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America’s Opioid Crisis Complicates Effort to Stop HIV: Solutions Explored in Indiana Pave the Path to Success

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As CDC Director and U.S. Surgeon General, we’ve been crisscrossing the United States in recent months, meeting with local public health leaders and community stakeholders about a historic opportunity to end the HIV epidemic in the United States.

This isn’t a pie-in-the-sky aspirational idea. A CDC analysis of HIV data found that more than 50 percent of new HIV diagnoses occurred in only 48 counties — including Marion County in Indiana — as well as Washington, D.C., and San Juan, Puerto Rico. The analysis also found that seven states had a substantial rural burden.

As proposed in the FY 2020 President’s Budget, under the direction of the U.S. Department of Health and Human Services (HHS), the “Ending the HIV Epidemic: A Plan for America” initiative would achieve maximum impact by focusing efforts on these geographic areas. Under the proposed plan, HHS would provide additional resources, expertise and technology into those parts of the country now most impacted by HIV.

We will work closely with local communities — including in Marion County — vigorously pursuing programs adapted to specific needs. We will also engage business, faith and political sectors in each community to help us understand — and break down — the barriers that keep people from getting the prevention services, treatment and care that they need.

One of the greatest barriers is stigma. In Indiana, and in other parts of the country, the stigma surrounding HIV is compounded by the stigma around substance use and addiction. The truth is that substance use disorder is a chronic medical condition, not a moral failing. There is no better example of that than in the Hoosier State — when in response to the Scott County HIV outbreak among people who inject drugs, Indiana offered compassionate care and opened comprehensive syringe services programs (SSPs) that helped connect these individuals to care.

After Indiana opened SSPs in response to the 2015 HIV outbreak, CDC found that the proportion of people who injected drugs and that shared needles fell from 74 percent to 22 percent. Those who used medical waste containers to dispose of used needles increased from 18 percent to 82 percent. And nearly all who tested positive for HIV used the SSP to obtain sterile needles.

Comprehensive SSPs are proven to be effective. They dramatically reduce both HIV and overdose risk: New users of SSPs are five times more likely to enter drug treatment and about three times more likely to stop using drugs than people who don’t use the programs. These programs work because of the hundreds of local volunteers and public health professionals around the country who devote their lives to these efforts. And while an SSP may not be the solution or approach for every jurisdiction, it is one of the evidence-based community strategies that we support and recommend through the national plan to end the HIV epidemic.

The plan to end the HIV epidemic in America is straightforward:

  • Diagnose all people with HIV as early as possible.
  • Treat people with HIV rapidly and effectively to reach sustained viral suppression.
  • Prevent new HIV transmissions by using proven interventions, including pre-exposure prophylaxis (PrEP) and SSPs.
  • Respond quickly to potential HIV outbreaks to get needed prevention and treatment services to people who need them.

To succeed in our battles against the opioid crisis and the HIV epidemic, people at risk must know that public health is non-judgmental. We in public health must live up to that imperative. Treatment and recovery can only begin with trust, and trust cannot exist when stigma is pervasive.

We now have a once-in-a-generation opportunity to end the HIV epidemic in the U.S. We have the scientific and medical tools. We have the opportunity. Working together, we can accomplish this ambitious goal — and the lessons learned in Indiana can help lead the way to success. 

Robert R. Redfield is the Director for the Centers for Disease Control and Prevention and Administrator for the Agency for Toxic Substances and Disease Registry. Vice Admiral Jerome Adams is the Surgeon General of the United States. He previously served as State Health Commissioner of Indiana.


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