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ENDING AIDS IN NEW YORK: STOPPING HIV INFECTIONS AMONG INJECTION-DRUG USERS

Posted by Tim Murphy , October 25, 2013

ENDING AIDS IN NEW YORK: STOPPING HIV INFECTIONS AMONG INJECTION-DRUG USERS

Raymond (pictured): “We’re doing a good job getting infections among IDUs under control, but we still see racial disparities in the numbers.”

[Editors note: Please email Tim Murphy, the current editor of the Housing Works update, with feedback or leads on stories.]

Recently, we reported that Housing Works has been a part of a community campaign calling for a plan to end AIDS as an epidemic in New York State. A working paper, written primarily by Housing Works and Treatment Action Group, is circulating among HIV and healthcare policymakers in New York State. It breaks into components a plan to end AIDS as an epidemic in New York State. Each week in the Update, we have been looking at each of those components more closely.

This week, we focus on bringing to zero new HIV infections among injection-drug users (IDUs). We checked with with Daniel Raymond, policy director at the Harm Reduction Coalition, for an update. Here’s what he had to say (excerpted from a phone interview):

Because New York State has always had high levels of HIV and AIDS compared to nationally, we’ve always gotten a lot of federal prevention and Ryan White dollars. But as our HIV numbers and our share of the national HIV epidemic decreases, so has our federal funding. We’re not 100 percent there yet ending AIDS in NYS, but going forward we’ll need to look at an environment with less federal money but maybe more opportunities to figure out how to tap into Medicaid dollars.

Both in New York and around the country, we’re doing a good job getting new infections among injection-drug users (IDUs) under control. The numbers are going down, especially in states like New York where there is a good harm-reduction infrastructure (e.g. syringe-exchange sites).

But we’re still seeing racial disparities in the numbers: HIV rates of 32.7 percent among African-Americans who inject versus rates of 10.6 percent among whites, according to this 2012 NYC health department report. (It also said that, in 2011, 4 percent of new HIV cases overall were attributable to injection-drug use.)

Why the disparities? We’re in the stop-and-frisk city, so HIV prevention strategies for IDUs have a harder time reaching African-American IDUs than white ones. Af-Am IDUs are more vulnerable to police harrassment, arrest and incarceration. We’ve seen this with condoms, too. Among sex workers, police have seized condoms as evidence of illegal prostitution, so sex workers don’t carry condoms, which puts them at risk.

The same rule applies to syringes. It’s legal to carry them, but if you’re vulnerable to being stopped, searched and arrested, it’s risky to carry a supply of clean needles to keep you safe from HIV and hep C.

So what needs to be done? Steady treatment for HIV is a form of prevention because undetectable viral load makes HIV+ people dramatically less, almost completely, uninfectious. We need to work on this for IDUs. NYC health department data shows that only 15 percent of HIV+ IDUs have suppressed viral load versus 30 percent of HIV+ gay and bisexual men.

And lest you think that’s because active drug users are less able or willing to be adherent to HIV meds, research shows that adherence to HIV meds among IDUs has actually increased over the past 13 years. Drug use in and of itself is not necessarily a barrier to adherence. Homelessness and incarceration play large roles.

Think about it. Your life can get turned upside down if you’re arrested or lose your housing. Suddenly, staying on HIV treatment goes out the window as a priority.

Recently, we’ve seen major challenges to the NYPD’s stop-and-frisk policy. With a likely new mayor coming in who has opposed stop-and-frisk, we have a broader opening to rethink how we police drug use and drug users. The housing factor is critical. We need to to develop housing programs that support sustained health care for IDUs. It appears we will be seeing this via programs thanks to Cuomo’s Medicaid Redesign Team.

New York is moving forward to allow Medicaid reimbursement for harm reduction programs. Broader Medicaid transformations open up new possibilities for bridging gaps between community-based harm reduction services and the health care system. That can create new opportunities to increase access health care for people who inject drugs.

There’s reform needed at the federal level, too. If someone in your Section 8 housing is arrested and convicted on a drug crime, you may lose that housing.

And meanwhile, even while we’ve seen HIV infections going down among IDUs, heroin overdoses (ODs) are going up on Staten Island. So there’s a new population potentially at risk for HIV and hep C.

But speaking of hep C, there’s good news: We have a chance going forward to wipe it out, due to new and forthcoming hep C treatments. In the past, treatment required interferon, which is hard to take. Going forward, hep C may be cured over just three months, no interferon required. We’re looking at 90-100 percent cure rates, even among HIV-coinfected individuals, who’ve always been harder to cure hep C among. We can eradicate hep C in the years ahead, and that’s good news, but it requires continued distribution of not just clean needles but entire “kits” of clean injection paraphernalia, because the hep C virus lives in paraphernalia much more easily than HIV does.

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