More People Using Syringe Services Programs, But Access Needs Improvement for Better HIV Prevention
Prevention has improved among the African-American and Latino populations
Significantly more people have used syringe services programs (SSP) over the past ten years, but the majority of people who inject drugs still do not use sterile needles every time, according to the Centers for Disease Control and Prevention (CDC).
The practice of sharing needles and syringes can directly transmit HIV and the hepatitis B and C viruses.
The CDC has found that more than half of those who inject drugs—54 percent—reported in 2015 that they had used an SSP at some point in the past year. This figure is higher than the one reported in 2005: 36 percent. The agency made this discovery from a study of people who inject drugs across 22 U.S. cities with a high occurrence of HIV.
However, although use of SSPs has risen, the findings also show too few people using only sterile needles when they inject. One in three, or 33 percent, said in 2015 that they had shared a needle at some point during the past year—close to the same percentage that reported sharing 10 years ago (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. "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."
Individuals who inject drugs account for roughly nine percent of the HIV infections diagnosed in the U.S. every year. Injection drug use has also played a part in an increase of 150 percent in acute cases of hepatitis C infections in recent years.
Since peaking back in 1993, yearly diagnoses of AIDS among those who inject drugs have fallen by around 90 percent. In spite of this decline, the CDC's new report indicates that there is still an unmet need for sterile injecting equipment and that many people are at risk of transmitting HIV, hepatitis C, and other infections. This risk may be even greater in rural locations where there may be a more limited access to sterile injection equipment as well as in urban and suburban places where SSPs are either restricted or not allowed at all.
"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 CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "Syringe services programs work, and their expansion is pivotal for progress in the coming decades."
It is at state and local levels where decisions are made regarding implementing SSPs, and comprehensive SSP access varies nationwide. Historically, the CDC has recommended that states make sure that those who inject have access to effective prevention services, such as sterile injection equipment, medication-assisted treatment for substance abuse disorder, and testing for HIV and hepatitis. In December 2015, Congress provided states and local communities with the opportunity to use federal funds to support certain parts of comprehensive SSPs under certain circumstances.
Comprehensive SSPs include sterile needles as well as syringes, and they also offer or refer users to services for prevention, care, and treatment. Such services include testing and treatment for HIV and hepatitis C in addition to other options for preventing HIV such as condoms, behavioral interventions, and pre-exposure prophylaxis, a daily pill that can prevent HIV. These SSPs also offer or refer users to treatments for substance abuse disorder—including medication-assisted treatment—in order to help stop drug use and prevent infections from HIV and hepatitis. They can also provide treatment for overdoses.
Although there have been notable successes made in preventing HIV among African American and Latino users, concerning trends have arisen among Caucasian users.
- The number of African American users who reported obtaining all syringes from a sterile source rose by 48 percent, while the number who reported sharing syringes fell by 34 percent from 2005 to 2015 among the cities included in the study.
- Nationwide, the number of HIV diagnoses among African American users fell by roughly 60 percent from 2008 to 2014.
- The number of Latino users who reported sharing syringes fell by 12 percent from 2005 to 2015.
- At the national level, the number of HIV diagnoses among Latino users decreased by almost 50 percent from 2008 to 2014.
- There continued to be high levels of sharing among Caucasian users: 45 percent reported sharing in 2005 and 43 percent in 2015.
- The number of Caucasian users who reported getting all syringes from sterile sources stayed at 22 percent throughout the decade among the cities studied.
- Nationwide, HIV diagnoses among Caucasian users fell by roughly 27 percent from 2008 to 2014 but stayed stable from 2012 to 2014.
"It is encouraging to see prevention efforts paying off in African-American and Latino communities," said Eugene McCray, M.D., director of CDC's Division of HIV/AIDS Prevention. "We must now take concrete steps that build upon and accelerate that progress. HIV risk remains too high for all people who inject drugs."