Researchers have found needle exchange programs can stem the spread of HIV, Hepatitis C and other diseases related to the epidemic of intravenous drug abuse in rural America.

But several states with rural populations prohibit syringe exchanges, which supply clean injection supplies, and sometimes education, to drug users. New research from the University of Nebraska-Lincoln demonstrates that states may need to rethink these policies and expand access to clean needle programs and educational outreach to prevent epidemics.

By examining access to and effectiveness of needle exchanges and preventative education programs in both urban and rural areas of Puerto Rico, researchers from Nebraska’s REACH Lab, a national research leader in community health, found that access to such programs lowered disease transmission by significantly reducing sharing needles and other supplies among drug users.

According to the Centers for Disease Control, Hepatitis C infections rose 150 percent between 2010 and 2013 in the United States, mainly from an increase of injection drug abuse. This trend could be seen more than a decade ago in Puerto Rico, which is why a team of Nebraska sociologists led by Kirk Dombrowski began studying the behaviors of injection drug users there.

Researchers said the findings also help explain the 2015 HIV outbreak in Scott County, Indiana, in which 190 new cases of HIV were reported in the generally rural area because of intravenous drug use. Indiana subsequently moved to allow needle exchange programs.

“We’ve seen that trend now on the mainland, with outbreaks of both HIV and Hepatitis C,” said Melissa Welch-Lazoritz, lead author of the newest study and project director of the REACH Lab. “In Indiana, almost all of the new HIV cases were due to injection drug use. It definitely shows that it’s happening in rural places here and we need to take care in trying to prevent it.”

The study – one of the first to look at rural and urban access and usage of syringe exchange programs – noted that such prevention programs are not always easily available in rural areas. While 79 percent of urban drug users had used needle exchange programs in the previous year, only 58 percent of rural drug users had done the same. Similarly, 29 percent of urbanites had spoken with an outreach worker about how to prevent the spread of HIV and Hepatitis C, compared with only 18 percent of the rural residents.

It’s important to continue researching best practices for reducing risky behaviors that spread disease, Welch-Lazoritz said.

“Injection drug users don’t exist in a bubble,” she said. “They have families, friends and sexual partners who don’t inject drugs but are part of the community at large, and these are easily transmissible diseases.

“It takes only a very small amount of blood to transmit Hepatitis C or HIV, especially Hepatitis C. It’s microscopic.”

The study, forthcoming in the International Journal of Drug Policy, was funded by grant from the National Institutes of Health (R01 DA0371170).

Health Rural Issues Sociology