President Trump recently declared the opioid crisis a public health emergency. Advocates and physician groups say this is a first step in increasing awareness about the opioid crisis and looking at the causes of the epidemic directly, but significantly more needs to be done. The opioid crisis has impacted cities and communities across the nation, including people living with or at risk for HIV. The intersection between opioids and HIV is apparent because HIV can spread through shared needles. For example, Scott County in Indiana experienced an HIV outbreak tied to injection of opioid drugs, resulting in 181 new HIV infections from November 2014 through November 2015. Nationally, 6% of new HIV diagnoses are attributed to injection drug use alone. In addition, approximately 30% of deaths among people with AIDS are attributed to injection drug use.
The Infectious Diseases Initiative at the O’Neill Institute for National and Global Health Law has expanded to address the opioid crisis and its relationship to HIV and other infectious diseases such as hepatitis C. Earlier this year, Jeffrey Crowley, Program Director of the Infectious Disease Initiative, co-authored a journal article, “Preventing HIV and Hepatitis Infections Among People Who Inject Drugs: Leveraging an Indiana Outbreak Response to Break the Impasse.” More recently, on October 23, 2017, Jeffrey Crowley participated in a congressional briefing entitled “HIV/AIDS, Viral Hepatitis and Opioids: Using Data and Mapping Technology to Understand Overlapping Epidemics at the National, State and Local Level.” Next month, as part of an event organized by amfAR on December 4, 2017, Jeffrey Crowley will participate in a roundtable discussion on using data to inform the opioid epidemic response.
Another area that we are exploring at the O’Neill Institute is the link between opioid use and HIV criminalization. HIV criminalization describes the unjust application of criminal laws to people living with HIV based solely on their HIV status. Many HIV criminal laws specifically target people living with HIV who inject drugs. Twelve states and one U.S. territory have provisions specifically criminalizing syringe sharing or sale by a person living with HIV. These laws intensify HIV stigma, and as a result, people who inject drugs may be less likely to seek testing or treatment for HIV. Thirty-two states also criminalize the possession of drug paraphernalia, including syringes. Advocates say these laws prevent people from carrying new syringes, which may cause them to share injection equipment and increase the chance that HIV hepatitis C will be spread. These laws run counter to public health best practices and do not reflect the idea that HIV and substance abuse are public health issues.
On November 30, 2017, the O’Neill Institute will host a presentation on HIV Criminalization and the Opioid Crisis in recognition of World AIDS Day. The presentation will include a discussion of HIV criminalization in the United States and its connection to drug and syringe use, before then turning to the opioid crisis and public health efforts in response to the crisis.
