OHIO: Increased HIV Transmission through Injection Drug Use
The Ohio Department of Health (ODH) is observing an increase in newly diagnosed HIV infections being reported among persons who inject drugs (PWID). While HIV remains predominantly a sexually transmitted infection, the proportion of cases reporting injection drug use (IDU) as the mode of transmission increased from seven percent of cases in 2015 to 13 percent in 2017. Preliminary 2018 data demonstrates this trend is continuing. ODH is currently working with local public health partners in Hamilton County to intervene in an ongoing cluster of new HIV diagnoses among PWID in northern Kentucky and southwest Ohio. In October, the CDC provided expertise in the form of an Epi-Aid technical assistance.
There is cause for concern due to the current opioid epidemic, unrecognized drug use in individuals, the rate of hepatitis C virus (HCV) infections, unsafe needle-sharing practices, and the introduction of fentanyl (both pharmaceutical and illicit synthetic) into the local drug supply. Fentanyl use often leads to more frequent injection. PWIDs may be unfamiliar with their increased risk for acquisition and transmission of HIV and HCV infections though unsafe needle and equipment sharing practices.
ODH asks local public health partners to be on alert and communicate with the regional HIV/STD Disease Intervention Specialist (DIS) supervisors, who coordinate HIV and sexually transmitted diseases case investigations, about any new reports of HIV among PWID. ODH also requests local public health work with emergency departments (EDs) to recommend HIV and HCV testing among persons presenting to EDs who have overdosed, and exhibit symptoms of substance abuse disorder and/or injection drug use.
ODH also asks clinical care providers to increase vigilance for the potential for HIV infection among patients who report current or recent injection drug use.
Protective factors to reduce transmission in PWIDs include reasonable access to sterile syringes (through local syringe service programs [SSPs] or pharmacies), access to substance use disorder treatment, and behavioral changes among experienced users.