HIV outbreak hits America

I have been avoiding reading the stories about the HIV outbreak in Indiana, USA, because, frankly, comparatively speaking it just seems paltry (95 confirmed cases so far) compared to the incidence of HIV in other lesser developed countries with thousands living with HIV.

But by definition it is an outbreak. A disease outbreak is the occurrence of cases of disease in excess of what would normally be expected in a defined community, geographical area or season. An outbreak may occur in a restricted geographical area, or may extend over several countries. It may last for a few days or weeks, or for several years.

I have to admit I don’t talk much about HIV transmission through sharing needles because I would like to think in Malawi there is not much drug abuse — at least not of the injecting drug kind. But there are always lessons to be learnt!

Last month the state of Indiana declared a health emergency after health officials reported more than 70 HIV-positive tests since December 2014, far more than the five cases typically found in Scott County (Indiana) each year. There have now been 106 HIV-positive tests related to the outbreak, including 95 confirmed and 11 preliminary cases.

The spread of HIV, which causes Aids, has been linked to the use of contaminated syringes and the painkiller Opana in the area. Almost all of the confirmed HIV cases have been from Austin, a rural city of about 4 200 people.

Misuse of prescription opioids has become a national concern in America, with more than 16 000 deaths attributed to it in 201. Opana is powerful prescription pain medication prescribed only in pill form but people are now abusing it and injecting it illegally. A way to curb the sharing of contaminated needles is to have a needle exchange programme where people can exchange used ones for sterile syringes but this a big debate in the USA. Some say this encourages illegal drug use and other say it will prevent spread of HIV. In my mind, it is a nonstarter, like the debate about whether condoms promote promiscuity or safer sex.

For a small period the ban on needle exchange programme has been lifted in Indiana. What are the lessons here for Malawi? A reminder that as there are many modes of HIV transmission, prevention programmes should consider all options; education and awareness about prevention is very important.