A study by associate professor in the Indiana University Richard M. Fairbanks School of Public Health – Indianapolis (IUPUI), Dr. Joan Duwve, and fellow researchers, investigating the 2015 HIV outbreak in Scott County, Indiana, found that a syringe services program is an important tool to control and prevent HIV outbreaks among people who inject drugs in a nonurban area.
Researchers said the program, which provides clients with sterile syringes along with prevention, education and social services, resulted in a rapid reduction in injection-related risk behaviors, including an 88 percent reduction in syringe sharing, a 79 percent reduction in syringe sharing to divide drugs and an 81 percent reduction in sharing of other injection equipment. There were 181 HIV infections diagnosed between Nov. 18, 2014, and Nov. 1, 2015, in Scott County, making it the largest HIV outbreak in a nonurban area in the U.S. among people who inject drugs.
The syringe services program was initially implemented on an emergency basis to combat the outbreak. It was the first time such a program had been tried in a nonurban area in the United States. A paper with the researchers’ findings, “Reduction of Injection-Related Risk Behaviors After Emergency Implementation of a Syringe-Services Program During an HIV Outbreak,“ was recently published in the journal Acquired Immune Deficiency Syndrome. At the outset of the study, researchers knew what had happened, but not why.
Two kinds of data were gathered, quantitative and qualitative, a move they believe enhanced their ability to understand what had happened in Scott County. Qualitative data was gathered from focus groups and one-on-one interviews with people who were injecting drugs in Scott County. Quantitative data came from answers by clients of the syringe services program to a set of questions asked of each person who took advantage of the program.
Researchers discovered the HIV outbreak was linked to injection of Opana ER, an opioid pain medication. The research elicited specific characteristics of the drug which, when dissolved, resulted in multiple injection episodes per day and multiple injections per injection episode, and prompted officials from Indiana and the Centers for Disease Control, working with the U.S. Food and Drug Administration, to request that the drug’s manufacturer voluntarily remove the drug from the U.S. market.
“If we just had the quantitative data, we wouldn’t have been able to dive into the unique injection practices around Opana ER, which we believe led to this outbreak of HIV,” said Dr. Duwve. Because a single 40-milligram pill costs about $160, drug users formed networks to pool their resources to buy Opana ER, she said. Multiple people would share syringes, or reuse old syringes to draw up the dissolved pill. Without access to sterile syringes, people in the networks frequently shared syringes as they injected multiple times a day, often until the syringe broke off in someone’s arm.
“It’s no wonder that as soon as someone who had HIV entered into that network, HIV spread rapidly,” said Dr. Carrie Foote, an associate professor in the School of Liberal Arts at IUPUI and the co-principal investigator of the study’s qualitative data.
Exploring harm-reduction measures like syringe exchange programs is part of Indiana University’s Responding to the Addictions Crisis Grand Challenge to create a comprehensive plan to reduce deaths from addiction, ease the burden of addiction on Hoosier communities, and improve health and economic outcomes.
[Photo: Syringe services program in Scott County, Indiana, was the first such program to be tried in a nonurban area in the United States.]