This month, the HIV, STI & Viral Hepatitis Interventions and Treatment Section of the Ohio Department of Health’s Office of Health Improvement and Wellness held its Combined Community Planning Group (CCPG) meeting. CCPG is a quarterly meeting of health service providers, community members, community-based organizations and other stakeholders who work across the HIV continuum – from HIV prevention, to the care of people living with HIV.
The meeting focused on support for people living with, or at risk for, HIV who have a substance use disorder (SUD).
Particularly striking was the 12-fold increase in incidence in Hamilton County since 2012…representing the state’s first HIV outbreak associated with the opiate crisis
Staff reported on the interaction between HIV and SUD. Substance use both directly and indirectly increases the risk of exposure to HIV/AIDS. Drug use reduces inhibition and impairs judgement; and sharing drug injection equipment is a direct risk associated with transmission not only of HIV but also hepatitis C. Individuals with a substance use disorder are also more likely to be living with HIV than individuals without a SUD. Sometimes, but not always, mental health diagnoses also correlate with substance use disorders. It was noted that Ohioans living with HIV who report injection drug use as a risk factor were less likely to have received HIV-related health care, be retained in care, or to be virally suppressed compared to Ohioans living with HIV who do not report injection drug use as a factor. The Substance Abuse Mental Health Services Administration (SAMHSA) data was shared in the table below.
| General Population (%) | Living with HIV (%) | |
|---|---|---|
| Substance Use Disorder | 7.4 | 22.7 |
| Methamphetamine Use | 0.3 | 5.1 |
| Cocaine Use | 0.3 | 5.8 |
| Mental Health Diagnosis | 18.6 | 37.7 |
It was reported that the percentage of HIV infections attributed to injection drug use (IDU) has increased dramatically in Ohio. In 2012, 62 infections were associated with IDU, representing 6 percent of total HIV infections in the state. In 2018, 149, or 15 percent of new HIV infections were associated with IDU.
Considering the geographic distribution of the IDU-associated infection, while Cuyahoga County has been spared an overwhelming increase in IDU-associated infection, attributed to the long-standing syringe services program, incidence in Franklin County has increased. Particularly striking was the 12-fold increase in incidence in Hamilton County since 2012, tragically representing the state’s first HIV outbreak associated with the opiate crisis (see New Diagnosis of HIV Infection).
| 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | |
|---|---|---|---|---|---|---|---|
| Cuyahoga | 17 | 7 | 6 | 14 | 12 | 8 | 6 |
| Franklin | 11 | 12 | 10 | 14 | 16 | 26 | 25 |
| Hamilton | 5 | 17 | 15 | 3 | 16 | 42 | 63 |
Source: Ohio Department of Health, HIV Surveillance Program. Data reported through October 31, 2019.
The state also presented results from its work on the risk of future HIV/hepatitis C outbreaks by county. The state developed risk scores that consider overdoses, overdose deaths, opiate prescriptions, HIV and hepatitis C diagnoses for each county. With the resulting composite score, red counties, mostly but not exclusively in the southern part of the state, were reported to be most vulnerable to an HIV cluster outbreak due to non-sterile injection of opioids.
The attendees discussed the need for increased access to sterile injection equipment, which is extremely effective to prevent HIV and hepatitis C transmission because it reduces equipment sharing. These services are not currently available across at-risk counties. And some counties continue to face misunderstanding of, and opposition to, the programs even though the programs have been found to:
- Increase the likelihood of substance use treatment among clients
- Increase naloxone access among at-risk communities
- Increase safe disposal of injection equipment
Importantly these programs have not been associated with an increase in drug use among clients or crime in host communities.
The percentage of HIV infections attributed to injection drug use (IDU) has increased dramatically in Ohio
Attendees also discussed the need for comprehensive harm reduction programs to address the health and safety of Ohioans who inject drugs, whether they are actively using, in recovery or relapse.
We anticipate these needs will be underscored in Cuyahoga, Franklin and Hamilton Counties as they progress on their ‘Ending the Epidemic’ planning. Additional attention and resources are warranted for outlying counties that are at risk for or experiencing increases in IDU-associated infection to ensure those residents are also protected from these complex and preventable diseases.