HEROIN AND HIV
CDC predicted epidemic within epidemic
Steven Linville remembers vividly when a doctor told him he was HIV-positive. ❚ “It was like a shovel came at me at a thousand miles per hour,” he says. “I just instantly thought I was a monster.” ❚ On June 1, Linville, 26, out of jail after getting caught with syringes, says he was finally ready to act on the diagnosis he’d heard a few months earlier after he’d overdosed. He got HIV from a contaminated needle, he says. ❚ If it was a surprise to Linville, it was not to national and local infectious diseases experts who saw this new public health crisis from a distance several years ago.
New HIV cases flooding the area were foreseen as a consequence of the heroin epidemic.
The Centers for Disease Control and Prevention even got specific two years ago, saying parts of Ohio and Kentucky, 65 counties among 220 identified nationwide, should be prepared for this potential epidemic within an epidemic.
It had already happened in 2015 in Scott County, Indiana, in a tiny town called Austin. An HIV outbreak, attributed to unclean needles used to shoot the opioid Opana, occurred before a needle exchange was introduced.
Cincinnati area health leaders and coalitions fighting the heroin epidemic spent the past few years going to doz-
ens of public meetings to try to convince elected officials to allow needle exchanges in their communities. They warned the public of the dangers of having HIV emerge among drug users – and the threat to the general public.
They defended their pro-exchange position with evidence from communities such as Baltimore, which went from an HIV rate among injection drug users of 62 percent in 1994 to 12 percent in 2011 after establishing a syringe-exchange program in 1994.
The response was slow, and many officials reacted to constituents’ fears of having exchanges in their neighborhoods and of needle giveaways enabling drug use, never mind what the experts said.
Judith Feinberg, an infectious diseases expert, started the Cincinnati Exchange Project in 2014, but it had funding struggles. The Northern Kentucky Health Department succeeded in 2016 in establishing a program in a little city in Grant County but failed in its three biggest counties, Boone, Campbell and Kenton.
“Being infected with HIV has robbed me of who I used to be.”
Ron Ward 49, of Middletown, Ohio, has been living with HIV/ Aids for nearly eight years.
‘Swift action is key’
The ramping up of needle exchanges in the region started this year.
That was after the big HIV hit in 2017: The Northern Kentucky Health Department identified four times more HIV cases than it had in 2016 among people with the risk factor of injecting drugs. The numbers continue to grow. In 2017, the Hamilton County Ohio Public Health Department (Cincinnati) reported three times more HIV cases among people who injected drugs than in 2016.
There were also increases in HIV among people who did not use drugs, but the jump among people who’d injected drugs led to a public health call for an immediate movement to reverse the trend:
“Swift action is key to stopping the rise in HIV,” says Stephanie Vogel, the Northern Kentucky Health Department’s director of population health.
Massachusetts’ northeast region saw a 62.5 percent jump in newly reported HIV cases from 2016 to 2017 among peo- ple who inject drugs. The state’s Health Department reported 18 there this year, suggesting “the outbreak is ongoing and keeping pace with 2017.”
Though Massachusetts has had needle exchanges for years, the northeast part of that state got its first program only in 2017 and a second this year.
“It was an area with no access to needle exchange,” says Carl Sciortino, executive director of the AIDS Action Committee of Massachusetts. He says the closest syringe exchange was in Boston.
For injection drug users, that’s a big ask. The addicted brain compulsively seeks the drug that stops painful withdrawal – not reacting to health and safety threats, experts say.
Here, as in Massachusetts, health officials called on the CDC for help with this crisis. They’re trying to find out whether the cases are linked and when people contracted HIV to identify the strains to see whether they’re the same.
From her office at West Virginia University, Feinberg fumes.
“It’s been known for years that injecting drugs was a risk for HIV,” she says. “This is exactly why I tried to put in syringe services.”
What’s the threat?
If HIV is left untreated, people can develop AIDS, which causes a range of opportunistic infections and death. Once someone is diagnosed, it’s imper- ative they take medication as directed to stay healthy.
It’s also urgent for those infected to avoid spreading the virus to others.
HIV can be transmitted through blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids and breast milk. The virus also can be spread through shared injection equipment that has traces of blood on it.
Treatment isn’t as hard to get or go through as it was in the 1980s or ’90s, but for this particular group – injection drug users – it’s not necessarily a cinch.
“Continued substance use and mental health issues, which tend to go handin-hand, are the main reasons that people with HIV do not get their virus under control,” Feinberg says.
“So they have progressive disease, suffer more, cost the health system more money for hospitalizations that could have been avoided,” she says, “and continue to be infectious to others.”
Life expectancy for people successfully treated for HIV is almost normal, but living with the disease is not normal, says Ron Ward of Middletown, Ohio. He went through six years of addiction after he and his wife and kids were left homeless when the Great Miami River flood in 2004 destroyed their five-bedroom home.
“I failed my family. I failed my kids,” he says.
Ward used drugs to escape his pain. Eventually, he injected meth, and in 2010, someone shot him up with heroin.
Finally, Ward said no more. He went in for detox. That’s when he learned he was HIV-positive.
As soon as he got out, he hit the internet – and came away terrified.
“I did not just have HIV,” Ward says. “I had AIDS.”
He secured counseling and got treatment. But the road is long. Depressed, he had to be medically stabilized after a failed suicide attempt. He has rebounded and relapsed.
The CDC estimates the lifetime cost of HIV treatment at $449,000.
“No one has to die from HIV,” says Jaasiel Chapman, clinical research community educator at the UC College of Medicine. “The medications allow individuals to live a normal lifespan. That is, of course, if they adhere to their regimen.”
Ward insists he is not the same man he was before drugs – or HIV.
“I get colds, I get sinus infections frequently,” he says. “I don’t have the energy I used to have. I’m constantly worried. I’m constantly concerned about my (viral) load. I’ll have to take a pill every day of my life.
“Being infected with HIV has robbed me of who I used to be,” Ward says.
The CDC continues to help health departments investigate their cases. Public health officials add needle-exchange operations. Public health workers announce times and locations of needleexchange operations and try to educate the public about HIV.
The Northern Kentucky Health Department spent $22,000 to inform the public of testing efforts through bus ads, text messages, brochures and posters in businesses and public locations.
One of public health’s most prominent messages reaches people through social media: Get tested for HIV.