Syringe Services Program Use is Increasing, But Increased Access Needed to Improve HIV Prevention Efforts

For a while now it has been known that injection drug users are at an increased risk for transmission of infections, particularly HIV and hepatitis B and C viruses. Through sharing syringes and needles, opiate use has substantially threatened progress made in preventive efforts. However, the Centers for Disease Control and Prevention (CDC) has been pushing syringe service programs, or SSPs, with the hopes that these programs will work to decrease the amount of virus transmission amongst injection drug users.

Although AIDS diagnoses amongst injection drug users has significantly decreased by 90% since 1993, the CDC has identified that there is a great need for sterile injecting equipment among individuals who take drugs. According to the CDC, one in 10 HIV diagnoses are among those who inject drugs and recently, “injection drug use has also contributed to a 150% increase in acute cases of hepatitis C infections.”

In a telebriefing this afternoon, CDC Director Tom Frieden, MD, MPH and Jonathan Mermin, MD, MPH, director of National Center for HIV/AIDs, Viral Hepatitis, STD, and TB Prevention, discussed a new CDC Vital Signs report that had been published today. This report took a closer look into the uptake and effectiveness of SSPs amongst injection drug users of all different ethnicities, from 22 cities where about half of US-HIV cases are diagnosed. The CDC’s analyses came from CDC’s National HIV Behavioral Surveillance system data, a system that has been following behavior risk since 2005 in individuals who inject drugs.

The analyses found that the number of individuals who inject drugs and are partaking in SSPs has substantially increased since 2005. In fact, in 2015, 54% of injection drug users reported having used an SSP in the past year, whereas, in 2005 only 36% claimed to have used one of these programs. Although this increased use of SSPs is definitely an improvement in preventive action against HIV and other harmful infections that can be transmitted through contaminated needles, the CDC also found that the number of injection drug users using only sterile needles leaves much to be desired. In 2015, 33% admitted to sharing a needle with someone else in the past year, making it only a 3% decrease in needle-sharing from 2005.

In addition, the CDC’s Vital Signs report showed that when it comes to HIV prevention in African American and Latino injection drug users, the numbers seem to be improving. The CDC reported a 48% increase in 2015, of African American injection drug users who received all of their syringe equipment from a sterile source and a 34% decrease in syringe sharing, from 2005. From 2008 to 2011, the overall number of HIV diagnoses declined among African Americans by a whopping 60% in the US. From 2005 to 2015, the number of Latino injection drug users who partook in sharing syringes declined by 12%. From 2008 to 2014, the number of overall HIV diagnoses had declined by 50%.

Unfortunately, the preventive efforts for white injection drug users had not proved as successful. Syringe sharing among white injection drug users remained about the same from 2005 (45%) to 2015 (43%). The percentage of white injection drug users who reported receiving all of their syringes from sterile sources also remained static, at a meager 22% over the decade-long study. The CDC notes that although a decline in the number of overall HIV diagnoses in white injection drug users was reported to have declined from 2008 to 2014 by around 27%, the number has remained “stable” from 2012 to 2014.

In a press release, Dr. Friedman commented, “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. 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.”

According to Dr. Friedman, SSPs work; they have low cost with a high impact, which can prevent a number of HIV cases, and ultimately save a number of lives. These programs not only work to provide those who inject drugs with sterile injecting equipment, but also, access to prevention, care, and treatment services. In the telebriefing, Dr. Friedman described SSPs as a “link between those who use drugs and the healthcare system.” This link only serves to benefit these individuals; they are provided with tools for infection prevention (such as condoms and pre-exposure prophylaxis, or PrEP) and can also be referred for substance use disorder treatment. Both of these provisions work in a synchronized effort to put a stop to drug use as well as HIV or hepatitis transmission and infection.

According to Dr. Mermin, “Until now, the nation has made substantial progress in preventing HIV among people who inject drugs, but this success is threatened. Syringe services programs work, and their expansion is pivotal for progress in the coming decades.”

Access to SSPs varies across the United States and the CDC notes that implementation of these programs is decided at the state and local level. In the telebriefing, Dr. Mermin mentioned that the CDC has approved 15 states and select counties to utilize funding provided by the Department of Health and Human Services (HHS) towards expanding access to SSPs. The CDC recommends that states “ensure people who inject drugs have effective prevention services, including sterile injection equipment, medication-assisted treatment for substance use disorder, and HIV and hepatitis testing.” When speaking of next steps, Eugene McCray, MD, director of CDC’s Division of HIV/AIDS Prevention commented in the press release, “It is encouraging to see prevention efforts paying off in African-American and Latino communities. We must now take concrete steps that build upon and accelerate that progress. HIV risk remains too high for all people who inject drugs.”

​Feature Picture Source: Centers for Disease Control and Prevention