In 2014 a county in southern Indiana experienced the largest HIV outbreak in a rural setting in the United States. Investigators utilized a mixed-methods approach to describe injection-related HIV risk behaviors before and after implementation of an emergency syringe services program (SSP) in Scott County among persons who inject drugs (PWID) between April and August 2015.
- 148 participants (62% of all SSP clients) had >2 SSP visits (>7 days apart) and were included in the analysis.
- Participants were predominantly male (56%), non-Hispanic white (98%), and had a median age of 34 years.
- Over a median of 10 weeks, participants reported significant reductions in:
- syringe sharing to inject (18% to 2%) and divide drugs (19% to 4%).
- sharing other injection equipment (24% to 5%).
- number of uses of the same syringe (2 to 1).
- Qualitative study participants described access to sterile syringes and safer injection education through the SSP as explanatory factors for these reductions.
Comments: Although this was the first example of an SSP implemented emergently to control an outbreak of HIV among PWID in a rural setting in the US, its findings, which demonstrate a rapid reduction in injection-related HIV risk behaviors, are consistent with those reported by SSPs implemented in non-outbreak settings. These findings underscore the need for harm reduction interventions for PWID that include access to syringes and sterile injection equipment as well as comprehensive HIV prevention services.
Seonaid Nolan, MD
Reference: Patel MR, Foote C, Duwve J, et al. Reduction of injection-related risk behaviors after emergency implementation of a syringe services program during an HIV outbreak. J Acquir Immune Defic Syndr. 2018;77(4):373–382.