Dying From a Slow Learning Curve: Drug Use and HIV/AIDS in Miami

Jabberwocky

Jabberwocky

Frumious Bandersnatch
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Jag Davies | 9/10/15 said:
Coming of age in Miami in the 1980s and 90s, the HIV/AIDS epidemic felt omnipresent, as everyone's life was touched by it in one way or another. When one of my childhood friends died of AIDS-related complications in 2009, I felt I could at least take some solace in the notion that this disease was largely a product of that bygone era.

How wrong I was. There’s a new explosion of HIV – all over the country, but particularly in the South – and it’s shaking me and many others from such illusions. Miami-Dade and neighboring Broward County are now #1 and #2 in the country for new HIV cases.

This has largely been driven by an increase in heroin use following "crackdowns" on prescription opioids in recent years, as people struggling with addiction switched to heroin, which is cheaper and often more accessible than prescription pills.

The frustrating thing about this new epidemic is that we've known for decades that there are practical, common-sense solutions to preventing HIV among people who use drugs. But we've let our fears and misconceptions about drug use and addiction stand in the way.

Throughout the world, research has consistently shown that repressive drug law enforcement practices force people who use drugs away from public health services and into the hidden margins where HIV risks are significantly elevated. Mass incarceration also plays a major role in spreading the epidemic, as inhumane conditions and lack of HIV prevention or treatment in prison lead to HIV outbreaks and AIDS cases behind bars – and among families and communities once those imprisoned are released.

Health interventions like sterile syringe access programs have a proven track record of effectiveness and cost-efficiency in reducing new HIV cases. They also link people to health care and connect people to addiction treatment, which in turn reduces overall drug use.

A new study published earlier this month in the journal AIDS and Behavior found that in the first two years after Washington, D.C. enacted a syringe access program, new HIV cases related to injection drug use fell by 72% – averting 120 new infections and saving people $45.6 million, much of which would have been absorbed by publicly-funded programs.

According to the CDC, injection drug use has historically accounted for more than one-third (36 percent) of AIDS cases in the U.S. Yet Congress still bans federal funding for sterile syringe access programs.

This refusal to adopt an evidence-based prevention strategy has cost us hundreds of thousands of lives, not to mention billions of taxpayer dollars. Ethan Nadelmann of the Drug Policy Alliance has long called this “the costs of a slow learning curve.”

Some U.S. cities and states have passed reforms to allow syringe access, as Kentucky and Indiana recently did, yet much of the U.S. remains stuck in the Dark Ages.

Florida is one of these places. That's why medical professionals like Dr. Hansel Tookes, a resident at Jackson Memorial Hospital in Miami, have been working with Broward Rep. Katie Edwards to pass the Infectious Disease Elimination Act. The law would authorize the University of Miami and its affiliates to establish a pilot syringe exchange program and it would remove criminal penalties for people who pass out sterile syringes.

Rep. Edwards has just introduced this bill for a second time. In the last legislative session, it died in committee. But Edwards is not giving up.

And she shouldn't give up, because there's good reason for hope. In places where addiction is treated as a health issue, the fight against HIV/AIDS is being won. Countries like Germany, England, Portugal, Australia, Switzerland, and even Brazil have significantly reduced and in some cases nearly eliminated new cases of HIV among people who use drugs.

We have the ability to end this epidemic, but not until we end the war on drugs and the mentality that gave rise to it. This notion may make some of us uncomfortable, but we need to embrace it as soon as possible.

The costs of a slow learning curve are simply too great.
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http://www.drugpolicy.org/blog/dying-slow-learning-curve-drug-use-and-hivaids-miami
 
Yup, but especially with needles it's a big issue where they're no legally and readily available. Shit, people even share needles when they are, just not nearly as much.
 
PriestTheyCalledHim said:
Don't people know not to share needles, and how to have safer sex? This has been known about for 30+ years.
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Its not that simple. When I was heavy into heroin I didn't care about safe IV use because I didn't think I would live long enough for it to matter. Like if I had dope and only a dirty needle to do it with then that was what was up. I don't think I am alone in that thinking. That means the key is to make clean needles convenient to addicts. I personally thing vending machines are the answer. 50 cents for a clean needle. Put them bitches on every corner just about. That's the best solution I got. We aren't stupid we know sharing is bad but survival is a priority below getting high.
 
Yea you definitely weren't alone.

And selling syringes for $0.50, even $0.25, would allow the people managing the vending machines to make bank.

They had (hopefully still do) crack pipe vending machines in the San Francisco or Bay area recently. I think might have been free, can't remember.
 
Society (even within drug user communities) has this really stigmatising view that sharing injecting equipment even once makes you a BAD IRRESPONSIBLE USER who only has themselves to blame if they get HIV or hep C. And, yeah, best practice is to always use new equipment every time. Most people know that by now.

But we don't attach this level of judgement to people 'running out' of any other household essential. People run out of milk or toilet paper or tampons all the time and it's not considered a moral failing. If you're a daily heroin user, injecting equipment is really just another household essential. We need to enable people to always have new injecting equipment on hand by making it super accessible and available, but also by giving people strategies for how to reduce harm when they inevitably run out and have to make choices around that.
 
SixBuckets said:
Society (even within drug user communities) has this really stigmatising view that sharing injecting equipment even once makes you a BAD IRRESPONSIBLE USER who only has themselves to blame if they get HIV or hep C. And, yeah, best practice is to always use new equipment every time. Most people know that by now.

But we don't attach this level of judgement to people 'running out' of any other household essential. People run out of milk or toilet paper or tampons all the time and it's not considered a moral failing. If you're a daily heroin user, injecting equipment is really just another household essential. We need to enable people to always have new injecting equipment on hand by making it super accessible and available, but also by giving people strategies for how to reduce harm when they inevitably run out and have to make choices around that.
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Come on, that's a pretty absurd analogy - running out of toilet paper doesn't result in the transmission of blood-borne viruses.
 
The point remains though, that clean works need to be available to intravenous drug users as a matter of public policy.
Where i live there is a free exchange program.
As injecting drug users are some of the most marginalised and vulnerable people in society, it makes sense for governments (or, failing that, charities and not-for-profit organisations) to make these facilities available.

It's an investment in public health, as well as an ethical matter i think.
It is front-line harm reduction, and can (should) go hand-in-hand with efforts to educate drug users in safer injecting practices.
 
Crankinit said:
Come on, that's a pretty absurd analogy - running out of toilet paper doesn't result in the transmission of blood-borne viruses.
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So? This is exactly the framing I find problematic. When a person is injecting drugs on a daily or near-daily basis, they don't think of injecting equipment in terms of "DANGER BLOOD BORNE VIRUSES" - they think of it as everyday items associated with pleasure or normal function. Framing health promotion messages in a way that addresses this mindset (don't run out of important everyday items because that's never fun for anyone) as opposed to using fear-based, stigmatising and absolutist campaigns that don't resonate with users (you must NEVER share needles because if you do you're a BAD USER and you deserve to get HIV/HCV) is much more reflective of best practice health promotion principles. It's a fundamental principle of effective health promotion that you need to address people's behaviours and attitudes on their terms, in a way that resonates with them.

Check out Winter et al's Technical Review of Hepatitis C Health Promotion Campaigns, or the UNSW CUPID project if you think I'm speaking nonsense. I've just completed a review of one of my work projects according to the twelve principles in the Technical Review and it's really emphasised the weaknesses in the traditional modes of referring to sharing equipment.
 
It's like this: How would someone who used insulin once or more times a day, every day, look at their insulin syringes? Same thing.

Amazing framing SixBuckets. The world, especially our community, needs more thoughtful voices like this.
 
In Florida's case, it doesn't help that possession of a single syringe is a felony.
 
Fuck people who moralize AIDS, but seriously: you have to be living under a rock to not know how the virus is transmitted. We've known since 1982-ish about this killer disease that's spread through bodily fluids. It's not rocket science. Even if you're poor and disadvantaged, you have to have seen ads warning about HIV or learned about it in health class. OR SOMETHING. At what point do we start placing responsibility on the individual? The information is out there. In the early years when nobody knew how it was spread, people could claim innocence and ignorance. Not anymore. If you contract HIV these days, it's because you put pleasure above your health. (With the exception of rape and other exceptional circumstances).

That said, our government needs to implement needle exchanges and other harm reduction methods STAT. Do away with the criminalization of "drug paraphernalia" like syringes so people won't be tempted to share needles. Pushing the drug war as a means of protecting society while it enables unnecessary death is hypocrisy.
 
toothpastedog said:
It's like this: How would someone who used insulin once or more times a day, every day, look at their insulin syringes? Same thing.
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As a massive pain in the ass that I hate.

As I understand it it's not that way many times with IV drug users, though, some of whom develop "needle fixation". I'm an injection drug user but, despite the fact that I have 100+ clean needles sitting around here I've never really been temped to try recreational IVing...I still hate syringes. But whatever. In this state there really isn't much of an excuse not to use a clean syringe, IMO, as they can be bought by anyone at a pharmacy in bulk amounts for a very low price. While I myself don't IV, I've known many IV heroin users, and stories have been related to me of people who KNOW that the person they're sharing a needle with has Hep C but still uses the rig anyway. I guess some people just get to the point where they don't care at all about their own health anymore and are consumed with self loathing.
 
Burnt Offerings said:
people who KNOW that the person they're sharing a needle with has Hep C but still uses the rig anyway. I guess some people just get to the point where they don't care at all about their own health anymore and are consumed with self loathing.
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A lot of us have been there, and I'd say this is a whole other issue. A IDU/heroin users, we're pretty much taught by next to everyone normal day to day society and culture that we're worthless, or at least that is how we're largely treated, and at a certain point a lot of us just say fuck it or something, or just really need to fix now, and don't have ready access to syringes (even in states where you can buy them OTC).
 
Thanks, toothpastedog.

I am legit curious as to what that guy thinks the point of an internet forum is if it's not to exchange posts that share ideas, responses and conversation.
 
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