Use of Syringe Programs Up, but Needle Sharing Continues

Megan Brooks

November 29, 2016

The last decade has seen a substantial increase in the number of injection drug users obtaining sterile needles through syringe services programs (SSPs), but greater access to these programs is desperately needed, federal health officials said today.

In 2015, more than half (54%) of people who inject drugs (PWID) reported using an SSP in the past year, compared with only about one third (36%) in 2005. Yet, one in three (33%) reported that they had shared a needle within the past year — about the same percentage that reported sharing needles in 2005 (36%), according to a Vital Signs report published November 29 in the Morbidity and Mortality Weekly Report. The findings come from federal data of PWID in 22 US cities with a high number of HIV cases.

Sharing needles and syringes is a "horrifyingly efficient" route of transmission for HIV and hepatitis B and C viruses, Tom Frieden, MD, MPH, director, Centers for Disease Control and Prevention (CDC), said during a media briefing.

"The bottom line is that opioids are threatening the progress we have made fighting HIV in this country. And the science shows that syringe services programs work. They save lives and they save money," he said. Yet, there is a "large unmet need" for sterile injection equipment in this country.

Program Expansion Pivotal for Progress

About 1 in 10 HIV infections diagnosed annually in the United States occur among PWID. In recent years, injection drug use has also contributed to a 150% increase in acute cases of hepatitis C, the CDC says.

"Until now, the nation has made substantial progress in preventing HIV among people who inject drugs, but this success is threatened," Jonathan Mermin, MD, MPH, director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said in a new release. Expansion of SSPs is "pivotal for progress in the coming decades."

The new report highlights progress in HIV prevention among African American and Latino PWID but also "worrying trends" in whites who inject drugs.

Among African American PWID, the percentage who report getting all syringes from a sterile source increased by 48% and the percentage who report syringe sharing declined by 34% from 2005 to 2015 among the 22 cities studied. Nationally, the number of HIV diagnoses among African American PWID declined by about 60% from 2008 to 2014.

Among Latino PWID, the percentage who report syringe sharing declined by 12% from 2005 to 2015. Nationally, the number of HIV diagnoses among Latino injection drug users declined by almost 50% from 2008 to 2014.

But among white PWID, high levels of needle sharing continue, with 45% reporting sharing in 2005 and 43% in 2015. The percentage of whites who inject drugs and reported receiving all syringes from sterile sources remained unchanged at 22% over the decade in the cities studied. Nationally, HIV diagnoses among white PWID declined by about 27% from 2008 to 2014 but have remained stable from 2012 to 2014.

"It is encouraging to see prevention efforts paying off in African-American and Latino communities," Eugene McCray, MD, director of CDC's Division of HIV/AIDS Prevention, said 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."

Access Issues

Dr Frieden noted that decisions about starting an SSP are made at state and local levels, and access to these programs varies around the country. In December 2015, Congress gave states and local communities, under some circumstances, the opportunity to use federal funds to support certain components of comprehensive SSPs. To date, "15 states have asked CDC to begin the process of allowing them to support SSPs through federal funding," Dr Frieden said.

Comprehensive SSPs provide not only sterile needles and syringes but also offer or refer PWID to prevention, care, and treatment services. Those include HIV and hepatitis C testing and treatment, as well as other HIV prevention options, such as condoms, behavioral interventions, and pre-exposure prophylaxis. For PWID, they are a "critical link" to the healthcare system, Dr Frieden said.

"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," he said.

What can health providers do? "First and foremost," Dr Frieden said, "is to recognize substance abuse." Multiple studies have shown that substance abuse is "the most under-recognized condition" in the healthcare system. "Open a conversation with patients about what drugs they are using and how they are using them," he advised.

He also encouraged providers to "accept what patients are doing, but not their behavior. To work with them to be as safe as possible for as long as they continue to use drugs and for them to get off drugs as quickly as possible through both harm reduction and treatment services."

MMWR Morb Mortal Wkly Rep. Published online November 29, 2016. Full text

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