Indiana’s Opioid-Related HIV Cases
A recent spike in new HIV diagnoses in southeastern Indiana has been linked to opioid use—specifically, the injection of the painkiller Opana (oxymorphone). Public health officials are now reporting the number of HIV cases at 162 (159 confirmed and three preliminary positive).
“In rural communities across the U.S.—and Indiana is no different—opioid abuse is common,” says Dr. Beth Meyerson, PhD, co-director of the Rural Center for AIDS/STD Prevention and Assistant Professor at Indiana University School of Public Health.
People in Scott County have described Opana’s high as preferable to heroin, she says, and yet they have to inject more frequently. “On average, a heroin user might inject twice a day. Some people inject Opana up to ten times a day,” says Meyerson.
The frequency of injecting, combined with the tissue damage caused by the larger-gauge needle needed to inject Opana, creates conditions ripe for skin abscesses and transmission of infectious diseases like HIV and hepatitis C when needles are shared. And it helps explain, says Meyerson, why HIV spread so easily among people who inject drugs in these communities.
Up until March of this year, Indiana state law prevented needle exchange programs from providing people with easily accessible sterile syringes and other drug injection equipment. On a national level, the U.S. government prohibits use of federal funds for needle exchanges or syringe access programs.
“People may think that providing access to syringes and safer injection supplies might encourage drug use, but in fact, research actually shows the opposite to be true. Drug users who use syringe access and exchange programs are actually more likely to access drug detox and treatment and other health and social services. Syringe access programs support the idea that some ways of using drugs are less harmful than others and seek to address those harms rather than simply condemning the drug use or drug user themselves. Providing sterile injection supplies promotes the health of the individual, their network of peers, and ultimately, the larger community,” explains Katie Bouché, Syringe Access Services manager for San Francisco AIDS Foundation.
As evidence surfaced that injection drug equipment sharing was responsible for the uptick in new infections, Indiana Governor Mike Pence—who opposes needle exchanges for anti-drug reasons—declared a state of public health emergency in March and signed a bill allowing counties to operate needle exchange programs temporarily. State legislators are now working to legalize needle exchange programs for at least a year.
Some public health advocates have used the outbreak to reinforce the importance of syringe access programs—and to admonish government anti-drug policies that prevent needle exchanges from operating.
“The new cases of HIV and hepatitis C among injection drug users in Indiana and Kentucky could have been prevented if syringe service programs were in place. For too long, government officials have refused to acknowledge the proven public health benefits of syringe service programs in spite of the scientific evidence,” said Kevin Robert Frost, amFAR CEO in a press release.
Meyerson is hopeful that a change in legislation will help curb HIV transmissions in the state, but also realizes that there will be challenges.
Stigma attached to the use of injection drugs, which Meyerson says this is even more pronounced in rural areas, can prevent people from accessing needle exchange services in public places. Also, setting up and running effective needle exchange programs takes time and expertise—organizational capacity that small communities may not readily have.
“The next piece is the heavy lifting it will take for the public health investment to change. Right now, we invest a whopping 13 dollars and eight cents per person for public health. This is the annual per-capita contribution per person for public health funding in Indiana, and that’s a big concern when it comes to addressing public health needs. We really need to make better investments in prevention and public health systems.”
Read the latest news about the HIV outbreak in Indiana on the Indiana State Department of Health website.