Hepatitis C Harm Reduction Project

San Francisco/Bay Area Syringe Exchange Programs

For those of you looking for a syringe exchange program in and around California's Bay Area, here's a great list of all the programs with locations and hours, covering the following counties:  Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo, Santa Clara, and Sonoma.

There's also a list of phone numbers for syringe exchange programs in Fresno, Lake Co., Mendicino/Ukiah, Monterey/Salinas, Sacramento/Davis, and Santa Cruz.

Also included: information about safer injection and legal status of syringe possession, and services offered at each site -- some offer hepatitis C testing and vaccination for hepatitis A and B, as well as HIV testing, overdose prevention and naloxone distribution, and other medical care.

Click on the link below for a 2-page PDF file:

Download san_franciscobay_area_syringe_exchange_january_2006.pdf

Thanks to Catherine Swanson from Points of Distribution for putting this great resource together.

Presentations from the National Viral Hepatitis Prevention Conference

The CDC has posted slides from last week's Viral Hepatitis Prevention Conference.  There were a lot of talks on hepatitis C and injection drug users (IDUs) -- be sure to check out the slides from Thursday's plenary session on hep C prevention for IDUs, particularly the talk by Steve Jones [link to PowerPoint file] that brings together epidemiology, ethnographic observation, and issues for prevention programs.

How Can You Prevent Hep C?

We've launched our hepatitis C social marketing campaign with a series of posters in New York City bus shelters.  The first series of posters focus on prevention -- they're in English and Spanish, scattered around the Bronx, East and Central Harlem, and Brooklyn.

We'll be rolling out related material on hepatitis C prevention in the coming weeks -- for now, here's the text that appears in the bottom of the poster:

Works, sets, rigs, gizmos. Cooker, spoon, cotton, filter, water. Whatever you call them, use them safely when you inject drugs. Hepatitis C is a virus spread through blood that can cause liver disease. So go to a needle exchange or ESAP pharmacy* and take care of yourself and your friends: use a new set each time you inject.

* ESAP pharmacies can sell syringes to drug injectors.  See this post for information about ESAP, and hours & locations of needle exchange programs in New York City.

More poster images available here (including pics with our project's Jen Curry, and the Harm Reduction Coalition's Executive Director Allan Clear).  Right-click on the following links to download larger images of the prevention poster (be patient -- they're big files, in JPEG format):

English and Spanish

Special thanks to our excellent designer, Shawn Torres -- see more of his work here.  Additional thanks to our photographer, Jose A. Arias.

Needle Exchange Programs in NYC

Here's a current list of needle exchange hours and locations in New York City.  We'll do our best to keep this updated, but schedules can change, so it's a good idea to call first.

Many pharmacies also sell syringes over the counter to drug injectors, through New York state's Expanded Syringe Access Demonstration Program (ESAP) -- information about ESAP here, participating pharmacies here.

Follow the link below for needle exchange schedules, organized by borough.

Needle Exchange Stalled in New Jersey

From the Kaiser Daily HIV/AIDS Report:

New Jersey Appeals Court Issues Temporary Injunction Blocking Needle-Exchange Programs in Atlantic City, Camden

The Mercer County, N.J., Superior Court Appellate Division on Thursday issued a temporary injunction to halt the launch of needle-exchange programs in two cities just two weeks before the programs were set to begin, the AP/Long Island Newsday reports. Atlantic City and Camden last year adopted ordinances creating needle-exchange programs and were scheduled to start the projects on July 1 (Delli Santi, AP/Long Island Newsday, 6/20). The cities planned to provide clean syringes for injection drug users in exchange for used ones, as well as referrals to health care providers, social services and addiction treatment programs if drug users asked for them (Livio, Newark Star-Ledger, 6/21). State health officials say the programs would help curb the spread of HIV among injection drug users, who make up more than half of the state's 62,000 people living with HIV/AIDS (Colimore, Philadelphia Inquirer, 6/21). The two cities, along with seven others, were invited by the state to apply for the programs under an executive order signed by former New Jersey Gov. James McGreevey (D) in October 2004. The order declares a "state of emergency" until Dec. 31, authorizes the state health department to administer needle-exchange programs in cities that meet specific requirements and allows up to three cities in the state to establish needle-exchange programs (Kaiser Daily HIV/AIDS Report, 5/20). Appellate Court Judge Stephen Skillman issued the injunction, which was requested by seven state lawmakers who say McGreevey had no authority to sign the order (Newark Star-Ledger, 6/21). The programs now will be postponed pending arguments about their legality (AP/Long Island Newsday, 6/20). An appellate panel will rule on the case after hearing briefs and oral arguments (Philadelphia Inquirer, 6/21).

Stayed tuned, and check for updates from the Drug Policy Alliance's New Jersey office.

Holly Hagan on Hep C and Drug Use

Attached are the slides from Holly Hagan's plenary talk on the epidemiology of hepatitis C and injection drug use in New York, from our recent conference.  Her presentation suggested that we're getting closer to understanding the dynamics of the hepatitis C epidemic among injection drug users (IDUs), and that while prevention will be difficult, it may not be impossible.

Here are some of her conclusions (adapted from her last slide):

HCV is easily transmitted and difficult to prevent -- we can’t apply what we know about HIV prevention to HCV and expect the same results.

However, variation in prevalence and incidence indicates that there are cases where HCV spreads more slowly:

Prevalence between 30 - 90%

Time to HCV seroconversion: 1.5 - 3.5 years from initiating drug injection

This is logical, because not all IDUs are alike and not all injection settings are alike.

We need to study this variation, to understand how we can alter behavior, beliefs and settings to reduce HCV transmission.

For more, see the full set of slides -- and check out the upcoming National Viral Hepatitis Prevention Conference in December, 2005.

Download epi_of_drug_use_and_hcv_in_nyc_hagan_2005.ppt [PowerPoint file]

Hepatitis at the National Harm Reduction Conference

The Harm Reduction Coalition (HRC) is holding its 5th National Conference, "Working Under Fire: Drug Users Health and Justice 2004" in New Orleans next month.

HRC's conference is a major event in the harm reduction world, bringing together advocates and researchers, drug users and program staff to discuss the latest information, program models, and advocacy strategies.

The conference agenda is filled with workshops and presentations on a range of harm reduction topics. Several sessions address hepatitis C and drug users.

Hepatitis highlights from the conference:

Hepatitis Services at New York City Syringe Exchange Programs

Narelle Ellendon, my colleague at the Hepatitis C Harm Reduction Project, has produced a great chart of New York City needle exchange programs, with addresses, hours of operation, and hepatitis services offered: Download the chart as a Microsoft Word file

Hepatitis A and IDUs

When we think of viral hepatitis and injection drug users (IDUs), we usually think of hepatitis C. But hepatitis A also poses a significant threat to IDUs. Here's why:

Hepatitis A can be transmitted through blood, so sharing needles and injection equipment (cookers, cotton, water) could put IDUs at risk for hepatitis A

A study in Baltimore from the mid-1990s found that 66% of IDUs had been infected with hepatitis A (see PDF of article from Clinical Infectious Diseases). More recently a Vancouver study found evidence of past hepatitis A infection in 43% of IDUs (full text of article from Canadian Medical Association Journal; PDF here)

The Centers for Disease Control (CDC) reports that 5% of all new cases of hepatitis A in the United States occur among IDUs – but since half of all new cases have no reported risk, this figure may underestimate the rate of new infections in IDUs.

Hepatitis A is rarely fatal. But if you already have hepatitis C, getting hepatitis A can cause fatal liver failure (see abstract in New England Journal of Medicine).

The good news is that hepatitis A is almost totally preventable through vaccination. Injection drug users and people with hepatitis C should be vaccinated for hepatitis A.

Call for Increased CDC Funding for Hepatitis C

A coalition of hepatitis C advocates is asking organizations to sign on to their request to Congress to increase funding to the Centers for Disease Control (CDC) for hepatitis C. Funding would be used towards implementing the CDC National Hepatitis C Prevention Strategy and recommendations from the National Institutes of Health's 2002 Consensus Statement on the Management of Hepatitis C.

From the CDC's Executive Summary of the national prevention strategy:

"The goals of the National Hepatitis C Prevention Strategy are to lower the incidence of acute hepatitis C in the United States and reduce the disease burden from chronic HCV infection. Achievement of these goals requires: 1) harm reduction programs directed at persons at increased risk for infection to reduce the incidence of new HCV infections; 2) counseling, testing, and medical evaluation and management of infected persons to control HCV-related chronic liver disease; 3) surveillance to evaluate the effectiveness of prevention activities; and 4) research to provide answers to questions pertinent to the prevention and control of hepatitis C."

The full strategy, released in 2001, is available as a PDF file here.

Here's the message from hepatitis C advocates:

The National Hepatitis C Advocacy Council (NHCAC) needs your organizations support!

Below is a sign-on letter to show your support for the increased hepatitis C
appropriations requested by members of National Hepatitis C Advocacy
Council. NHCAC has delivered this letter to Senators and Congressmen
supporting the “Hepatitis C Epidemic Control and Prevention Act.”

WHO SHOULD RESPOND: Organizations serving people with, or at risk for,
hepatitis C (Please do not sign as individuals, if you are not a member of
an organization but are in support of the appropriation request and your
local group is not listed, call your local organization, make sure they are
in support of this and are signing on. Also, please register yourself and/or
your organization for our “Legislative Update” email action alert list at
the NHCAC website.)

WHEN SHOULD YOU RESPOND: Organizations wishing to sign on should e-mail by 5 pm EST, Wednesday, April 14, 2004.

WHERE SHOULD YOU RESPOND: Send emails to Lorren Sandt.

The “Hepatitis C Epidemic Control and Prevention Act” can be viewed here.

Please help distribute this letter and encourage organizations to sign-on.

Full text of the letter appears below.