TIME Health Care

Needle-Exchange Programs Could Prevent HIV Outbreaks, Experts Say

Congress should make it easier for programs to exist, experts argue in the wake of Indiana's recent outbreak

Offering programs that allow injection drug users to receive clean needles in a bid to avoid reuse and sharing could be one way to combat HIV outbreaks like the one in rural Indiana, two researchers argue in a paper released Wednesday.

In a new commentary published in the New England Journal of Medicine, Dr. Chris Beyrer, a Johns Hopkins Bloomberg School of Public Health professor, and Steffanie Strathdee, director of the Institute of Global Health at the University of California, San Diego, argue that Congress should immediately lift a ban on federal funding for needle-exchange programs.

As of June 10, 169 people living in Scott County, Indiana, had been diagnosed with HIV and more than 80% of them also had hepatitis C. The spread was traced to residents dissolving prescription painkillers and then injecting themselves. As TIME reported in June, some of the residents injected themselves up to 20 times a day, often sharing needles with others to do so. The U.S. Centers for Disease Control and Prevention even reported instances of three generations of family members passing needles around.

“There are going to be more of these outbreaks and what’s urgently needed is a public health response before things get even worse,” Beyrer said in a statement. “Now is the time to implement needle and syringe exchange programs, wherever they are needed. We can’t put politics above public health. We have a cheap tool to prevent this.”

The authors note that buying syringes over the counter is illegal without a prescription in 25 states and that in places where needle-exchange programs are legal, organizers cannot use federal funds. Indiana Governor Mike Pence has opposed needle exchanges, but allowed for them as an exception in the affected region. Still, the authors write that many programs are only open until 6 p.m. and ask for a lot of personal information that may deter people from seeking them out.

As America’s drug-addiction problem has pushed deeper into rural white communities, the report’s authors argue, America’s approach needs to become more nimble. In addition to exchanges, other strategies like asking people about drug use during HIV screenings and considering the use of opioid replacement therapies could help the U.S. combat the growing health problem.

Read next: Why America Can’t Kick Its Painkiller Problem

TIME health

Miley Cyrus: We Will Make an AIDS-Free World a Reality

Miley Cyrus was honored for her work in the fight against AIDS and gave this speech at amfAR's Sixth Annual Inspiration Gala Tuesday

This article was originally published on MIMI, a Time Inc. site.

Thank you so much, Tyler. I am honored to have such a beautiful date tonight that speaks just as beautifully.

As Tyler mentioned, we met when I was filming “Backyard Sessions” for the launch of Happy Hippie. And I got the privilege to shoot this incredible subject for Happy Hippies newest project #InstaPride that just launched yesterday as Tyler said (just gotta get the plug in there) and to now be standing here beside you tonight, this is so cosmic.

Getting the Inspiration Award tonight is an honor that is unbelievable. Seriously, I didn’t believe them when they told me because—to be honest—it seems just too easy. Seems like there is no way I have done nearly enough to be standing here on the receiving end of this honor. But I am thinking of tonight as not celebrating what we have already done, but what we are doing and going to do in the future! Tonight is not a finish line, but a starting point. I want to work every day to do something good for someone else or I will feel not only as if this honor has just been wasted, but my life and all the influence that comes with it. There are so many people around the world that deserve this recognition and have dedicated their lives to finding a cure for those living with HIV/AIDS and using their voices to speak out about the brutal and unfair condemnation and abominable stigma that comes with the disease. By receiving this award tonight, I promise to continue to fight along with such an industrious army for a cure to this epidemic.

There have been too many families, partners, friends, and animals that have lost someone they cherish from this illness. Someone they want to say “I love you” to right now. So let’s do that for them—on the count of three, let’s say “We love you” to the men, women, and children throughout the world who have died or are currently fighting for their lives because of HIV/AIDS. One, two, three—

It is so beautiful to hear you all say “I love you” to people who unfortunately—in many situations—don’t hear it nearly enough. 1.6 million young people are homeless each year and 40% of homeless youth identify as LGBT. This community is disproportionately affected by this disease. Discrimination can lead to homelessness and once these young people are on the street, many young people find that exchanging sex for food, clothing, and shelter are their only chance of survival, putting them at a much greater risk of contracting HIV/AIDS.

Inspiration is something that makes us feel or do something, especially something creative. amfAR and their amazing team of researchers have used their inventiveness and knowledge to help extend, improve, and save the lives of countless people around the world living with AIDS or vulnerable to the infection. amfAR has funded more than 3,300 grants to research teams worldwide, and in addition to research, amfAR leadership also advances public policy and has helped pass federal legislation to provide people living with HIV the access to care they need and protect their dignity and rights.

My hero is not only a classic entertainer and icon, but is the founding international chairman of amfAR, Dame Elizabeth Taylor. She said, “With celebrity comes responsibility.” She was an illustration of someone who was committed to using their power and fame to bring awareness to something so much greater than her own power and fame.

When I found out I was receiving this award, I thought about just dedicating this award to the admirable life of Ms. Taylor, but it was never about her—she always directed the spotlight to those in need, she was a pioneer and spoke out against hypocrisy and discrimination, compassion, and care in a revolutionary time. For many Americans, it was Elizabeth Taylor who brought the issue of AIDS into the general mainstream. She, with Founding Chairman Dr. Krim and a small group of physicians and scientists, united to form the American Foundation for AIDS Research—amfAR.

Another woman who even though she was unable to be here with us tonight, amfAR and anyone who has said the “stone experience” knows that longtime supporter and Campaign Chair Sharon Stone is definitely here in spirit and maybe under the table pickpocketing you. (I am still not convinced it was the white wine last year that racked up such a bill.) Sharon’s audaciousness makes her one of amfAR most effective spokespeople at the 2014 Cinema Against AIDS event. She helped raise a record $35 million in a single evening. (So don’t be cheap tonight, people—Sharon is watching from nanny cams and has tonight’s roster of attendees with your name, number, and home address—and possibly banking information.)

Chairman of the Board, Mr. Kenneth Cole—I would like to say thank you for all that you do and for this honor tonight. Happy Hippie and I look forward to all that we can do together in and for the future.

And everyone on team Happy Hippie—the future is a blank canvas and I am lucky to be surrounded by artists as devoted and benevolent as you.

Before I finish, I just want to say a few final thank-you’s—

John Dempsey and everyone at MAC Cosmetics and MAC AIDS Fund, thank you so much for introducing me to the amazing people of amfAR and for using your immense brand for making such an impact on the future of HIV/AIDS and those affected. As a little girl, it wasn’t a dream of mine to be the face of a lipstick, but it was a dream of mine to change the world! A quote from John Lennon I love and use way too often is, “A dream you dream alone is only a dream, but a dream you dream together is a reality.” Thank you.

My mom and dad—who are out of the house tonight, which is rare—looks so handsome and beautiful. I want to tell you how much I love you, and how I hope I make you proud. And this makes up for all the torture I’ve put you through. I’m sure being my parents hasn’t been easy, but you are two of the most selfless people and have always taught me and my siblings how important it is to be there for those who need us, how important it is to care. They say you don’t chose your family, but I would pick mine every time. I’d like to think even if you weren’t my mom and dad, we would still be sitting in this room together right now on a quest for a cure. One of my favorite quotes is from another heroine of mine, Audrey Hepburn, who said, “As you grow older, you will discover you have two hands. One for help yourself and one for helping others.” Thank you for instilling the proper priorities in me.

I hope one day I am here on earth to experience an AIDS-free world. And I am honored to have even been a twinkle in the diamond sky of this dream that will be a reality because of the people in this room.

This is a horrible and ghastly disease, and outside of this room there are millions of people—young, old, of all races and genders—who are waiting for a cure to this illness that has brought us all together tonight, and for that I feel thankful. I feel so grateful to be in a room full of so many people who care about other people because unfortunately, that is too rare in the world we live in. Maybe that’s why it’s so easy to be standing up here receiving this award tonight. Again, this is a privilege and honor, and amfAR, I will not let this—my life, your dedication and hard work, and all of these valuable souls—go to waste. We will continue to fight against judgement and we will find a cure for HIV/AIDS.

Thank you everyone for tonight.

Read next: Miley Cyrus: ‘You Can Just Be Whatever You Want to Be’

TIME Drugs

New HIV Cases Down Dramatically in Previously Stricken Indiana County

HIV Outbreak Indiana
Darron Cummings—AP New needles, which clients can get as part of the needle exchange program at the Austin Community Outreach Center, are displayed in Austin, Ind. on April 21, 2015

Good news after a 3,400% rise in infections over recent months

After a dramatic spike earlier this year, the number of new HIV cases in rural Scott County, Indiana, has fallen considerably, public health officials announced Wednesday.

The rate of new cases has decreased to between zero and two a week, down from a maximum of 23 per week in April, deputy state health commissioner Dr. Jennifer Walthall told Reuters.

Since December the county has diagnosed 170 HIV cases, a near-epidemic that has been attributed to a corresponding explosion in intravenous drug use. Up from a previous county maximum of five diagnoses per year, that represents a more than 3,400% increase.

The rapid spread of HIV forced Governor Mike Pence, who had previously opposed needle exchanges, to reconsider and sign off on one in Scott County in March. News of the decline in infections came on the heels of that program’s implementation, and nearby Madison County also applied for a needle exchange Wednesday to help fight a sudden rise in Hepatitis C infections. The disease is often seen as a warning sign for a later HIV spike.

Despite the good news, state health commissioner Dr. Jerome Adams told reporters that the fight in Scott County was not yet over. He said his office planned an initiative to help identify so-called “high-risk negatives” — individuals who are not infected but are at risk because of their lifestyles — and stressed that there was much work still to be done. “This is something that is going to require continuing vigilance,” he said.

[Reuters]

TIME Music

Poet-Rapper-Artist Mykki Blanco: I’m Living With HIV

Lovebox Festival - Day 3
Burak Cingi—Redferns/Getty Images Mykki Blanco performs on stage on day 3 of Lovebox Festival in London on July 21, 2013

He's been positive since 2011

Mykki Blanco, the poet-rapper-performance-artist hyphenate, who alternately identifies as transgender and multigendered, revealed Saturday that he is living with HIV.

“I’ve been HIV Positive since 2011, my entire career,” he wrote on his Facebook account. “F— stigma and hiding in the dark, this is my real life.”

Blanco explained that he decided to come clean as a way of living up to his artistic and personal ideals. “I’m healthy I’ve toured the world 3 times but ive been living in the dark, its time to actually be as punk as i say I am,” he wrote. He added later in response to a fan, “I just cant be an image living in fear having people call me brave and it being a lie.”

Blanco, who grew up in Harlem and whose real name is Michael Quattlebaum Jr., considers his music to be a product of the Riot Grrl movement and counts among his influences diverse artists including Kathleen Hanna, Lauryn Hill, Marilyn Manson, and Lil’ Kim. He took his stage name from Lil’ Kim’s alter ego, Kimmy Blanco.

His confession was met with words of support from fans. “You make me so proud with everything you do,” one wrote. “You are a hero and a warrior,” another added.

TIME opioids

FDA Warned Drugmaker About Pain Pill Injection

Endo Pharmaceuticals Opana Drug Pain Killer
Tripplaar Kristoffer—Sipa/AP A logo sign outside of a facility occupied by Endo Pharmaceuticals in Malvern, Penn. on May 30, 2015.

A new form of pain killer could be driving addicts to inject the drug, hastening the spread of HIV

As officials in Indiana scramble to contain a fast-spreading HIV outbreak, TIME has learned that government officials warned one company that the newest version of a drug it manufactured could be driving behavior that is contributing to the crisis.

In May 2013, federal regulators from the Food and Drug Administration told Endo Pharmaceuticals, the maker of the widely used prescription pain pill Opana, that a new form of the medication could be driving abusers to inject the drug intravenously instead of snorting it.

The HIV outbreak in southern Indiana, which has ballooned from 8 cases in January to 166 as of June, is the result of addicts dissolving and injecting Opana, according to the Centers for Disease Control and Prevention (CDC) and local officials in Scott County, where the outbreak is centered. 96% of those who tested positive for HIV and were interviewed by the CDC said they were injecting Opana, according to an April health alert by the agency.

In 2012, Endo introduced a new version of the drug that it said was designed to be abuse deterrent. Where a previous version of the drug could be easily crushed and snorted or dissolved and injected, the new version had a special coating that supposedly made doing so more difficult. Endo removed the previous version from the market and asked the FDA to rule that it had been unsafe. Such a ruling would have prevented other drug makers from introducing generic versions of the pill.

The FDA denied Endo’s request, rejecting the company’s claims about the new coating’s ability to deter abuse. While the new formulation made it harder to crush and snort the drug, the FDA found, “it may be easier to prepare OPR for injection.” That raised, the FDA said, “the troubling possibility that the reformulation may be shifting a non-trivial amount of Opana ER abuse from snorting to even more dangerous abuse by intravenous or subcutaneous injection.”

Officials in Scott County say abusers discovered they could cook down the abuse deterrent version of the pill, dissolving it and preparing it for injection. Officials say addicts prefer the drug to heroin, even though it is more expensive, and the high doesn’t last as long. Addicts in Scott County have transmitted HIV to each other by sharing needles as they shoot up, sometimes as often as 20 times a day.

Endo, a Pennsylvania-based company that specializes in pain medications, earned $1.16 billion in revenue from Opana from 2008-2012. The company has denied Opana is at the heart of the outbreak and has suggested generic versions of its drug that didn’t have the “abuse deterrent” coating might be at fault, as discussed in the current cover story of TIME on opioid abuse in America:

In April, Endo held a conference call with public-health officials in Scott County. The Endo officials “thought it was a mistake,” says [Scott County public health nurse, Brittany] Combs, who was on the call. Around the same time, [Scott County Sheriff Dan] McClain says an Endo security official called him and offered to help investigate the source of the pills. The Endo official told him the drug being abused couldn’t be Opana because it had been reformulated to be “abuse deterrent.” McClain was skeptical. “I’ve got an evidence room full of Opana over there right now, and I don’t have any generic forms of that pill that are being purchased off the street,” McClain says.

Endo officials declined repeated requests to be interviewed for this article. In response to questions emailed to the company regarding its marketing of Opana and its response to the crisis in Scott County, Keri Mattox, senior vice president for investor relations, said, “Patient safety is a top priority for Endo,” and the company has “an ongoing, active and productive dialogue” with the FDA regarding Opana’s “technology designed to deter abuse.” Mattox says the company supports “a broad range of programs that provide awareness and education around the appropriate use of pain medications” and has reached out to the CDC, Indiana state officials and Scott County health and law enforcement officials, among others.

 

 

 

TIME Infectious Disease

Hookup Apps May Be to Blame for Rhode Island’s Spike in STDs

Social media and hookup sites are contributing to the "epidemic"

Rhode Island is currently experiencing what health experts are calling an “epidemic of sexually transmitted diseases” — and hookup apps may be partially to blame, officials said.

From 2013 to 2014, infections of syphilis increased 79%, gonorrhea cases went up 30% and new HIV cases increased by about 33%, according to data released by the Rhode Island department of health.

The agency noted that the uptick could be sparked by better medical testing and more people having their STDs checked out and reported. However, the agency also acknowledged the role of high-risk behaviors, including “using social media to arrange casual and often anonymous sexual encounters, having sex without a condom, having multiple sex partners, and having sex while under the influence of drugs or alcohol,” the agency wrote in a health alert.

Overall, the rates of HIV/AIDS and syphilis transmission were greater among populations of gay, bisexual, and other men who have sex with men. The rates of all STDs in the state were also higher among African-American, Hispanic and young adult populations, the agency reported.

The health department said the uptick is indicative of a national increase in STDs.

TIME Innovation

How the U.S. Foreign Service Lacks Diversity

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

These are today's best ideas

1. Two top diplomats have a message about America’s foreign service: It’s “too white.”

By Thomas R. Pickering and Edward J. Perkins in the Washington Post

2. Can we ‘test’ strategies against poverty like we test new medicines?

By Michaeleen Doucleff in Goats and Soda by NPR

3. Here’s why the fall of one town to ISIS might push Iraq toward total sectarian war.

By Dexter Filkins in the New Yorker

4. When HIV patients drop out of care, they die. Kenya found a way to prevent that.

By the University of California San Francisco

5. We can end the illegal sex trade.

By Jimmy Carter and Swanee Hunt in Politico

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Addiction

Health Officials Worry as HIV Cases in Indiana Grow

TIME.com stock photos Health Syringe Needle
Elizabeth Renstrom for TIME

Health officials say families are using drugs together

The number of new HIV infections in Scott County, Indiana, has risen to 142, prompting local and state officials to call it a public-health emergency.

A new report released by the federal and state health officials on Friday reveals disturbing trends in injection drug use in a county of only 4,200 people. Scott County has historically reported less than five new cases of HIV each year, making the new tally of 142 all the more alarming. Health experts say the recent outbreak is reflective of a growing drug epidemic nationwide.

“There are children, and parents and grandparents who live in the same house who are injecting drugs together sort of as a community activity,” said Dr. Joan Duwve, the chief medical consultant for the Indiana State Department of Health, at a press briefing. “This community, like many rural communities, especially those along the Ohio River and Kentucky and West Virginia, has really seen a lot of prescription opioids flooding the market. With few resources [and] not a lot to do, the use and abuse has been occurring for at least a decade and probably longer.”

Health officials note that like many other rural counties in the U.S., Scott County has high unemployment, high rates of adults who have not completed high school and a large proportion of residents living in poverty with limited health care access. The report underlines the fact that the county consistently ranks among the lowest in Indiana for health and life expectancy.

“The outbreak highlights the vulnerability of many rural, resource-poor populations to drug use, misuse and addiction,” said Duwve.

The ages of the men and women diagnosed with HIV in Scott County range between ages 18 and 57. The health officials report that no infants have tested positive, though a small number of pregnant women have. Ten women in the cluster were identified to be sex workers. Around 84% of the patients have also been infected with hepatitis C. Eighty percent of the patients with HIV have reported injection drug use and among those people, all of them have reported dissolving and injecting tablets of oxymorphone. Some also reported using methamphetamine and heroin.

Dr. Jonathan Mermin, who runs the CDC’s National Center for HIV/AIDS, reminded reporters that the United States is facing an epidemic of prescription opioid abuse. “An estimated two million people are dependent on or abuse prescription opioids nationally. So while opioid pain relievers can play an important role in the management of some types of pain, the overprescribing of these powerful drugs has created a national epidemic of drug abuse and overdose,” he said.

The CDC estimates that nationwide about 3,900 new HIV infections each year are attributable to injection-drug use, which is down nearly 90% from a peak of about 35,000 in the late 1980s, says Mermin. He adds that opioid poisoning deaths in the United States have nearly quadrupled from 1999 to 2011. This epidemic has already played a major role in a growing epidemic of viral hepatitis among people who inject drugs with a 150% increase in reports of acute hepatitis C nationwide between 2010 and 2013.

State health officials and the CDC are working together to control the outbreaks of HIV and hepatitis C. The state has launched a public health campaign to notify residents of the support available to them: lab testing and treatment, referrals to addiction services and employment, and help with insurance registration. The state initially declared a 30-day public health emergency for Scott County on March 26, but expanded the executive order another 30 days. “I want to assure everyone [that] the state of Indiana will not abandon this community once the executive order is over,” said Dr. Jerome M. Adams, the Indiana State Health Commissioner.

The CDC also released a health advisory on Friday, and is asking states to look closely at their most recent data on HIV and hepatitis C diagnoses, overdose deaths, admissions for drug treatments, and drug arrests in order to help identify communities that could be at high risk for unrecognized clusters of the infections.

“We must act now to reverse this trend and to prevent this from undoing progress in HIV prevention to date,” said Mermin.

TIME Innovation

Five Best Ideas of the Day: April 20

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. America loves to take sides in regional conflicts. In Yemen, we shouldn’t.

By Paul R. Pillar in the National Interest

2. Here’s why Congress should drop the ban on federal funds for needle exchanges. (It’s because they work.)

By Kevin Robert Frost at CNN

3. Cheap coal is a lie.

By Al Gore and David Blood in the Guardian

4. How small-batch distilling could save family farms.

By Andrew Amelinckx in Modern Farmer

5. Can you fix city management with data? Mike Bloomberg is betting $42 million you can.

By Jim Tankersley at the Washington Post

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME health

How One Teenager Changed the Way the World Sees AIDS

Ryan White
Taro Yamasaki—The LIFE Images Collection/Getty Ryan White, 16, a hemophiliac who contracted AIDS, surrounded by mikes held out by reporters on April 21, 1988

Ryan White, who put a new face on AIDS, died 25 years ago

In 1984, when Ryan White was diagnosed with AIDS, the disease itself was still mystified medical professionals. When his name became national news, some of the only things that were well-known about it were that it was terrifying and communicable.

White — who was 18 when he died 25 years ago, on April 8, 1990 — was a hemophiliac and had acquired HIV through a blood transfusion. In and around 1985, he made headlines by trying to attend middle school in his hometown of Kokomo, Ind. Though the state’s health department declared that it was fine for him to attend school as long as he was well enough, the district superintendent decided he would have to attend class by phoning in. His parents sued in response.

As TIME remarked as the case progressed, relatively few people were directly impacted by the case: fewer than 200 school-age Americans had been diagnosed with AIDS at the time. Fear among parents, many of whom were unaware that HIV could not be transmitted through casual contact, was disproportionate.

A year later, in the fall of 1986, White started eighth grade, thanks to a court order — and, then and in the years that followed, he put a familiar face on a disease that had seemed to many Americans to be distant or foreign. The sympathetic story of a young boy who just wanted to go to school ended up helping all AIDS sufferers get a fairer shake; in 1990, for example, shortly after he died, Congress passed his namesake act, which helps Americans get medical care for the disease. As Rev. Ray Probasco, a family friend of the Whites’ who eulogized Ryan, put it:

”Not much was known about the disease back then. So very quickly a great deal of fear permeated Ryan’s community. At first, Ryan and the disease were perceived as one and the same. In time, we saw the boy and the disease, and they were not the same. It was Ryan who first humanized the disease called AIDS. He allowed us to see the boy who just wanted, more than anything else, to be like other children and to be able to go to school.

”And children began asking Ryan, ‘Are you afraid to die?’ And Ryan responded, ‘Everyone’s going to die. If I die, I know I’m going to a better place.’ I believe that God gave us [a] miracle in Ryan. He healed a wounded spirit in the world and made it whole.”

Read TIME’s original 1985 coverage of White’s attempt to attend school, here in the TIME Vault: The AIDS Issue Hits the Schools

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