Shared Ignorance Makes Matters Worse

By SAM URETSKY

When the AIDS epidemic first appeared in the 1980s, terrible as it was, the infection appeared in an area that facilitated research and treatment. The highest case loads were seen in high population density areas convenient to major teaching hospitals. San Francisco General Hospital was the first facility to dedicate a ward to the disease. New York University Medical Center probably had the heaviest case load and was backed up by the university hospitals of Coiumbia and Cornell. Cases came from discrete neighborhoods which made it easier to perform epidemiologic studies.

Beyond that, the nature of transmission led to community support and education. While a presentation by the Public Broadcasting System, We Were Here revisits San Francisco’s AIDS epidemic of the early ’80s and describes the intense homophobia, it also notes the high levels of support within the gay community itself.

Today, combination therapies composed of three antiretroviral agents have been effective in changing HIV disease from the perfect killer to a chronic condition, more akin to arthritis than an acute infection. In one study among HIV-infected white people who were diagnosed and started treatment with a CD4 (white blood cells) above 350 cells per cubic milliliter, the expected survival could be as high as 54 years, which meant a life span roughly equal to uninfected persons. These are amazing results.

But recently there have been reports increasing reports of HIV infections in rural Indiana. The patients have been intravenous drug users who shared syringes. The CDC describes the health conditions in Austin, Ind.: “Like many other rural counties in the United States, the county has substantial unemployment (8.9%), a high proportion of adults who have not completed high school (21.3%), a substantial proportion of the population living in poverty (19%), and limited access to health care (1). This county consistently ranks among the lowest in the state for health indicators and life expectancy .”

Austin, Ind., is a small town, population 4,200, With a current caseload of 150 HIV infected patients, it is getting assistance from the Centers for Disease Control and Prevention, the state and nonprofit groups like the AIDS Healthcare Foundation. In spite of efforts at public education, HIV has been unknown in this area, and there is a great deal of strongly held but incorrect information. While the state authorized a needle exchange program, it is not being managed as it should be, and while residents of Austin have been given a priority for addiction treatment, there is still a delay in admission to a treatment facility

Reports from Austin show a great deal of ignorance and confusion. The New York Times reported that some addicts were using the same needles as many as 300 times. Beyond that, Gov. Mike Pence (R) has opposed needle exchange programs, saying that they perpetuate drug abuse, and many of the local residents share his opinions. Initially there was resistance to registering with the needle exchange programs because patients had to register and get a laminated identification card. The local police are arresting anyone found with a needle but without a card.

The most popular abused drug in the area is Oxymorphone Hydrochloride Extended Release (Opana ER). This is a very potent narcotic analgesic, meant for oral use, for patients who need round-the-clock pain relief. The tablets have an extended release formulation which is intended to prevent getting a narcotic high. When patients found they could get higher blood levels by crushing and snorting the powder, the manufacturer started coating the tablets to make crushing them more difficult to crush. Inevitably patients learned to dissolve the tablets and inject them. When the drug is injected, the needles can transmit AIDS and hepatitis – but beyond that, the crush-proof version qualified for a patent extension, and blocked competition from generic equivalents. Similarly, in 2010, Purdue Pharma released a crush proof version of its popular narcotic analgesic OxyContin. The Food and Drug administration concluded that the new version was significantly safer, and the patent was extended. The crush resistant versions of the drugs have become the preferred versions, and are usually injected.

In the end, so many people were well intentioned, starting with the residents of Austin, who felt they were safe from AIDS because they lived in a small town, and Gov. Pence, who opposed needle exchange because he wasn’t facilitating narcotics abuse. But in the end, all we had was shared ignorance, and today we’re worse off than before.

Sam Uretsky is a writer and pharmacist living on Long Island, N.Y. Email sdu01@outlook.com.

From The Progressive Populist, September 1, 2016

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