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Prevention Efforts Have Mixed Results for Injection-Drug Users

Although heroin use has increased, CDC reports cases of syringe sharing and use of syringe services programs have decreased overall.


 

Although syringe services programs (SSPs) are attracting those who would benefit from this service, many patients still aren’t always using sterile needles, according to a CDC Vital Signs report. Thus, they’re still at risk for HIV and hepatitis B and C infection.

Researchers conducted a study in 22 U.S. cities with a high number of HIV cases of people who inject drugs. In 2015, > 50% of people who inject drugs said they used an SSP in the previous year compared with about one-third in 2005. But the percentage of people who received at least 1 syringe from an SSP and shared syringes was about the same as those who had not received any syringes from SSPs (31% vs 38%).

The good news is that annual AIDS diagnoses among people who inject drugs have dropped by 90%. Nonetheless, about 9% of HIV infections diagnosed each year is due to injecting drugs. Injection drug use has also contributed to a 150% rise in acute cases of hepatitis C infections.

But prevention efforts are paying off in the African American and Latino communities, said Eugene McCray, MD, director of CDC’s Division of HIV/AIDS Prevention. The number of African Americans getting all syringes from SSPs was up by 48%, and the number sharing syringes was down 34% from 2005. The number of HIV diagnoses among African Americans who inject drugs declined by 60% from 2008 to 2014.

Syringe sharing also was down 12% among Latinos, and HIV diagnoses dropped by 50% from 2008 to 2014.

By contrast, whites who inject drugs continue to share at similar levels—45% in 2005, vs 43% in 2015. The number receiving all syringes from sterile sources remained unchanged at 22%, and HIV diagnoses remained stable from 2012 to 2014.

Recent trends indicate that heroin use and injection drug use among whites are rising; that, coupled with high rates of syringe sharing, might “challenge the decades of progress in HIV prevention,” the researchers say. They also point to obstacles such as a potential lack of sufficient sterile equipment, too few SSPs in rural areas, and absence of legal support in many states.

Decisions about SSPs are made at state and local levels, the report notes. In 2015, Congress gave states and local communities the opportunity to use federal funds to support “certain components of comprehensive SSPs,” which also offer or refer people to prevention, care, and treatment.

Related: Changing Treatment Landscape of Hepatitis C Virus Infection Among Penitentiary Inmates

“Until now, the nation has made substantial progress in preventing HIV among people who inject drugs, but this success is threatened,” said Jonathan Mermin, MD, MPH, 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.”

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