The nation’s progress in slowing the spread of HIV among people who inject drugs is in jeopardy as heroin use expands across the country and preventive services fall short, a top federal official said Tuesday.
“We risk stalling or reversing decades of progress in HIV prevention,” said Dr. Tom Frieden, director of the US Centers for Disease Control and Prevention, pointing to a growing need for programs that provide clean syringes to addicts, at a time when injecting drug use is increasing among whites. HIV and other infections such as hepatitis C are easily spread when addicts share needles.
Massachusetts has increased access to clean syringes in the past year. Seven communities have approved new needle exchanges, and two of them have already opened. Eight syringe programs — which allow addicts to exchange used needles for clean ones, and offer other health services — are now operating in the state. Additionally, two weeks ago the Massachusetts Supreme Judicial Court agreed to rule on efforts by the Town of Barnstable to shut down a needle exchange in Hyannis.
The CDC report noted that AIDS diagnoses among drug users have dropped by 90 percent since 1993. But Frieden highlighted disturbing trends in a new CDC studyof people who inject drugs in 22 American cities with high rates of HIV, including Boston.
More than one-half the drug users in the study reported using a syringe program in 2015, compared with about one-third in 2015. Even so, three-quarters did not always use a sterile syringe, and one-third reported sharing a needle within the past year, about the same percentage as a decade earlier.
The study found that HIV infections among blacks and Hispanics who inject drugs declined significantly from 2008 to 2014. But among whites, the drop-off was less steep and leveled out after 2012. In 2014, whites made up more than one-half of drug users diagnosed with HIV. Whites also tend to begin injecting at younger ages, are least likely to use sterile syringes, and are most likely to have shared syringes.
“As the epidemic expands and changes, we need to adapt the services we provide,” Frieden said. “There’s still a large unmet need for sterile injection equipment.”
Syringe programs “can help prevent thousands of cases of HIV and save literally hundreds of millions of dollars,” Frieden said. “They are also a critical link between people who use drugs and the health care system.”
More than 250 syringe exchange programs operate across the country, according to an estimate by Daniel Raymond, policy director of the Harm Reduction Coalition, an advocacy group for needle exchanges.
But the nation is “an uneven patchwork in access to syringes,” said Dr. Jonathan Mermin, director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Only 17 states and Washington, D.C., have laws explicitly allowing needle exchanges.
The experience in Massachusetts has also been uneven, with two communities fighting to close syringe exchanges and several others welcoming new programs. The state Department of Public Health has doubled its spending on needle exchanges, up to $2 million.
In Holyoke, a judge this year ordered a four-year-old state-funded needle exchange to shut down because it had not received City Council approval. The program was ultimately saved by a change in state law that took effect July 1, specifying that only Board of Health approval was needed, which the Holyoke board provided.
In Hyannis, a different legal argument took place.
In 2009, the AIDS Support Group of Cape Cod established a needle exchange without local approval or state funding. The group instead relied on a 2006 law that legalized syringe possession and allows anyone to purchase syringes without a prescription. When the local Board of Health took the program to court, a judge ruled in favor of AIDS Support Group. The town has appealed, and the Supreme Judicial Court agreed Nov. 16 to take the case.
If the high court rules in favor of the needle exchange, it will clarify that state law allows anyone to distribute syringes anywhere in the state, said Bennett Klein, lawyer for the AIDS Support Group of Cape Cod.
“The opioid epidemic is happening statewide,” Klein said, and the problem cannot solely be addressed by state-funded programs.
Meanwhile, officials in North Adams, Greenfield, Lawrence, Taunton, Fall River, Worcester, and Brockton have approved needle exchanges. The Worcester and Brockton programs have already opened, while the others are in progress.
Tapestry Health Systems, the agency that runs the Holyoke needle exchange, has been selected to operate the programs in North Adams and Greenfield. Liz Whynott, Tapestry’s director of HIV health and prevention, said both are expected to open in about a month.
Whynott said she faced little opposition in either community.
“It’s always taken multiple presentations and meetings for people to get an understanding of what syringe access and needle exchange is about,” she said. But with the new state law giving boards of health the final say, she said, it stopped being a political issue.
Heroin use has always been a problem in Western Massachusetts, Whynott said, but recently it’s gotten worse and the people have gotten younger.
Mayor Richard J. Alcombright of North Adams, a strong proponent of the needle exchange, said his city has a history of offering support to addicts and their families.
“For the most part, people understand that this a health-related issue,” he said.