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HIV Cases Increase Kenton, Campbell Counties, Prompting More Calls for Syringe Access

As was warned over the past few years if action were not taken, Northern Kentucky is now dealing with an increase in HIV cases directly related to needles in the use of heroin.
 
Eighteen of the thirty-seven new HIV cases in 2017 are likely related to intravenous drug use, Northern Kentucky and state health officials said on Tuesday.
 
Ten of the new cases are in Kenton County and eight are in Campbell County. Neither has an operational syringe access/needle exchange program. By comparison, HIV rates in Grant County and Pendleton County, which have operational syringe access/needle exchange programs, have remained steady at close to zero.
 
“These numbers are concerning to us because they may be an indication of more widespread HIV infections in our community,” said Dr. Lynne M. Saddler, district director of health at the Northern Kentucky Health Department MD, MPH, District Director of Health for the Northern Kentucky Health Department. “Thus, we are working closely with the Kentucky Department for Public Health to investigate the situation and are recommending several measures to limit further transmission of HIV in our community.”
 

HIV case monitoring data for 2017 shows that:
  • The total number of cases has increased, with 37 new cases of HIV reported to public health officials for the year, compared to 25 cases in 2016 and 34 cases in 2015.
  • When asked about their risk factors for HIV infection, the number of individuals reporting IV drug use has risen significantly. In 2017, a total of 18 people reported injection drug use among their risk factors, compared to only five reports of this risk factor in 2016.
  • Further analysis of the data shows that new HIV infections among individuals who inject drugs is concentrated in two Northern Kentucky counties—Campbell and Kenton.

 
Saddler was joined at Tuesday's news conference, which was originally scheduled for Monday but moved due to inclement weather, by St. Elizabeth Healthcare president & CEO Garren Colvin, the Kentucky Department of Public Health acting commissioner Dr. Jeffrey Howard, Kentucky public health epidemiologist Dr. Jonathan Ballard, and NKY Health Department director of population health Stephanie Vogel.
 
Representatives from the Northern Kentucky Health Department and the Kentucky Department for Public Health announced today that they have initiated a cluster investigation of HIV infections among people who inject drugs in Northern Kentucky.

The officials were careful not to characterize the HIV numbers as an outbreak, referring to it instead as a cluster.

“We do not want to give the impression of widespread community risk for HIV in Northern Kentucky,” said Dr. Howard. “But we also want the public to know that the overall health of our communities depends on the health of all citizens.

“We consider this change in HIV transmission risk to be extremely important. It is equally important to emphasize that this change was discovered as part of the regular monitoring of HIV in Kentucky, which is a routine part of our work in public health. We are actively engaged in the continued surveillance and prevention of HIV/AIDS in Kentucky.”

As the heroin crisis in Northern Kentucky continued to rise over the past several years, health officials have warned local governments that a syringe access/needle exchange program would be needed in order to stave off HIV and hepatitis C infections. Now, both types of infections are on the rise, and of the 18 new HIV cases related to drug use, 78 percent are also infected with hepatitis C.

And still, there is no needle program in Kenton or Campbell Counties.

State law adopted in 2015 allows for the operation of such programs pending approval of the local board of health, the county government, and the government of the city in which the program would operate. The Northern Kentucky District Board of Health approved the program quickly and both Grant County and the City of Williamstown, which are covered within that district, opted to allow a program at the NKY Health Department's offices in Williamstown.

275 people have used the program and many have been referred to drug treatment programs and also receive access to other health-related issues, such as condoms.

Boone County and the City of Florence have each been presented the opportunity to move on such a program but no action has taken place. Kenton County and the City of Covington each voted in 2016 to allow a needle exchange/syringe access program but with many stipulations, including that it be a mobile unit that only operates one day a week for three hours in the parking lot of St. Elizabeth's Covington campus. It also stipulated that three of the four counties in the NKY Health District have an operating program. Grant County is one, and with Boone County out, that leaves Campbell County.

The Campbell County government voted in 2016 to allow such a program to operate but does not yet have a city to work with. County Commissioner Tom Lampe said Tuesday that it is needed and noted that the program received approval at the fiscal court by a 3-1 vote.

Newport Mayor Jerry Peluso told The River City News last month that the city commission would look at the issue again in February, citing fears for an increase in HIV and hepatitis C cases. There has been disagreement in Campbell County about whether the program would operate at St. Elizabeth's Newport campus or at the health department's offices, which it leases from the fiscal court.

Colvin and Saddler both said Tuesday that they would continue to encourage local governments to move on this. Colvin encouraged citizens to do the same.

“We know that access to clean injection equipment is a proven measure to reduce the spread of HIV and other infectious diseases among individuals who inject drugs,” said Garren Colvin, President and CEO of St. Elizabeth Healthcare. “For the last several years, St. Elizabeth and the Health Department have advocated for syringe access exchange programs in our region. Now more than ever, we need to move from advocacy to action, and encourage local officials to act quickly to allow for such programs to operate.”  

Meanwhile, epidemiologists and disease intervention specialists with the Northern Kentucky Health Department and the Kentucky Department for Public Health are collaborating to better understand the cases of new HIV reported in 2017. As part of the cluster investigation, health officials hope to establish whether the cases are linked to one another.

Individuals who are infected will be asked to provide blood samples, which will then be genetically tested by the Centers for Disease Control and Prevention to determine if those in Northern Kentucky are infected with the same strain of HIV. Further, public health officials will attempt to interview the infected individuals to learn if there are others who are at risk for infection, to better understand the behaviors that led to HIV infection and to determine if additional response measures are needed.

Health officials also recommended that actions be taken in Northern Kentucky to facilitate the identification of additional people infected with HIV and to reduce the risk of further transmission.

Public health measures that will be implemented include:

  • Ensuring that people who have been diagnosed with HIV have access to appropriate care, both for infectious diseases and addictions treatment.
  • Conducting targeted HIV testing among individuals who inject drugs. Testing for other infections that are common in this at-risk population as well, including hepatitis C and sexually transmitted infections, will be done.
  • Encouraging other actions to reduce the risk of HIV infection, including the use of condoms and access to clean injection equipment.
  • Expanding access to HIV preventative medications, such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).

“This is a complex investigation and the medical and social needs of the individuals are complicated,” said Vogel. “But we must not forget that the individuals impacted here are members of our community. They are our friends, family members and neighbors and they deserve our support and understanding.”

Community members can support this response by:

  • Promoting HIV and hepatitis C testing.
  • Recognizing that individuals who appropriately manage their HIV can live long healthy lives and take steps to protect others from infection.
  • Encouraging friends and family members who are using injection drugs to do so as safely as possible, and to get tested for HIV and hepatitis C. When feasible, helping to facilitate access to addiction and medical treatment. We all need to be supportive of the people in our community who are living in recovery.
  • Understanding the need for access to clean injection equipment through the expansion of syringe access exchange programs.

The business community is also supportive of the response. Northern Kentucky Chamber of Commerce president Brent Cooper said, "Based on the data, we agree that a syringe exchange programs are needed in cities throughout NKY. From a business perspective, we need healthy employees, we need our collective health care costs to be less, we want good government where elected officials make the best, most cost effective decisions, and we recognize that it is much more difficult to attract businesses and employees to a region that has a disease outbreak.

"We are encouraging everyone to engage on this critical issue for our community's health."

For more information on the HIV cluster investigation and response in Northern Kentucky, visit: nkyhealth.org/hiv-investigation/.​
 
-Michael Monks, editor & publisher
Photo: Garrin Colvin talks at Tuesday's news conference as Dr. Lynne Saddler listens (RCN)