By Tina Reed
On a recent bitterly cold Thursday, a thin stream of clients entered the Clark County Health Department in Jeffersonville, Ind. They were there to take advantage of the free needle-exchange program at The Interchange.
After months of trying to secure funding, the Clark County program started on Jan. 26, 2017, to help alleviate the spread of HIV and hepatitis C by discouraging the shared use of needles among intravenous drug users. Since then, 185 people have participated, officials say, with 82 who come back each month. Hepatitis cases in Clark County have hovered near 270 in the last year, they said.
The NEP in Clark County is funded by donations from local organizations and government grants, and has been approved for another year, said Amelia Johns, a public health nurse for the Clark County Health Department.
“We received grant funding to extend our program for more hours and outreach in the community,” Johns said.
According to the Indiana State Department of Health, there are seven counties in Indiana that are approved for a needle-exchange program and the return rate of needles is 80 percent statewide. The total number of people participating in the programs in the state of Indiana is 3,750.
Such exchange programs are not without detractors who contend that exchanging needles perpetuates drug habits. Indeed, several programs in Indiana have been closed because of it, including one in Lawrence County that halted its program citing the Bible.
Johns says she believes that some critics feel the programs feed the addiction, enabling drug users and “giving them a free ride when we are only trying to prevent disease.”
The clients who come in for the needles or to be tested for diseases are of all ages, with the average age being 30, she said. They are single, divorced or widowed, with or without children. Some work and maintain jobs, she added.
Across the Ohio River
By contrast, the Louisville Metro Department of Public Health and Wellness, Kathy Harrison Turner, director of communications, said that Louisville’s syringe-exchange program has had over 13,000 participants since it started on June 9, 2015.
The program also helps to stop the spread of disease through testing for HIV, hepatitis C, and connects clients to treatment for diseases through medical and wraparound services, Turner said. It provides training and education on how not to spread diseases.
The needle-exchange program in Louisville is funded through local and state governments, according to Turner. Mayor Greg Fischer recently cited the program in a year-end interview with Insider, saying, “We started the needle exchange long before anybody else did.”
Dave Langdon, spokesman for the Louisville Metro Department of Public Health and Wellness, said the primary reason for the syringe exchange program was not so much to reduce HIV, but to prevent transmission that could be spread by drug users, which has worked since it started.
As an example, Langdon referred to Austin, Ind., which is 35 miles north of Louisville, with a population of about 4,200.
“I believe they had somewhere in the area of 125 new HIV cases as a result of intravenous drug use,” Langdon said. “If you translated that proportionally to the actual size of Louisville, I think we might have anticipated more than 36,000 new HIV cases — and that certainly hasn’t happened.”
The syringe exchange has been a big factor in preventing that sort of output, said Langdon.
“Our HIV rates here in Louisville have not significantly increased like they anticipated,” he said.
Since the start of the exchange, Langdon said, there have been 13,389 clients and out of those, 5,873, or about 44 percent, are returning clients, with 1,780,832 syringes provided.
“The most recent numbers, 89,000 to 90,000 syringes are used per month,” said Langdon. “With 70 to 80 percent of those coming back.”
Some 500 people have been referred for drug treatment, 1,300 have been tested for hepatitis C, and 463 of those have been referred for treatment; 1,030 have been tested for HIV and 22 of those have been referred for HIV treatment, he said.
Hepatitis still a concern in Clark County
Since the start of the NEP program in Clark County, there has not been a decline in hepatitis C or other blood-borne illnesses, according to Johns.
“Our hep C numbers are still high,” said Johns. “But most of these cases are chronic cases the patient has had hep C, but because of education and awareness at our clinic, these members are getting tested more often,” she said.
These clients may have had the disease six months or longer coming in, she added.
“We hope to see a decrease in hep C cases over the next few years,” Johns said. “We just can’t provide adequate information on those numbers yet.”
Until cures are found for bloodborne diseases such as HIV and hepatitis C, Johns said prevention is the next best way to fight them and NEPs remain an important strategy for doing so.
With the re-use of needles repeatedly, Johns said, infections such as sepsis, abscess, blood clots and endocarditis are the leading cause of readmissions for users.
The NEP offers training for Narcan, the brand name for naloxone, which revives people who overdose on opioids and blocks the effects of opioids. “The overall overdoses in our county have declined in the past year since we have started giving out Narcan,” Johns said.
The Interchange provides referrals for drug treatments and detox, and medical and wound care, insurance assistance, halfway houses, group therapy, homeless shelters, food and clothing assistance.
“We just don’t hand out needles here at The Interchange,” said Johns. “We want to build a relationship with the members so they trust us: we want to educate and encourage them.”
The NEP has referred several members to rehab, she said, and they no longer come for needles. “We can only hope they are not coming back because they are now not using,” she said.
On another recent afternoon, a client exiting the Clark County Health Department exhaled a puff of cold breath, a fresh batch of needles in hand. For Johns, it was the end of another day at the needle exchange. As she locked the door behind her, she looked around with a satisfied expression on her face as if she had made a difference in someone’s life.