Syringe Exchange Program Stops HIV Epidemic in Its Tracks

Pam Harrison

October 19, 2015


In the face of an unprecedented HIV outbreak in Indiana, an emergency syringe exchange program markedly and rapidly reduced injection risk behaviors, and seems to have halted the outbreak, according to a new study.

"Prior to the syringe exchange program, we would hear from the community that they did not have access to clean syringes, so they would use the same syringes over and over again," said Monita Patel, PhD, from the Centers for Disease Control and Prevention (CDC), at IDWeek 2015 in San Diego.

The HIV outbreak in Indiana started in November 2014, and by August 2015, there were 181 new cases. Of these newly diagnosed individuals, 94% reported using injection drugs, and almost all of them injected extended-release oxymorphone (Opana ER, Endo Pharmaceuticals).

In response to the outbreak, an emergency executive order was issued on March 26, 2015, and a syringe exchange program — previously illegal in Indiana — was established in Scott County, where 90% of the newly infected people lived.

"The syringe exchange program is not a stand-alone program," Dr Patel told Medscape Medical News.

It's not just giving patients sterile syringes and removing their dirty ones, it's a much broader approach than that.

The local emergency department provides sterile syringes and takes in used syringes for safe disposal. At the same time, clients are educated about safe injection practices and are offered other interventions, such as HIV testing.

People are also referred to other services in the community, such as substance abuse treatment programs and other mental health services.

"The more people with HIV you can treat and suppress viral load, the more future infections you are going to prevent," said Dr Patel.

And HIV-negative people are offered pre-exposure prophylaxis.

"It's not just giving patients sterile syringes and removing their dirty ones, it's a much broader approach than that," Dr Patel emphasized.

People who made at least two visits to the syringe exchange program at least 7 days apart during the first 2 months of the program were included in the analysis.

There were significant improvements between the first visit an injection drug user made to the program and the most recent visit.

Interestingly, the number of times clients reported injecting each day increased between the first and most recent visits (5 vs 9; P < .001).

However, since mid-August, there have been no reported new cases of HIV infection.

Dr Patel has disclosed no relevant financial relationships.

IDWeek 2015: Abstract 638a. Presented October 8, 2015.


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