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B.C. researchers identify multiple strains of HIV ‘time bombs’ hibernating in cells

“If you can’t identify it, you can’t cure it.” Study confirms that the latent HIV reservoir is genetically diverse and can contain viral strains dating back to transmission.

Dr. Zabrina Brumme, an associate professor in medical sciences at SFU, has been hired as director of the HIV/AIDS laboratory program at the BC Centre for Excellence. COURTESY OF B.C. CENTRE FOR EXCELLENCE / PNG

B.C. researchers have discovered a way to identify multiple strains of HIV that lay dormant in the cells of an individual.

HIV evolves continually while it is active, storing versions of itself in the DNA of infected cells that then go dormant, waiting to reactivate at some future date, like an archive of genetically unique “time bombs,” said Zabrina Brumme, director of the HIV/AIDS lab at the B.C. Centre for Excellence in HIV/AIDS.

Brad Jones, a Ph.D. student involved in the B.C. Centre for Excellence in HIV/AIDS and Simon Fraser University study, said researchers “created a highly calibrated ‘time machine’ that gives us a specific time stamp for when each dormant HIV strain originally appeared in a person.”

That allowed scientists to construct a family tree of the virus in each patient to see how it evolved over time, right from when the virus was contracted, even decades earlier.

While the discovery is a long way from a cure, this study does give scientists a clearer idea of how challenging it will be to extricate the virus from a patient’s cells.

“If you can’t identify it, you can’t cure it,” said Brumme, who was the study’s lead author.

Eliminating the virus from an individual would require a way to remove not just a single version of the virus from archive cells, but the whole evolutionary history of the virus in that patient, she said.

“Curative strategies will need to address this new study’s key findings,” said Julio Montaner, Director of the B.C. Centre for Excellence in HIV/AIDS.

Dormant versions of the virus are untreatable with antiretroviral therapy, which is why HIV treatment must be maintained for the lifetime of the patient.

“In order to eradicate HIV from a person’s body, you first need to know the characteristics of HIV in the latent reservoir,” said Western University assistant professor Art Poon, a co-author on the study.

A cure for HIV would likely require several simultaneous kinds of therapy and it would almost certainly require treatment that was personalized for individual patients, possibly based on the genomes of all the strains of HIV stored in the patient’s cells.



HIV infections among the youth on the risein Kenya


Health Cabinet Secretary Sicily Kariuki. She said over 40 per cent of all new HIV infections occur among adolescents aged 15-24 years. PHOTO | FILE | NATION MEDIA GROUP

In Summary

  • AHF Kenya is an NGO working in the HIV/Aids sector in areas of treatment, testing, condoms programming and advocacy.
  • AHF Kenya chairman Stephen Karau said they have tested over three million Kenyans and distributed 18 million condoms for free.


The Ministry of Health has raised concerns over the rise in new HIV infections among the youth, terming it a drawback in the fight against the disease.

Health Cabinet Secretary Sicily Kariuki said over 40 per cent of all new HIV infections occur among adolescents aged 15-24 years.

She said the 2018 Global Progress Report by UNAids confirms that attainment of 90:90:90 targets by 2020 may be an uphill task if interventions are not scaled up, especially in regard to new infections and stigma levels.

Ms Kariuki made the remarks in a speech read on her behalf by the Health Chief Administrative Secretary Rashid Aman during the 10th anniversary of Aids Healthcare Foundation (AHF) Kenya.

AHF Kenya is an NGO working in the HIV/Aids sector in areas of treatment, testing, condoms programming and advocacy.


The organisation works in Makueni, Mombasa, Nairobi, Murang’a, Kilifi, Kwale, Turkana, Nairobi and Homa Bay counties and serves more than 50,000 people.

AHF Kenya chairman Stephen Karau said they have tested over three million Kenyans and distributed 18 million condoms for free.

He said the NGO has enjoyed good partnerships with both levels of government and is happy to contribute towards the Big Four Agenda, especially in providing universal health coverage to all Kenyans.

Dr Karau said AHF Kenya will continue to offer good services and work closely with relevant government agencies like the National Aids Control Council, the National Aids and STIS Control Programme and the civil society in the fight to reduce the HIV/Aids spread.


“This is remarkable progress which we have achieved in the short ten years. We will continue working with our partners and all stakeholders to ensure that we achieve the country’s HIV/Aids goals,’’ said Dr Karau.

Meanwhile, Ms Kariuki said Kenya has, over the past decade, made deliberate efforts towards HIV prevention. These include embracing of biomedical approaches such as test and start strategies, condom programming and high-impact interventions towards the elimination of mother-to-child HIV and syphilis transmissions.

Ms Kariuki cited other initiatives such as the Linda Mama programme and First Lady Margaret Kenyatta’s Beyond Zero Campaign, which have contributed to successes in healthcare provision.




Alberta Announces Coverage For HIV Prevention Drug PrEP Starting Oct. 1

The generic version costs about $250 a month.

Alberta’s provincial government has announced it will cover the costs for the preventative HIV medication PrEP starting this fall.

Premier Rachel Notley made the announcement on Saturday during a Pride Week event for Camp fYrefly, a retreat program for queer and trans youth.

“By making [the drug] more accessible and more affordable to people who are at greater risk of getting HIV, then we’re able to reduce the incidences of HIV,” she said while making the surprise announcement, according to the Calgary Herald.

“It’s that simple.”

Rachel Notley speaks during a news conference in April.

PrEP, short for pre-exposure prophylaxis, is often sold under the brand name Truvada and is prescribed to people at high risk of contracting HIV. It’s highly effective at preventing HIV transmission, according to the Centre for Disease Control. Daily use of PrEP can reduce the risk of contraction by over 90 per cent.

Gay or bisexual men, and transgender women are most likely to be prescribed the medication, according to CATIE, a source for Canadian HIV and AIDS information.

Despite the medication’s effectiveness, its cost can be a significant barrier. PrEP’s generic form can cost about $8.30 a day, or $250 a month, while Truvada can sometimes cost up to $1,000 a month, CBC News reports.

Alberta has the fourth-highest rate of new HIV infections in the country, according to government data. The number of cases has increased 11.6 per cent between 2015 to 2016.

Notley credited the policy change to advocacy work by health groups.

Community health advocates in general have been asking us to move forward(on this),” Notley said on Saturday, according to CTV News.

Several other provinces currently cover PrEP under their health plans, including B.C., Saskatchewan, Ontario, Quebec, Nova Scotia and New Brunswick.

Coverage in Alberta will begin on Oct. 1 and will require a doctor’s prescription.

#KnowTheDisease: Everything you need to know about HIV and AIDS



#KnowTheDisease: Everything you need to know about HIV and AIDS

In this series, today we shall discuss about HIV and AIDS.

The HIV, which stands for Human Immunodeficiency Virus, targets the infection-fighting CD4 cells (T4 cells) of the immune system, making people more vulnerable to diseases and some kinds of cancers.

If left untreated for years, HIV infection progresses to Acquired Immune Deficiency Syndrome (AIDS).

Once diagnosed with HIV, the virus stays in your body for life. Currently, there’s no cure for it.

Three stages of HIV: Acute HIV infection, Clinical latency, AIDS
HIV’s stages

Once someone is diagnosed with HIV and doesn’t get treatment, then they typically go through three stages of infection: Acute HIV infection, Clinical latency, and AIDS.

In Acute HIV infection, people may experience fever, swollen glands, joint aches and pains, sore throat, rashes, and headaches. During the initial stages, a large amount of virus is being produced in the body and is contagious.

Clinical Latency: The second stage of HIV infection
Second stage

The second stage of HIV infection is Clinical Latency. During this period, the virus continues to multiply in body but at pretty low rates.

Affected people don’t show any symptoms of the virus, but can still, transmit it to others.

For people who aren’t on HIV medicine, Clinical Latency stage usually lasts for a decade or longer, though in some, it may advance faster.

AIDS: The last and most severe form of HIV
Third stage

The last and most severe form of HIV infection is AIDS. Infected people are extremely contagious.

During this stage, the immune system of the person is so badly damaged that the body can’t fight off opportunistic infections, like bacterial/fungal diseases.

The symptoms include weight loss, chronic diarrhea, night sweats, and fever among others.

People having AIDS typically survive about three years.

How does HIV spread?

According to WHO, HIV can be transmitted via the exchange of a variety of body fluids from infected individuals, such as blood, semen, and vaginal secretions.

Reportedly, unprotected anal or vaginal sex puts individuals at greater risk of contracting HIV.

The virus can be transmitted to the child from mother during pregnancy, breastfeeding, or birth.

Sharing needles with infected persons can also transmit the infection.

Treatment for HIV infection

Presently, there’s no cure available for HIV infection. However, the virus can be treated using Antiretroviral therapy (ART), consisting of three or more antiretroviral drugs.

ART doesn’t cure the disease but prevents the infection from multiplying and reduces the amount of infection in the body. As a result, the immune system gets a chance to recover and prevents the infection from advancing to AIDS.

Basics of HIV prevention

Anyone can have HIV infection, but there are certain steps to protect yourself from the infection.

Measures include the correct and consistent use of male and female condoms while having anal and vaginal penetration, testing and counseling for HIV and sexually transmitted infections (STIs), and by limiting sexual partners.

Other steps include the use of the antiretroviral drug and avoiding injecting drugs among others.

Some noteworthy facts

It is imperative to note that the individuals cannot acquire HIV infection through ordinary day-to-day contacts such as kissing, hugging, shaking hands, sharing personal objects, food or water. HIV also doesn’t spread through the air or in water or by ticks, mosquitoes, or blood-sucking insects.



Inspired by Pokemon Go, Philippines app helps LGBTI access condoms

The app’s creator hopes to tackle extremely high rate of new HIV infections in the Philippines

Inspired by Pokemon Go, Philippines app helps LGBTI access condoms
Philippines app Safe Spaces was inspired by Pokemon Go (Photo: Tumblr)

The app’s developer, advocacy group LoveYourself, hopes to tackle the country’s high rate of new HIV infections.

The Safe Spaces app came about after the LGBTI community and the country’s health department reported poor access to condoms, said Vinn Pagtakhan, Founder and Executive Director of LoveYourself.

Volunteer developers were inspired by Pokemon Go that was a hit in the capital, Manila, during development, he said.

The Philippines has some of the highest rates of new HIV infections in the world. Men who have sex with men (MSM) and transgender women (TGW) are particularly at risk.

Often, stigma and discrimination prevent MSM and TGW from accessing protection.

The Safe Spaces app provides users with the location of sex positive places to grab free condoms and lube without being judged.

Users can locate a ’safe place’ on the app and find a dispenser by the discreet logo.

‘We had 1,000 downloads in the first month,’ said Pagtakhan.

‘Now, we have had almost 10,000 downloads and  72 partner establishments distribute 1,000 condoms less than a week,’ said Pagtakhan.

Safe Spaces app directs LGBTI and others to condoms and lubricant in the Philippines. (Photo: LoveYourself)

Safe Spaces app directs LGBTI and others to condoms and lubricant in the Philippines. (Photo: LoveYourself)

Tackling the Philippines’ ‘national emergency’

New HIV cases in the Philippines in 2017 hit 11,103. Astoundingly, that’s up more than 3,000 percent compared to ten years earlier.

Health professionals have described the high rates, especially among 15 to 24 year old MSM and TGW, as a ‘national emergency.’

Low condom use in the Philippines is the primary reason for the dramatic increase in HIV infections, according to experts.

The predominately-Catholic country is socially conservative, which prevents access to condoms.

Moreover, laws prohibit health-care workers from providing people younger than 18 years with protection. Laws also forbid HIV testing for under 18s without parental consent.

The Philippines government has failed to advocate condom use and provide adequate sex education, Carlos Conde of Human Rights Watch told The Lancet HIV earlier this month.

‘Condoms are the most reliable and easily available way to prevent the spread of HIV,’ he said. ‘Unfortunately, the government has its head in the sand or is just deferring too much to conservatives.’

More than just safe spaces

LoveYourself is in the process of adding more condom dispensers across Metro Manila. It aims to have 150 across the country by the end of the year.

The condom dispensers are the beginning of what LoveYourself wants the mobile app to become: a onestop place for sexual health promotion.

Pagtakhan hopes to offer awareness videos, sex diaries, condom promotions, PrEP, and other HIV and sexual transmitted diseases prevention efforts.




Safe injection sites a success in Canada

San Francisco’s safe injection site initiative is modeled after a program in Canada that started in Vancouver.

We spoke with people there about how that program is working.

Doctor MJ Malloy is with the British Columbia Centre on Substance Use.

“In the first four years the facility was open, there were over 1,000 overdose events within the facility itself,” said Dr. Malloy.

A model of what a safe injection site could look like is now open in San Francisco. Here’s a tour of the facilities.

He’s been studying the impacts of safe injection sites like this one in Vancouver, called Insite. It opened in 2003.

Now San Francisco is hoping to open one as well.

“The primary objective of insite are to reduce the risk of disease transmission, and in particular HIV and hepatitis C. To reduce deaths from overdose and to increase uptake of medical care,” said Dr. Malloy.

Here’s how it works: An addict walks into a center with heroin he bought on the streets, then shoots up with a nurse watching. That addict then relaxes in the “chill out” room, where he can talk with case workers who may convince him to go into rehab.

Researchers say the safe injection sites work.

There are now roughly two-dozen similar centers open across Canada.

Dr. Malloy said, “We found that rates of fatal overdose in the area around insite declined 35-percent after the facility opened -versus 9-percent in the rest of the city of Vancouver.”>

There was also 30-percent increase in people getting into detox and in new HIV infections have declined 96-percent.

But isn’t just addicts who experienced a significant change. Like in San Francisco, neighbors were concerned safe injection sites would lead to an increase in problems in the neighborhood. It didn’t happen.

“Which really makes sense because instead of people injecting in back alleys or parking garages they were injecting at insite, so they were out of the public’s way,” said Dr. Malloy.

Public opinion polls in Vancouver show support for the safe-injection sites at around 80%.

by Ken Miguel

Free cannabis offered at B.C. clinic to help illicit drug users detox

Cannabis was once considered by many a dangerous gateway drug that could lead smokers to experiment with stronger drugs on the street.

But could smoking weed actually be an effective tool to kick addiction? That’s the hypothesis at High Hopes, Canada’s first full-time cannabis harm reduction program.

Based out of Vancouver’s East End, ground zero for the deadly opioid crisis, the clinic provides addicts with free or low-cost marijuana and cannabis-derived oils to help them stop using illicit drugs.

The program has been effective, organizers say. Of the 100 people registered in the program over the last year, up to 50 per cent are taking fewer street drugs, and 25 per cent are off opioids altogether. The success appears to support promising preliminary research out of the University of British Columbia that suggests daily cannabis use significantly lowers the risk of overdoses.

Co-ordinator Sarah Blyth opened the clinic last year after consulting with drug users looking for help.

“It gives them a way to have an alternative to the drugs that they’re getting on the street. It’s safe, it can reduce pain,” Blyth told CTV News.

The program started by collecting cannabis donations from patients with licences from Health Canada. It has since accepted help from what Blyth calls the “grey market” – local dispensaries that are not yet legal.

High Hopes also offers CBD oil, which does not contain marijuana’s psychoactive ingredient, THC, and is touted as an aid for anxiety, pain relief and inflammation.

Last year, nearly 4,000 Canadians died of opioid overdoses. About 1,400 of those deaths, or about one in three, were in B.C. The province announced plans Wednesday to launch a class-action lawsuit that alleges 40 pharmaceutical companies falsely marketed opioids as less addictive than other painkillers.

The clinic is operating well before cannabis becomes legal nationwide on Oct. 17. But Blyth said waiting wasn’t an option.

“What we are doing is not fully legal but we see it helps and we are desperate to help people,” she said. “Watching people die isn’t OK.”

Melanie Pratt credits marijuana with helping her detox. She turned to cannabis after nearly losing her arm when a needle broke while injecting crystal meth. She underwent treatment in hospital where she swore to quit illicit drugs.

Pratt says smoking marijuana helped her eat, sleep and find peace.

“If you’re not withdrawing or feeling any pain, then you feel good. And I just think it’s a lot less harmful than other drugs,” said Pratt, who volunteers at High Hopes.

Dr. M-J Milloy, a UBC research scientist, has a soon-to-be-published study that found drug users who used cannabis once a day were significantly less likely to suffer an overdose.

The research followed 1,461 participants, including HIV-positive illicit drugs users and street-involved youth.

Researchers say the study is the first of its kind to observe the connection. But they warn that more studies are needed before making any firm conclusions.

Regardless, the findings are promising, Milloy said.

“So this seems to indicate cannabis might be almost a sort of ad hoc harm reduction strategy by people who are trying to control or change their use of other drugs,” Milloy said.

Milloy and his research team are planning a clinical trial to further test their findings.


B.C. mothers call for an end to stigma surrounding drug use and overdose

‘Some days I can barely even breathe. I just can’t believe [he] is gone.’

Each piece of yarn in Judith Conway’s display represents a person who died of overdose in Canada in 2017. Her count is currently at 3,987 lives. (Submitted by Judith Conway)

On Friday, International Overdose Awareness Day will be observed in communities all around the world.

In B.C., mothers whose children have either died of an overdose or suffer from drug addiction are calling on the public to increase awareness of the opioid crisis.

“Some days, I can barely even breathe. I just can’t believe that Matthew is gone,” Judith Conway told On the Island guest host David Lennam, speaking from Comox of her son who died of a fentanyl overdose last year.

He was 30 years old.

“I realize that people need to shut down the shame. People need to start talking about it. We need to stop the silence.”

So, Conway decided to create her own memorial display in her backyard. She says it honours not only Matthew’s life, but the lives of others lost to overdose. Part of the display features pieces of yarn, each one representing a deceased person. There are 3,987 pieces of yarn, according to Conway.

Matthew Conway died on an overdose in November 2017. He was a CrossFit trainer and manager of a gym in Port Coquitlam. (Submitted by Judith Conway)

Increasing awareness

Matthew’s first experience with opioids was after an accident, said Conway.

“From then, things went really downhill. It was very difficult for him to get proper help from the medical profession. He desperately felt alone and desperately felt shame.”

Conway said that most people did not know that Matthew was afflicted with addiction. He worked as a CrossFit trainer and manager of a gym in Port Coquitlam up until the end of his life.

Conway is calling for changes to public policy around drug use.

“[That might] mean helping them medically come down from the opioids, instead of treating them like they are just addicts,” said Conway.

Sandra Tully from Kamloops lost her son, Ryan, to an accidental overdose of fentanyl in January of 2016.

She and others involved with promoting International Overdose Awareness Day are urging people to display a purple ribbon or simply wear purple on Friday.

Tully is a member of “Moms Stop the Harm,” a network of Canadian families whose loved ones have either died of overdose or hope to recover from addiction.

She told Daybreak Kamloops host Doug Herbert that a lot of the people dying are those who experimented with drugs a few times or who party on the weekends. It is not just addicts.

Judith Conway’s memorial: each coloured flag represents a person from B.C. who has died of an overdose. The white flags represent those who are predicted to die of an overdose this week. (Submitted by Judith Conway)

“Aug. 31 is a day of remembrance,” said Tully Tuesday at Kamloops city council.

“A time to shed light on the stigma surrounding substance use and offer compassion to those in the throes of addiction. A time to declare that we are in the midst of a deadly opioid crisis that affects all walks of life.”

Author: Laura Sciarpelletti 


‘American Circumcision’ Director Talks HIV and Toxic Masculinity

Director Brendon Marotta questions why the surgery is routinely done on infants in the U.S. and its ramifications.

The new documentary American Circumcision takes what may be the last, most stigmatized subject matter in America and powerfully questions the assumptions and pseudoscience that justify this practice of genital mutilation.  Parts of it are difficult to watch especially where they concern “botched circumcisions” that resulted in nearly severing the child’s penis. More revealing though is the suggestion in the film that the routine surgery done on infants leads to a particular kind of PTSD that may contribute to what we refer to as “toxic masculinity” now. According to director Brendon Marotta, “Even the most pro-circumcision doctor in our film admits the pain from circumcision creates a lasting change in behavior that has been scientifically proven. Change in behavior is a form of memory, what in this case is known as somatic memory.”

Marotta continues, “When it comes to toxic masculinity or rape culture, one of our interview subjects notes that circumcision teaches men that if you are bigger and stronger than someone else, you get to do what you want to their body. It teaches this in their first shared sexual experience, the first time someone else touches their genitals, and in the relationship all other relationships will be patterned on, their relationship with their mother.”

Marotta understands that some people might have some resistance to this information and underscores his point by adding, “Imagine a friend told you when he was an infant, his parents paid someone to cut off his pinky finger without anesthesia. Would it be hard to accept this experience was formative in some way? If he told you he felt he had lasting trauma, would you believe him? Which is more personal — a finger or the penis?”

Just one example of how this manifests itself is in how circumcised men have sex.

Marilyn Milos one of the film’s subjects says, “When you alter the genitals you alter the mechanics of sex,” which Marotta says refers to the gliding mechanism of the foreskin. “In intact sex, the foreskin glides over the head of the penis, and allowing it to stimulate itself. The penis is actually meant to have moving parts that work together. When we remove these parts, the penis is stimulated through friction, rather than gliding. The man needs longer strokes to cover the same surface area. So the entire mechanics is changed.”

Milos is the founder of the National Organization of Circumcision Information Resource Centers (NOCIRC) and one of the central, compelling voices in the film. Milos, a retired registered nurse and sexual abuse survivor,  sees a connection between the “arousal state that is engendered when the penis is scrubbed right before the incision is made” akin to the sexual abuse she endured as a child.

Americancircumcision Marilynmilos

Marilyn Milos, RN, Founder of NOCIRC 

Marotta became interested in the subject during a period of his life where he was letting go of old beliefs and exploring things that had happened to him as a child. After running across this issue, Marotta had what one of his interview subjects calls, “ ‘the obsessive epiphany’ where you research everything you can about the subject. That research lead to the film, because I felt compelled to share what I was learning with others.”

“Circumcision,” Marotta says, “affects men in the most personal way possible. It affects partners of men, parents and children and yet no one has ever made a documentary about it on this scale. When circumcision is discussed in American media, it is typically viewed as a one-time decision that parents make and never have to think about again. The truth is it’s more like dropping a stone in a pond — a decision that ripples through that man’s life — through his sexuality, his body, his self-image, his relationships, his feelings, his culture, religious institutions, medical institutions, and even through the laws of his country — for the rest of his life.”

Brendon Marotta 750x422 Copy

Brendon Marotta, director of the film American Circumcision. 

In the film, Marotta also challenges another conventionally held belief — that circumcision prevents HIV — which is widely practiced in Africa now — and interviews the authors of the HIV circumcision studies and their critics. “The authors of those studies acknowledge that the circumcised men tended to have a higher rate of condom use. So the African studies are not circumcision studies, they are condom studies. They show that condoms lower the rate of HIV transmission, which we all know.”

Marotta confesses, “Honestly though, those studies have so many methodological issues that the first edit of the sequence on the HIV studies was nearly an hour. I’ll probably release that edit as a bonus feature in October. Unfortunately, most people only read the headlines, and don’t get into the data. I could spend paragraphs on the data here, but I think most people instinctively know: you can be circumcised and still get HIV. The studies are not relevant to the United States, and don’t address the larger questions about sexuality, and human rights.”

Multiple interview subjects in the film suggest the HIV studies are, “Scare tactics by pro-circumcision,” advocates, “Yet millions of dollars are run through these programs. $40 million from PEPFAR, more from The Bill and Melinda Gates Foundation, The Clinton Foundation… Undoubtedly, there is a story here, one that goes beyond the scope of our film.”

However he adds, “These organizations are spending millions of dollars to set up circumcision clinics in places that do not have clean drinking water. People are being trained to do the procedure, but not fix complications or botches, of which there are many even in the United States. One doctor I interviewed makes most of his living fixing circumcision botches, and even admits that you can make more money fixing the complications when it goes wrong than doing it right the first time. So it isn’t just scare tactics but a selective focus. While you’re looking at the HIV issue, you’re not looking at the other effects of these programs: the botches, the money (that could be going elsewhere), the human rights issues, the ethical issues, the impact on sexuality…”

Marotta thoughtfully concludes, “The entire American circumcision debate suffers from this selective focus. Our goal with the film is to expand your awareness.”

Author: Savas Abadsidis


Infectious Diseases on the Rise Amid the Opioid Epidemic

In a recent Association of Health Care Journalists (AHCJ) webcast, 2 public health experts discussed the recent rapid increase in the incidence of infectious diseases that has been linked with injection drug use (IDU).

Jonathan Mermin, MD, MPH, Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), US Centers for Disease Control and Prevention, Atlanta, Georgia, shared a national perspective on this problem.

More than 600,000 Americans have died from opioid overdose since 2000, he said. Of particular concern, he added, is the interconnectedness between drug overdoses and reports of new cases of hepatitis C virus (HCV) infection.

The United States has seen a steady rise in the incidence of HCV cases since 2010, including doubling of the number of reports of pregnant women infected with the virus; this surge in HCV incidence is linked to IDU with sharing of needles, Dr. Mermin explained.

“We are also seeing an increase in the proportion of HIV infections,” he said. Progress made in recent decades with respect to declining HIV rates associated with IDU is now leveling off, and even reversing, because of the opioid crisis, he noted. In addition, hepatitis A outbreaks have also become a crisis for some states, especially among adults experiencing homelessness.

Cases of syphilis are also on the rise in the United States. This includes congenital cases, said Dr. Mermin, reports of which have increased 176% since 2012. He noted that 88,000 cases of syphilis were reported in the United States in 2016. Increasing numbers and proportions of cases of syphilis in heterosexual individuals are occurring among people who use drugs, said Dr. Mermin, including among those who inject drugs.

Jay Butler, MD, chief medical officer and director, Division of Public Health, Alaska Department of Health and Social Services, also shared his state-level perspective from working on the front-lines of the opioid crisis in Alaska.

In 2017, approximately 1 in 30 of all deaths in Alaska were associated with opioid overdoses, he said.

The opioid epidemic in Alaska is a very dynamic one, he noted. Although the state had made progress with respect to reducing the numbers of death associated with prescription painkillers and heroin, Dr. Butler noted that these gains have now been wiped out due to the emergence of illicit fentanyl in recent years. This epidemic is different, he said. “We’re now seeing clusters of deaths. And, many users do not even realize they are taking fentanyl—they think it’s heroin.”

The rise in infectious disease cases is an increasing challenge, too, said Dr. Butler. For example, Alaska has seen an increase in the rate of HCV diagnoses among individuals younger than 30 years since 2015. Self-injection drug use is a major driver behind the HCV epidemic, he explained.

Alaska was the second state to issue a disaster declaration on the opioid epidemic, said Dr. Butler. And statewide efforts are now underway to address the opioid crisis, he added. These center on a 3-pronged approach to managing addictions and substance-use disorders that targets: harm reduction to prevent life-threatening adverse outcomes (for example, by increasing access to naloxone and to syringe/needle exchange programs); diagnosis and treatment (including removing the associated stigma, and understanding addiction as a chronic disease of the brain); and prevention (for example, by encouraging judicious opioid prescribing and holding drug take-back events).

At the national level, CDC has taken a 5-point strategy to prevent opioid overdoses and harms, said Dr. Mermin. These focus on: conducting surveillance and research; improving state, local, and tribal efforts to prevent overdoses and harms; supporting health care provider and health systems; raising awareness about opioid use disorder and the severity of the epidemic, to empower people to make safe choices; and improving collaborations between public health officials and public safety officials.

He emphasized the importance of introducing comprehensive syringe service programs (SSPs) at the community level. These cost-saving programs prevent infections, he said, and do not increase drug use or crime in communities. Indeed, people who use SSPs are 3- to 5-times more likely to stop injecting drugs.

“Large-scale public health action and targeted, comprehensive, community-wide programs can prevent infections, reduce drug use, save lives, and save money,” Dr. Mermin concluded.