Year: 2019
Type: article
Abstract: In his 2019 State of the Union address, President Donald Trump announced a new initiative with the ambitious goal of reducing HIV transmission in the United States by 90% within 10 years, in part by focusing on the burden of disease in rural America.The Department of Health and Human Services has outlined several steps for achieving this goal but hasn't focused on the role of injection-drug use in HIV transmission.Ever since the 2015 outbreak of HIV and hepatitis C virus (HCV) in Scott County, Indiana, it has been clear that the sharing of syringes among people who inject drugs is fueling the spread of these diseases in rural America.After intense resistance, then-Governor of Indiana Mike Pence declared a public health emergency in response to the outbreak and authorized a temporary syringe-exchange program.The program was successful, with 277 enrollees and more than 90,000 syringes distributed and returned between April and October 2015, 1 and the number of new HIV infections decreased.The Scott County outbreak was a wake-up call for advocates, epidemiologists, policymakers, and program administrators throughout the United States.Never before had the country seen such a swift outbreak of HIV in a rural community.Soon after the outbreak ended, Congress overturned a long-standing ban on using federal funding to support syringe-exchange programs.The Centers for Disease Control and Prevention (CDC) then released a report identifying the 220 rural counties in the United States that were most vulnerable to HIV and HCV outbreaks among people who inject drugs.The director of the CDC at the time, Tom Frieden, called the sharing of unsterile syringes a "horrifyingly efficient route for spreading HIV, hepatitis, and other infections" and called for states to implement more syringe-exchange programs.2 The aftermath of the Scott County outbreak presented an opportunity for a transformative change in the use of harm-reduction interventions in rural America, as syringe-exchange programs regained prominence as cost-effective tools for reducing the spread of HIV and Disclosure forms provided by the authors are available at NEJM.org.
Source: New England Journal of Medicine
DOI: 10.1056/nejmp1901276
Authors: Sanjay Kishore, Margaret Hayden, Josiah Rich
Institutions: Harvard University, Brown University, Miriam Hospital
Language: English
Topic: HIV, Drug Use, Sexual Risk
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2942598735