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How Safer Drug Consumption Programs Can Help HIV Prevention Southern California HIV/AIDS Policy Research Center releases policy brief showing the impact of safer drug consumption sites

Ian Holloway

A policy brief published by the Southern California HIV/AIDS Policy Research Center confirms that safer drug consumption sites can reduce the risk and incidence of HIV and Hepatitis C infection.

The Southern California HIV/AIDS Policy Research Center is a partnership between the UCLA Luskin School of Public Affairs, APLA Health and the Los Angeles LGBT Center. Ian Holloway, assistant professor of Social Welfare at UCLA Luskin, is the center’s principal investigator.

Proposed legislation in California Assembly Bill 186 seeks to implement safer drug consumption sites in locations throughout California. These sites provide supervision by trained personnel, offer safe and sterilized equipment, and link people to medical care and substance use treatment.

Given that the risk factors presented by the opioid epidemic and increased intravenous drug use overlap substantially with risk factors associated with higher rates of HIV transmission, the policy brief clarifies the state of research pertaining to both epidemics. It identifies Californians that are impacted by and at greater risk of both intravenous drug use and HIV infection, and reviews research evidence for how safer drug consumption sites may be a key HIV prevention tool.

“Evidence shows that the HIV and opioid epidemics dangerously intersect,” said lead author Robert Gamboa, a Master of Public Policy (MPP) student at the UCLA Luskin School of Public Affairs. “Because of this relationship, the evolving frontier of HIV prevention must consider implementing safer drug consumption sites as an effective strategy. This intervention has the potential to prevent the further spread of HIV and other blood borne diseases while also saving lives from opioid overdose.”

Key findings of the report:

  • In 2015, California saw more than 4,700 new cases of HIV, was third in the nation for HIV transmissions via injection drug use and first in the national among men who have sex with men who inject drugs.
  • Other key groups impacted by both epidemics include women, people of color, those who are homeless and youth. Research has found that people who inject drugs from these subgroups are 4-29 times more likely to have an HIV-positive diagnosis.
  • Safer drug consumption sites offer supervision by trained personnel, safe and sterilized equipment, and link people to medical care and substance use treatment thereby reducing risk of HIV and Hepatitis C infection.
  • Safer drug consumption sites can help to facilitate continuity of care for both addiction and HIV among people living with HIV who use drugs.
  • In California, researchers have estimated that a single safe injection site in San Francisco could prevent 3.3 new HIV transmissions per year and would save the State of California roughly $3.5 million per year in expenses related to health care, emergency services and crime.

San Francisco recently joined Seattle and Philadelphia in implementing safer drug consumption sites in their jurisdiction. Prior research has provided evidence for leveraging safer drug consumption sites as an effective HIV prevention strategy.

Should state legislation clear the way for California to implement the strategy statewide, research supports the inclusion of broad HIV prevention and treatment services at local sites. To access the full report, visit www.chprc.org.

 

Making a Local Impact Luskin Senior Fellow Mitchell Katz talks about boosting health care at the local level — even when the feds won’t pitch in

By Zev Hurwitz

Mitchell Katz, a UCLA Luskin Senior Fellow, knows of several projects that would demonstrate the potential for effectiveness of local government.

“When people talk about public policy, typically people think about Washington [D.C.] or they think about state government,” said Katz, MD, director of the Los Angeles County Health Agency during a talk May 9, 2017, at the UCLA Faculty Center. “I have to say I’ve never been interested in working in either because I like seeing problems directly and figuring out how to solve them. What I want you to think about is, ‘What are the opportunities to do interesting things at a local level that perhaps you could never do at a federal level?’”

More than 50 attendees also heard from Director of the Los Angeles Initiative and former L.A. County Supervisor Zev Yaroslavsky, who moderated a Q&A that followed Katz’s discussion of experiences that employ creativity to improve public health.

For example, when HIV/AIDS was spreading in San Francisco more than two decades ago, Katz helped create a needle exchange program that drastically lowered the number of new infections. In order to bypass state laws prohibiting taxpayer-funded needle exchanges, Katz and his colleagues needed to be creative in finding a legal loophole.

“We came up with the idea that we would declare an emergency,” he said. “The idea was that this was the leading cause of death among men … and here was something that was a transmissible agent. It seemed to me that this cause of death was a public health emergency.”

Katz likened the response to AIDS during the epidemic to an earthquake, during which normal county bureaucratic channels would be bypassed in providing emergency services.

“You were on the County Board of Supervisors for many years,” he said to Yaroslavsky. “If there’s a huge earthquake, you don’t want Zev and his colleagues to follow the process of getting request for proposals and figuring out who’s going to clean up your street — you want everybody to waive all the rules.”

Because rules for emergencies are time-sensitive, keeping the needle exchange program alive meant renewing the emergency order every two weeks for the next nine years.

“This gives you some sense about how absurd it was,” he said of navigating the bureaucracy.

Needle exchanges finally became legal in 2011, yet today no federal funding can be used to pay for such programs.

Katz also spoke about his work banning tobacco sales in pharmacies, improving public housing for homeless and chronically ill patients, advancing teleretinal screenings and remote doctor’s appointments to reduce waiting time for specialist appointments.

During the Q&A, he and Yaroslavsky engaged in a conversation about the future of health in Los Angeles and the country.

Yaroslavsky had high praise for Katz. “One of the best decisions the Board [of Supervisors] made in my day was getting Mitch Katz to come to Los Angeles even though he was from San Francisco,” he said.

Associate Dean and Urban Planning Professor Anastasia Loukaitou-Sideris opened the event, which was co-sponsored by the Fielding School of Public Health, and she introduced Katz. She also discussed the Luskin Senior Fellows program, which pairs leaders in the public, private and nonprofit sectors with graduate students at the UCLA Luskin School of Public Affairs for mentorship and engagement on field-specific issues.

VC Powe, director of career services and leadership development at Luskin, oversees the program, which is now in its 20th year. She noted that the fellowship program’s speaker series allows the Luskin community to hear directly from community leaders.

“The Senior Fellows Speaker Series was created to provide a public square in which these prominent community and policy leaders can discuss their roles in public service and provide insights to their efforts to solve pressing public and social policy challenges,” she said.