an SSP in the past year, compared to only about 36 percent in 2005. But even though SSP use has increased, the report said too few PWID use only sterile needles, with 33 percent reporting in 2015 that they had shared a needle in the past year compared to about the same percentage (36 percent) in 2005.
"The prescription opioid and heroin epidemics are devastating families and communities throughout the nation, and the potential for new HIV outbreaks is of growing concern," said CDC Director Tom Frieden, M.D., M.P.H., in the release. "Our goal is for people to live long enough to stop substance use and not contract HIV or other serious infections while injecting -- SSPs can help people accomplish both."
- The CDC recently published a Vital Signs report along with an accompanying article in the Dec. 2 Morbidity and Mortality Weekly Report (MMWR) that found use of syringe services programs has increased substantially during the past decade, but injection drug users still aren't always using sterile needles.
- For this report, the CDC used National HIV Surveillance System data collected from all 50 states and the District of Columbia through June of this year to analyze trends in HIV diagnosis among people who inject drugs from 2008 to 2014.
- The MMWR report highlighted some successes in HIV prevention among blacks and Hispanics who inject drugs but found concerning trends in white injection drug users.
For this report, the CDC used National HIV Surveillance System data collected from all 50 states and the District of Columbia through June of this year to analyze trends in HIV diagnosis among PWID from 2008 to 2014.
In addition, National HIV Behavioral Surveillance interviews with PWID in 22 cities between 2005 and 2015 were analyzed to describe risk behaviors and use of prevention services among all PWID, with further analysis conducted among PWID who first injected drugs during the five years before their interview (new PWID).
During 2008-2014, overall HIV diagnoses among PWID in the United States decreased by 48 percent.
"Until now, the nation has made substantial progress in preventing HIV among people who inject drugs, but this success is threatened," said Jonathan Mermin, M.D., M.P.H, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, in the release. "Syringe services programs work, and their expansion is pivotal for progress in the coming decades."
Decisions about implementing SSPs are made at state and local levels, and access to comprehensive SSPs varies across the United States. Comprehensive SSPs provide sterile needles and syringes and offer or refer people who inject drugs to prevention, care and treatment services, including HIV and hepatitis C testing and treatment. They also offer additional HIV prevention options such as condoms, behavioral interventions and pre-exposure prophylaxis.
Substance abuse disorder treatments that SSPs offer or refer patients to include medication-assisted treatment to help stop drug use and prevent HIV and hepatitis infection. SSPs may also treat substance overdose.
The CDC has historically recommended that states ensure that people who inject drugs have access to effective prevention services, including sterile injection equipment, medication-assisted treatment for substance use disorder and HIV and hepatitis testing.
In December 2015, Congress gave states and even local communities the opportunity to use federal funds to support certain components of comprehensive SSPs(www.aids.gov) under specific circumstances.
Progress in HIV Prevention
The MMWR report highlighted some successes in HIV prevention among blacks/African Americans (blacks) and Hispanics/Latinos (Hispanics) who inject drugs in 22 cities and nationally. However, it found concerning trends among whites who inject drugs.
- The percentage of blacks who inject drugs who reported getting all their syringes from a sterile source increased by 48 percent between 2005 and 2015 for the cities studied, and the percentage who reported syringe-sharing declined by 34 percent.
- Nationally, the number of HIV diagnoses among blacks who inject drugs declined by about 60 percent from 2008 to 2014.
- The percentage of Hispanics who inject drugs who reported syringe-sharing declined by 12 percent from 2005 to 2015.
- Nationally, the number of HIV diagnoses among Hispanics who inject drugs declined by almost 50 percent between 2008 and 2014.
- High levels of sharing continued among whites who inject drugs during the period examined, with 45 percent reporting sharing in 2005 and 43 percent still reporting sharing in 2015.
- The percentage of whites who inject drugs who reported receiving all syringes from sterile sources remained unchanged at 22 percent.
- Nationally, HIV diagnoses among whites who inject drugs declined overall by about 27 percent between 2008 and 2014, although they reached a plateau in 2012.
"It is encouraging to see prevention efforts paying off in African-American and Latino communities," said Eugene McCray, M.D., director of the CDC's Division of HIV/AIDS Prevention, in the release. "We must now take concrete steps that build upon and accelerate that progress.
"HIV risk remains too high for all people who inject drugs."
Related AAFP News Coverage
ACIP Recommends MenACWY-D for HIV-infected Patients, Cholera Vaccine