Transcript for CDC Telebriefing: New Vital Signs Report - HIV & Injection Drug Use

OPERATOR: Thank you for your patience, your conference will begin momentarily. 

OPERATOR: Welcome back and thank you for standing by.  All participants will be able to listen only until the question and answer portion of today's conference.  To ask a question, please press star one.  If you have any objections, please disconnect at this time.  I would like to turn the conference over to Ms. Michelle bonds.  Miss, you may begin.

MICHELLE BONDS: Thank you, Julie. And thank you all for joining us today for the release of the latest CDC Vital Signs. This edition is on the topic of HIV and injection drug use.  We're joined by Dr. Tom Frieden and Dr. Johnathan Mermin, Director for The National Center for HIV, AIDS, Viral Hepatitis, STD and TB prevention.  I'll turn the call over now to Dr. Frieden. 

TOM FRIEDEN: Thank you very much for joining us.  As you know, every month we focus on a critical health issue that faces our nation and what can be done about it.  We choose these topics well in advance, a year in advance.  The topic of today's report was chosen very early this year to be released in advance of world aids day on December 1st.  The topic is HIV prevention among people who inject drugs.  As CDC has highlighted for many years, this country is dealing with an epidemic of opioid mis-doses.  It has led to an increase in HIV, hepatitis b and hepatitis c, and as the injection drug epidemic expands and changes, we need to adapt the services that are provided as well.  Today, we release new findings from CDC's surveillance system which has been monitoring HIV risk behavior among people who inject drugs in 22 cities since 2005.  This is the first release of data for 2015.  We've long known that sharing needles and syringes is a horrifyingly efficient route for spreading HIV, hepatitis and other infections.  About 10% of all HIV diagnoses in the U.S. occur among people who inject drugs.  That's more than 3,000 new HIV infections per year, and there also clusters of hepatitis c infections.  These infections can be prevented when people who inject drugs use sterile needles, syringes and other injection equipment.  The bottom line for today's briefing, the bottom line for what we found in this month's vital signs, is that opiates are threatening progress reversing HIV.  Opiates are threatening the progress that we have made fighting HIV in this country.  We risk stalling or reversing decades of progress in HIV prevention.  And the science shows that syringe services programs work.  They save lives and they save money.  Since its peak in 1993, annual AIDS diagnoses among people who inject drugs have dressed by about 90%, a really dramatic improvement.  There are many reasons for that decline.  One of those is the wider use of syringe services programs known as SSPs.  SSPs are low cost, they're high impact, and they can be a critical component in efforts for HIV prevention.  SSPs can help prevent thousands of cases of HIV and save literally hundreds of millions of dollars.  A very small proportion of federal HIV funding, currently less than 1%, is spent on SSPs.  SSPs recognize that we have to deal with the world and the problems of the world as they are and not as we wish they were.  We wish drug use were far less common than it is.  But in fact, it is common and sadly it has been increasing.  That's why already 15 states have asked CDC to begin the process of allowing them to support SSPs through federal funding.  SSPs are pragmatic, effective ways to help address a terrible problem in our society.  Our goal is for people who inject drugs to live long enough to stop substance abuse and not get HIV or other infections while they're injecting.  SSPs can help people accomplish both.  SSPs don't simply provide sterile needles and syringes.  They're also a critical link between people who use drugs and the health care system, tying them into treatment for addiction, to testing and treatment for an infectious diseases, to primary care and other services. 

While there has been a lot of progress preventing HIV infection among people who inject drugs, today's Vital Signs report shows that most don't always use sterile needles, making them vulnerable to HIV and other serious infections.  There are some major findings of this report.  of 22 urban areas, fewer African-Americans appear to be injecting drugs.  However there appears to have also been an increase in white Americans injecting drugs.  We also found that more than half of people who inject drugs reported that they had used syringe services programs at least once in the prior year and that's a big increase from just over a third reporting use of these programs a decade ago.  However, only 25% of people received all of their syringes from sterile sources.  That's similar to the 22% reported in 2005 and one-third, 33%, reported that they had shared a syringe within the past year, also similar to the rate ten years ago.  There is still a large unmet need for sterile injection equipment.  This finding reinforces the concern that outbreaks could occur in people who inject drugs in areas where sources of sterile equipment are limited.  While today's report on HIV risk behavior focuses on urban areas, the risk appears to be even higher in some rural areas where access to sterile equipment is even more limited.  Now, I'll turn it over to dr.  Johnathan Mermin, Director of the CDC center dealing with these issues, for more detail on today's report. 

DR. JONATHAN MERMIN: Well, thank you, Tom.  As Dr. Frieden highlighted, comprehensive SSPs provide access to sterile needles and syringes and offer or link people to other services like HIV and Hepatitis testing and treatment, condoms, treatment for substance use, including medication assisted treatment, and pre-exposure prophylaxis, a pill that people who do not have HIV take daily to prevent getting it.  They also provide vaccinations for hepatitis a and b and overdose treatment.  The syringe service programs deliver a dual infectious disease solution.  They help prevent HIV and Hepatitis transmission.  I would like to look at more of the key findings from today's report.  When we break down HIV diagnosis and behavioral data by race and ethnicity, we see some notable differences.  Nationally, from 2008 to 2014, HIV diagnoses among African-Americans who inject drugs declined by approximately 60%.  HIV diagnoses among Latinos who inject drugs declined by almost 50%.  And HIV diagnoses among white Americans who inject drugs declined by 27%.  But have remained stable from 2012 to 2014.  So these different diagnosis trends could be due in part to changing risk behaviors by race and ethnicity.  For example, in our study of urban areas from 2005 – 2015, We've seen the greatest  improvement in terms of reducing risk behavior and in reducing HIV diagnoses among African-Americans who inject drugs.  We're also seeing evidence success among Latinos who inject drugs.  In 2015, 28% of African-Americans who inject drugs reported getting all their syringes from a sterile source compared to 19% in 2005.  Syringe sharing has also decreased among this population.  In 2015, 21% reported that they had shared a syringe in the past year compared to 31% in 2005.  Among Latinos who inject drugs, there was no change during the decade in those who reported they got all of their syringes from a sterile source.  In 2005, 27% reported they got all their syringes from sterile sources compared to 29% in 2015.  There has been progress however in syringe sharing.  In 2015, 33% of Latinos drug users reported sharing compared in 38% in 2005. So although these are signs of progess, the vast majority of African-Americans and Latinos who inject drugs continue to get syringes from unsterile sources and continue to share needles. We are the not seeing that same progress among white Americans who inject drugs.  In our study in urban areas from 2005 to 2015, the percentage of white Americans who reported sharing syringes remained high over the decade.  45% reported sharing in 2005, 43% reported sharing in 2015.  Also the percentage of white Americans who inject drugs are reporting that they got all of their syringes from a sterile source remained about the same, 24% in 2005 and 22% in 2015.  So as we recognize encouraging declines in HIV diagnoses and risk behavior overall among people who inject drugs, we can accelerate progress by ensuring all people who inject drugs in all parts of the country have the tools and support they need to protect themselves and improve their health.  There are concrete steps that we can take right now to accelerate progress in HIV prevention among people who inject drugs.  As we heard from Dr. Frieden, one of those steps is expanding access to comprehensive syringe service programs.  At the end of last year, congress began allowing state and local health departments under specific circumstances to use federal funding to support certain components of syringe programs.  However, even with federal funding available, some state and local communities still have barriers to establishing an SSP.  The result is an uneven patchwork of access to clean syringes across the country.  To make further progress, CDC encourages states and local communities to evaluate whether these barriers can be removed, and identify where additional steps can be taken to expand access to critical services particularly as many communities struggle with higher levels of opioid injection.  I'll close by summarizing what CDC with its state and local health partners, is doing to accelerate declines in HIV among people who inject drugs.  We're helping to determine where syringe service programs will be needed and most effective.  To do this, CDC conducted a national county by county assessment that identifies areas of the country that are potentially vulnerable to HIV and hepatitis outbreaks among people who inject drugs.  More than half of the potentially vulnerable counties were located in Appalachian core region of Kentucky, Tennessee and Western Virginia. But CDC encourages all states to review their most recent HIV and Hepatitis surveillance data for increases that might be related to nonsterile injection drug use.  So far CDC has worked with 15 states and select counties in one of those states to use some of their HIV prevention funds to support syringe service programs.  Additionally requests are under review.  We've also issued guidance for the use of Pre-exposure Prophylaxis (PreP) among people who inject drugs now that research has shown this is a safe and effective HIV prevention option for this community.  So these targeted efforts augment the substantial support CDC provides to health departments and community based organizations to expand access to HIV testing, treatment, and prevention strategies among people who inject drugs and other at risk populations.  And lastly, I just wanted to say, life while injecting drugs is hard.  Avoiding HIV and hepatitis shouldn't be. 

MICHELLE BONDS: Thank you, Dr. Mermin.  Julie, we are ready to take questions. 

OPERATOR: Thank you.  If you would like to ask a question, please press star one and you will be prompted to record your first and last name.  Please unmute your phone when you state your name.  One moment please for our first question. 

OPERATOR: Francie Diep with Pacific Standard, your line is open. 

FRANCIE DIEP: Thank you.  I have two questions.  My first was, what is the CDC's relationship like with jurisdictions that ban or restrict needle exchange, do you contact them what do you do?  My second question was, why do you think these patterns are occurring among injection drug users?  You talked about there being a lot of white injection drug users in rural areas data, yet the actual data in the paper comes from cities.  That's not necessarily an explanation.  Thanks again. 

TOM FRIEDEN: Thank you.  I'll start.  This is Dr. Frieden.  First off, the role of CDC is to support jurisdictions with information, data, analysis, evidence of what works.  What we provide is information on what the problems are and what programs can address those problems effectively.  We work with every jurisdiction in the country.  In fact most of CDC's resources, more than 60%, go out to state, local, tribal, territorial entities.  We also provide safe embedded in state and local health departments to support them in their work.  Our goal is to provide information so people can make the right decisions at the right time and help as many people as possible and prevent as many infections as possible.  In terms of the pattern, there are several things going on.  One is the extension of the opiate use epidemic in rural areas among predominantly younger and more likely to be white individuals.  What we see is a difference in needle sharing behavior, younger compared to older people who injected drugs.  The older individuals who inject drugs have been around long enough to see the terrible things that happen when you share needles.  They've had friends die from HIV and hepatitis and other problems.  So we see a higher rate of needle sharing in younger individuals and white drug users are more likely to be younger than other drug users.  Dr. Mermin, anything you would like to add? 

DR. JONATHAN MERMIN: I think you covered it, thank you. 

MICHELLE BONDS: Next question, please. 

OPERATOR: Yes, our next question comes from Mike Stobbe with the Associated Press.  Your line is open. 

MIKE STOBBE: Hi. Thank you for taking my call.  I had two questions.  One is, first, I just wanted to confirm, you all talked about the decline in HIV diagnoses among injection drug users since 1993.  That decline, that long term decline was seen in blacks, Hispanics, and white, all of them, right?  Not just overall.  And the second question had to do with, I was wondering what your expectation is of funding and other kinds of support for syringe service programs as we move into the new administration.  I know the Scott county example, where Mike Pence was involved, I was wondering what kind of conversations you've had with vice president-elect Pence about syringe programs or anyone from the Trump team about support moving forward. 

TOM FRIEDEN: In answer to your first question, yes, this reflects progress among all races and ethnicities.  What we've seen in more recent years is a stalling of that progress among white individuals who inject drugs.  In terms of the incoming administration, CDC stands ready to work with the administration to support progress protecting Americans from health threats.  in terms of specifics of the Indiana response, our team there including Dr. Mermin met with Governor Pence at the time and provided information on the essence of what works and the state of Indiana and the local communities decided to implement a syringe services program there in Scott county.  And that program was extremely important in curtailing the outbreak of HIV there. 

DR. JONATHAN MERMIN:  And mike, just to give you some data, some of our greatest success in HIV prevention has been among people who inject drugs.  But recent data and the events signaled the progress could be jeopardized.  In 1993, there were 28,707, almost 29,000 aids diagnoses among people who inject drugs.  That dropped 90% up to 2014, where there were only about 2,800 cases.  So it has been an area where we've had success.  It's just now vulnerable. 

MICHELLE BONDS: Next question, please. 

OPERATOR: Our next question comes from Jennifer Abessy with JAMA Medical News.  Your line is open. 

JENNIFER ABESSY: Thank you. What can physicians do to promote the use of syringe services programs to people who inject drugs?  And is there a national online resource where physicians can locate SSPs in their area so they can refer patients to them? 

TOM FRIEDEN:  I'll handle the first of this questions and ask Dr.  Mermin to handle the second.  There is a lot that practicing physicians and other clinicians can do.  First and foremost, to recognize a substance abuse.  Multiple studies have shown that the most under recognized condition of all in the health care system is substance abuse.  Even among patients who have obviously apparent signs and complications of substance abuse, the fact is that this is often unrecognized and unaddressed by clinicians.  So the first is to open a conversation with patient about what drugs they're using and how they're using them.  The second is to accept what patients are doing but not accept their behavior, to work with patients to be as safe as possible for as long as they continue to use drugs and for them to get off drugs as quickly as possible through both harm reduction and treatment services.  Dr. Mermin? 

DR. JONATHAN MERMIN: I'll just say there is a list of kind of known syringe service programs that's compiled by a nonprofit organization.  But they are changing as new ones are being introduced.  We can get you at another time a link to that site. It is an important question because science tells us syringe service programs work, they save lives and money and the scientific reviews have found that they do not result in the negative consequences that some people had anticipated, such as increases in injection frequency, increased drug use or unsafe disposal of syringes  and they do prevent HIV and hepatitis. 

MICHELLE BONDS: Next question, please. 

REPORTER: Thank you, Dr. Frieden and Dr. Mermin, for hosting this.  I just missed some of the last answer because I was dealing in my question.  I'm reporting specifically on Georgia, where we have an epidemic of HIV and an epidemic of fentanyl abuse.  I'm wondering how you take those concerns into account with regard to the people who might say SSPs can perpetuate drug use.  I'm wondering if there is any correlation between drug use statistics and the success rates of SSPs. 

TOM FRIEDEN: Dr. Mermin? 

DR. JONATHAN MERMIN:  I'm not sure I completely understand the question.  But there is strong data that SSPs reduce the incidence of HIV and hepatitis infection, that they reduce the frequency of having needles in the community, and that they are not associated with increased injection drug use.  Two U.S. surgeon generals have stated that, as well as many scientific studies.  And SSPs can help prevent thousands of new HIV cases each year with about 3,400 diagnoses among people who inject drugs annually and a lifetime treatment cost of $400,000 for each, it can be very beneficial.  There was an article recently that cited that for every dollar spent, that we can save about $8 in costs.  So SSPs do work.  It is true that the ability to implement them effectively varies by state and local jurisdiction.  And it's important that when they're established, that you work with the community that is concerned, as well as with local law enforcement.  and that they continue to be supported over time because they provide not only ways of avoiding infectious diseases but also links for people who are currently injecting drugs to drug treatment and our ultimate goal is to help people stop using drugs. 

TOM FRIEDEN: I'll just add to that that we do understand that when people first hear about syringe exchange programs, they think, why would we do that, why would we help people do something that's harmful and illegal?  But what we've found over and over is when we meet with communities, when we actually monitor the programs that are established, they help people get onto treatment, they prevent the spread of infection, and they serve as a link to get people into services that save lives and save money.  In fact I remember working with one community which initially objected to the idea of a syringe exchange program, but in a series of community meetings, individuals came forward and told their stories, including one woman who had not known that her husband had been injecting drugs.  She became pregnant. When she was pregnant, she was tested for HIV, found to be infected, diagnosed with HIV, and she pointed out that a syringe exchange program might have not only prevented her husband's infection but hers as well. 

MICHELLE BONDS: thank you. That was our last question.  I would like to ask Dr. Frieden to make any concluding remarks. 

TOM FRIEDEN: Thank you. I would just conclude by emphasizing that comprehensive syringe services programs can help people stop substance abuse and improve many lives.  Opiates threaten to undo the progress we've made preventing HIV over the past three decades.  It's encouraging that more people who inject drugs are accessing syringe services programs.  And that's been one of the things that's helped dramatically reduce the rate of HIV infection among these individuals.  But most people who inject drugs still aren't using sterile equipment every time.  That's why we need to continue to make syringe services programs available where they're needed most as part of a comprehensive prevention strategy for people who inject drugs.  The science shows that syringe services programs work.  They save lives and money.  And study after study has demonstrated that they don't increase illegal drug use or crime.  Jurisdictions should closely monitor the epidemic in their area in order to apply resources to what works.  When we fight HIV through syringe exchange programs, we also help stop Hepatitis C, reduce overdose deaths, and contribute to rebuilding communities and helping individuals escape from the addiction that can control their lives.  Thank you very much. 

MICHELLE BONDS:  Thank you for joining us today.  For follow-up questions, call the press office at 404-639-3286 or send an e-mail to media@CDC.gov.  Thanks for joining us.  This concludes our call.  

OPERATOR: Thank you for your participation. You may disconnect at this time.

###
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES