Increased Opioid Use Increases HIV Infection and Deaths
What Can Be Done
The opioid epidemic is one of the most important public health problems that the USA faces. Opioid overdose death rates have increased steadily for more than a decade. In fact, overdose deaths doubled between 2013–17, as the highly potent synthetic opioid fentanyl entered the drug supply. In addition, the increase in the use of methamphetamines to offset the downer effect of opioids has resulted in more opioid overdose deaths. There were 70,237 drug-related deaths in 2017, which increased slightly to 70,630 in 2019 and resulted in a decrease in life expectancy.
The demographics of new HIV diagnoses among people who inject drugs are also changing. More new HIV diagnoses are occurring among white people, young people (aged 13–34 years), and people who reside outside large central metropolitan areas. Racial differences exist in syringe sharing, which decreased among Black and Hispanic people but remained unchanged among white people between 2005–15. Recent HIV outbreaks have occurred in rural areas of the USA, as well as among marginalized people in urban areas where adequate HIV prevention and treatment services exist. Women who inject drugs are 1-2 times more likely to get HIV. These factors have stalled the steady decline in new HIV infections.
Multiple evidence-based interventions can effectively treat opioid use disorder and prevent HIV acquisition. For example, local programs that employ syringe service programs have not only reduced HIV but also hepatitis C infections. In addition, the MOUD (Medication for Opioid Disorder) approach has been very successful but underutilized. However, considerable barriers exist that prevent delivery of these solutions to many people who inject drugs. If the USA is serious about HIV prevention among this group, stigma must be diminished. This is very challenging and takes effort at every level. Also, discriminatory policies must change, and comprehensive health care must be accessible to all. Finally, root causes of the opioid epidemic such as hopelessness need to be identified and addressed. If you fit into one of these categories, then you are encouraged to seek help, perhaps starting with your primary care physician.
This abstract adapted from printed summary in: The opioid crisis and HIV in the USA: deadly synergies Sally L Hodder, Judith Feinberg, Steffanie A Strathdee, Steven Shoptaw, Frederick L Altice, Louis Ortenzio, Chris Beyrer
www.thelancet.com Published online February 19, 2021 https://doi.org/10.1016/50140-6736(21)00391-3