Three Southern Indiana counties have been approved for new state needle exchange program, which could help curb the spread of Hepatitis C and HIV in the wake of a serious HIV outbreak earlier this year in Scott County. A handful of other counties are considering instituting a needle exchange program, but so far Northwest Indiana hasn't seen an uptick in new cases.
In the wake of an HIV outbreak that infected 169 people in Southeastern Indiana, the Indiana General Assembly approved a measure this spring that allows counties with high rates of Hepatitis C and HIV infection to create needle exchange programs. Hepatitis C is a disease affecting the liver that is mainly transmitted via intravenous drug use. Scott, Madison and Fayette counties have been approved so far, and Clark and Monroe are preparing to apply for public health emergency declarations from the state that would pave the way for needle exchanges.
Marianne Kundich, the nursing supervisor at the Lake County Health Department, said the state is focusing on counties with a high incidence of acute Hepatitis C cases.
"That's the reason Lake County hasn't shown interest," Kundich said. "Acute Hepatitis C affected a lot of people in Scott County and they are also linked to HIV. But in talking with the State Department of Health, Lake County is shown to be under control in that link so far."
Jennifer Harkel, a registered nurse and communicable disease supervisor at the Porter County Health Department, said the county isn't considering a needle exchange as its numbers have stayed pretty steady — with 43 acute or chronic Hepatitis C cases reported in 2013.
"We don't have what we would consider an epidemic situation with Hepatitis C and HIV infections in the county," Harkel said. "We know there is IV drug use, so we do testing at the health department and we can refer people if have risks for those things. We go to the Porter County Jail and test there. We don't test as many people as we'd like, but we feel like we're pretty proactive."
According to the Indiana State Department of Health, Lake, Porter and LaPorte counties each had fewer than five confirmed acute Hepatitis C cases for 2014, the most recent year for which data are available. When there are fewer than five cases, the Indiana State Department of Health does not provide exact numbers due to privacy concerns, according to ISDH spokesperson Jennifer O'Malley.
O'Malley said the Centers for Disease Control and Prevention defines an epidemic as any increase in the number of cases of a disease above what's normally expected in a given area or among a specific group of people over a particular period of time. For example, Scott County had 79 HIV cases over the first three months, when it typically has five cases annually.
With needle exchanges, drug users can trade in used syringes for sterile hypodermic needles and associated paraphernalia to prevent the spread of Hepititis C and HIV. Gov. Mike Pence approved an emergency exchange for Scott County in the wake of the HIV outbreak in March despite his misgivings that such a program would promote IV drug use.
But numerous studies — from the Centers for Disease Control to the World Health Organization — have indicated that needle exchange programs do not result in higher rates of drug abuse in communities.
Undertaking the needle exchange isn't easy, as it requires approval from the county health officer, the county commissioners and the state, and there are no state or federal funds available. Most exchanges receive funding from nonprofit foundations or from local governments.
Acute Hepatitis C refers to the period shortly after someone becomes infected. With Hepatitis C, Harkel said about 85 percent progress and it becomes chronic infection, and the virus stays in body and can infect others.
"About 15 percent of people, they clear the infection," Harkel said. "Usually with Hepatitis C, you don't get them whenever they get it because they're not that sick. But if someone is jaundiced, in abdominal pain, has high level liver enzymes, and history of iv drug use, a hospital will order tests for HepC and HIV.
"Ideally, anyone who uses IV drugs, and might share needles, should be tested for HepC and HIV," Harkel said. "The sooner they know have it the better and hopefully they don't infect others. Also, the sooner they can start treatment."