In the past two decades, the state of Kentucky has witnessed a relative rise in the incidence of HCV (Hepatitis-C-Virus) and HIV (Human-Immunodeficiency-Virus) infection. IDU (Injection-Drug-Use) is the main risk factor associated with the increase of new cases of HCV and HIV infections in the state. To reduce the prevalence of HIV and HCV, the public health department in Kentucky enacted the HRSEP (Harm-Reduction-Syringe-Exchange-Program). Since the HRSEP has been operating for the past four years, it is critical to determine whether the legislative measure succeeds in containing the spread of HIV and HCV.
The spread of blood-borne diseases such as HIV and HCV has a connection with IDU (Injection-Drug-Use). Drug users in the US often share injection equipment and thus are incredibly vulnerable to HIV and HCV infections. Syringes, for instance, retain residual blood and accordingly act as a conduit of spreading infected blood among multiperson sharing such equipment (Christian et al., 2010). Consequently, HIV and HCV are on the rise in the US. For instance, the CDCP (Centers-for-Disease-Control-and-Prevention) notes that more Americans succumb to hepatitis C in comparison to other infectious diseases (Zibbell, Suryaprasad & Sanders, 2015). The CDCP points out that around 3.5 million US citizens are living with HCV (Zibbell, Suryaprasad & Sanders, 2015). The KDPH (Kentucky-Department-for-Public-Health) postulates that between 2008 and 2015, Kentucky, and in particular the Appalachian region, was the leading state in the US in terms of HCV cases (KentuckyOne Health, 2017). Equally, Kentucky is on one of the four states in the US that registered a rise of approximately 365% in HCV infection cases between 2006 and 2012 (Christian et al., 2010). Overall, the US, and Kentucky in particular, is witnessing a continuous rise of opioid overuse, which is increasing the spread of HCV and HIV as more drug abusers share injection equipment.
The Harm Reduction Syringe Exchange Program in Kentucky
The HRSEP (Harm-Reduction-Syringe-Exchange-Program) is an effective legislation enacted in 2015 to reduce the spread of HIV and HCV. The HRSEP is similar to the NSEP (Needle-Syringe-Exchange-Programs), which is a universal public health program in the US. The NSEP alongside the SSP (Syringe-Service-Program) facilitates reduction of blood-borne infections such as HIV and HCV among drug users and the general population (Peters et al., 2016). In the US, over 55 cities have embraced NSEP including Indiana, among others. Indiana, for instance, created NSEPs in 2015 through the SEA 4612 bill (Peters et al., 2016). The program is one of the holistic public health responses to the local HIV and HCV epidemic. However, some states in the US have failed to adopt NSEPs because of several obstacles including economic, legal, and behavioral factors (Peters et al., 2016).
In 2015 the General Assembly of Kentucky enacted the HRSEP (Harm-Reduction-and-Syringe-Exchange-Program) bill. The purpose of the law is to facilitate a flawless exchange program where they exchange used syringes and hypodermic needles for new ones. Bixler et al. (2018) state that Kentucky banned NSEPs in before the approval of the new legislation in 2015, However, after the enactment the largest counties in the state; Lexington and Louisville, had operational NSEPs by the end of 2015, while 29 other counties established SPPs by the end of 2017 (Bixler et al.., 2018). Consequently, out of the 54 rural and urban counties that are vulnerable to HCV and HIV outbreak, 21 of them had operational SSPs by the end of 2017 (Bixler et al., 2018). Overall, the strategy reduces risk factors associated with drug users sharing injection equipment among them.
The Effectiveness and Efficiency of the HRSEP in Reducing HIV and HCB
Four years after the 2015 enactment HCV is still prevalent in Kentucky. Bixler et al. (2018) point out that HRSEP can reduce transmission of HIV and HCV by 56%, however, presently approximately 38,000 people in Kentucky live with hepatitis C (KentuckyOne Health, 2017). Therefore, it is not clear whether increasing SSP has a significant effect on reducing the rates of blood-borne diseases. Based on the KDPH it takes several years before HCV symptoms appear (KentuckyOne Health, 2017); hence, most people are oblivious of probable infections. Therefore, in the absence of official data on Hepatitis C infection since 2015, some of the current HCV infection probably occurred before the state passed the NSEPs in 2015. Moreover, increased opioid addiction has raised the number of persons infected with HCV in spite of the 2015 enactment (Smith, 2018). Since drug trafficking in the US is illegal most drug abusers, who are the principal individuals sharing syringes, fail to participate in the program because of probable apprehension. Overall, to address the HCV crisis, the state of Kentucky must use mixed approaches that include legislation such as the HRSEP enactment and encouraging people to undertake regular screening.
The 2015 HRSEP legislation is a critical public health measure in Kentucky to reduce the spread of HCV and HIV. Since the bill’s approval, the state has witnessed a significant rise in the number of SSPs serving persons vulnerable to the proliferation of blood-borne diseases through IDU. However, the lack of official data after passing the legislation makes it difficult to determine whether the bill has reduced HIV and HCV infections significantly. Nonetheless, based on information from other states that have implemented NSEPs, it is clear that such programs reduce the spread of HIV and HCV by around 56%. Therefore, the HRSEP is effective legislation that will continue to contribute to the overall well-being of Kentuckians vulnerable to HIV and HCV through IDUs
Bixler, D., Corby-Lee, G., Proescholdbell, S., Ramirez, T., Kilkenny, M. E., LaRocco, M., … & Asher, A. (2018). Access to syringe services programs—Kentucky, North Carolina, and West Virginia, 2013–2017. Morbidity and Mortality Weekly Report, 67(18), 529.
Christian, W. J., Hopenhayn, C., Christian, A. M. Y., McIntosh, D., & Koch, A. (2010). Viral hepatitis and injection drug use in Appalachian Kentucky: a survey of rural health department clients. Public health reports, 125(1), 121-128.
KentuckyOne Health. (2017). Kentucky has the highest hepatitis C Rate; Kentuckyone health encourages testing | News | KentuckyOne Health. Retrieved from https://www.kentuckyonehealth.org/body.cfm?id=7604&action=detail&ref=1307
Peters, P. J., Pontones, P., Hoover, K. W., Patel, M. R., Galang, R. R., Shields, J., … & Conrad, C. (2016). HIV infection linked to injection use of oxymorphone in Indiana, 2014–2015. New England Journal of Medicine, 375(3), 229-239.
Smith, L. (2018, July 03). KY becomes first US state to require hepatitis C testing for pregnant women. Louisville, KY: WDRB. Retrieved from: http://www.wdrb.com/story/38567039/ky-becomes-first-state-in-nation-to-require-hepatitis-c-testing-for-pregnant-women
Zibbell, J. E., Suryaprasad, M. D., & Sanders, K. J. (2015). Hepatitis awareness month and national hepatitis testing day—May 2015.
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