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Prevent new transmissions by using proven interventions, including pre-exposure prophylaxis (PrEP) and syringe services programs (SSPs)

Proven interventions such as PrEP and SSPs are tools that can be utilized to prevent new transmissions of HIV and HCV. When taken as prescribed, PrEP reduces the risk of getting HIV, with an effectiveness estimate of transmission through sex of ~99%, and among PWID from 74-84%.[1] Despite these findings, only a quarter of the one million Americans who could benefit from this preventative medication are using it.[2]

Another proven intervention that has been shown to dramatically reduce the risk of HIV and HCV transmission is SSPs, which provide PWID with sterile syringes and substance use education.[3] SSPs can also be utilized for promoting prevention education and as testing locations for HIV, HCV, and other infectious diseases.

The Scott County outbreak in 2015 was primarily driven by IDU. Implementation of SSPs as a response during this outbreak demonstrated the dramatic preventative impact of this intervention.[4] Since the implementation of the Scott County SSP, the number of individuals sharing syringes has dropped drastically, from 74% to 22%.[5] In 2018, a study conducted by the CDC examined the effectiveness of the Scott County SSP and found an association between SSP use and greater awareness of PrEP.[6] Only nine out of the 92 counties in Indiana allow SSP services, one of which is currently not in operation.

In areas where SSPs are not legally allowed, non-syringe harm reduction programs can be utilized, though only 13 counties in Indiana do so. Through these programs, individuals can obtain sterile non-syringe items used to prepare and introduce substances. Providing non-syringe programming is still an effective prevention method because non-syringe items also have the potential to transmit HIV, HCV, and other bloodborne infections.

Another preventative measure shown to reduce the transmission of HIV is consistent condom use, which reduces transmission by over 98%.[7] Though the CDC does not recommend condom use to prevent HCV transmission, the risk increases significantly when an individual has HIV.[8]

Despite these proven interventions, significant barriers to implementation exist and slow progress toward ending the HIV epidemic and eliminating HCV. Preventing community transmission of HIV and HCV requires validation and implementation of proven harm reduction interventions, and accurate, representative messaging to increase awareness, reduce stigma, and encourage health-seeking behaviors. The strategies within the Prevent pillar focus on empowering high-risk populations with the knowledge and resources they need to take proactive measures to avoid or prevent the spread of HIV/HCV in their communities.   

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[1] Centers for Disease Control and Prevention. (2019). Effectiveness of Prevention Strategies to Reduce the Risk of Acquiring or Transmitting HIV. Retrieved from https://www.cdc.gov/hiv/risk/estimates/preventionstrategies.html

[2] Centers for Disease Control and Prevention. (2019). Prevent new HIV transmissions by using proven interventions, including pre-exposure prophylaxis (PrEP) and syringe services programs (SSPs). Retrieved from https://www.cdc.gov/endhiv/prevent.html

[3] Ibid.

[4] Indiana Department of Health. (2017) Indiana Department of Health Syringe Services & Harm Reduction Program Manual for Local Health Departments. Retrieved from https://www.in.gov/isdh/files/Guidance%20Document%20-%202017%20Update%20-%209-12-17-EC.pdf

[5] Centers for Disease Control and Prevention. (2018). CROI 2018 Select CDC Studies of Interest. Retrieved from https://www.cdc.gov/nchhstp/newsroom/2018/croi-studies-of-interest.html

[6] Fentem, S. (2018). New CDC research links Scott County syringe program with HIV testing, prevention. WFYI: Side Effects Public Media, Retrieved from http://sideeffectspublicmedia.org/post/new-cdc-research-links-scott-county-syringe-program-hiv-testing-prevention

[7] United States Agency for International Development. (2015). Condom Fact Sheet. Retrieved from https://www.usaid.gov/sites/default/files/documents/1864/condomfactsheet.pdf

[8] Picco, M. (2019). How common is sexual transmission of hepatitis C? Retrieved from https://www.mayoclinic.org/diseases-conditions/hepatitis-c/expert-answers/hepatitis-c/faq-20058441