U.S. Hepatitis C Rates Continue to Rise as Implementation of Syringe Service Programs Lags Far Behind Community Needs
September 16, 2019 | Last week, the CDC released the latest viral hepatitis surveillance data that shows reported new cases of hepatitis C virus (HCV) continue to increase, rising 7% from 2016 to 2017, contributing to an upward trend that has seen reported new cases of HCV increase by 375% from 2010 – 2017. This rise comes despite having curative drugs on the market for over 6 years, and increased awareness of the populations at greatest risk. The majority of acute – or newly acquired – cases of HCV are attributed to the rise in people injecting drugs such as opioids and methamphetamine, and sharing needles, syringes, and other equipment to do so.
This upward trend persists due to limited resource allocation and slow implementation of evidence-based programs and strategies aimed at improving the health of persons who inject drugs (PWID) as an essential tool to prevent new infections and reduce transmission rates.
Syringe Services Programs (SSPs) are an evidence-based harm reduction approach to reduce rates of infectious diseases such as HCV and HIV in PWID. SSPs provide a safe, consistent, and non-judgmental space where PWID can not only get sterile injection equipment, but also receive the medical and social services they need to improve their health and well-being, including treatment for their substance use disorder.
Regions that have expanded SSPs in response to their high prevalence of injection drug use have seen improvements such as reduced rates of infections, increased use of sterile equipment, and fewer overdose deaths. However, expansion of these programs is not keeping pace with the need. This is largely due to discrimination against people who use drugs and unsupported negative perceptions about SSPs that fuel a lack of public and political support. Namely, political pressure has caused restrictions and closures of SSPs in West Virginia, a state with the nation’s highest rates of HCV infections and drug overdose deaths. The 2018 closing of the only SSP located in the state’s capital city of Charleston severely limited access to sterile equipment in a community with tremendous need and few alternatives. Requirements such as proving residency in the county where the SSP is located in order to receive services pose a barrier to many PWID without stable addresses or who are trying to access services from neighboring counties without SSPs. As a result, West Virginia is seeing a decrease in sterile injection equipment distribution and usage, and nearly all of the 28 new HIV cases in Cabell County, WV could have been avoided with the use of sterile needles and syringes.
The O’Neill Institute’s latest policy brief highlights the need for expanding SSPs throughout the country, and offers examples of innovative approaches and strategies from existing programs that can provide guidance to other jurisdictions facing similar challenges.
The path to HCV elimination must prioritize meeting the health care and social needs of PWID so they can treat their substance use disorder and protect their health. More jurisdictions should implement comprehensive interventions such as SSPs that address the health needs of those at greatest risk for acquiring and transmitting the virus. Widespread access to these programs is essential to realizing the elimination goal.