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Democratic Sen. Edward J. Markey said that the Trump administration’s plan to use funds from HIV and AIDS programs to fight the opioid addiction crisis is unsound. Specifically, the Massachusetts senator said that increased opioid abuse has led to an increase in HIV and AIDS.
The administration’s Oct. 26 declaration of the opioid epidemic as a national public health emergency allows flexibility in the use of resources in HIV and AIDS programs to allow people eligible for those programs to get substance abuse treatment.
"The administration’s proposal to reallocate funding from HIV/AIDS programs to the opioid crisis is robbing Peter to pay Paul, especially as HIV and AIDS rates spike due to increased heroin and fentanyl use," Markey said in an Oct. 26 statement.
We wanted to know if increased use of heroin and fentanyl have led to increased rates of HIV and AIDS. We found some truth to Markey’s claim but not enough national data to fully back it.
The Centers for Disease Control and Prevention told us it does not have data specific to heroin and fentanyl, and estimates that HIV and AIDs diagnoses have declined in recent years among people who inject drugs. Still, there are risks associated with opioid injections and HIV transmissions, as was the case in an Indiana county.
More than 64,000 people died in 2016 from drug overdoses, the majority linked to opioids, which include the synthetic opioid fentanyl and the illicit drug heroin, according to the CDC.
Increased availability, a relatively low price and the high purity of heroin in the United States are driving increased use of heroin, the CDC said. Fentanyl use, including illicitly-made fentanyl, has also increased in recent years.
People who inject drugs are at risk for infectious diseases that can be transmitted through used needles and syringes.
Human immunodeficiency virus, or HIV, is most commonly acquired or transmitted through sexual behaviors and needle or syringe use. If not treated, HIV can lead to acquired immunodeficiency syndrome, or AIDS.
The CDC’s HIV Surveillance Report, 2015, noted that HIV and AIDS diagnoses tied to injection drug use declined from 2010 to 2015. The report did not specify diagnoses by types of drugs injected.
From 2008 to 2014, estimated annual HIV infections among people who inject drugs declined 56 percent (from 3,900 to 1,700), according to February 2017 data from the CDC. That report did not include AIDS data.
Experts we reached said they were not aware of reports showing a national spike in HIV and AIDS among injection drug users, but noted that data collection and reporting tends to lag.
"It is very possible that increased HIV transmission due to fentanyl and/or heroin use is occurring" but have not yet been identified through HIV testing and screening or have not yet been reported to CDC, said Brandon Marshall, an associate professor of epidemiology at the Brown University School of Public Health.
When we contacted Markey’s office, they highlighted reports about HIV spikes in Scott County.
Scott County historically had fewer than five cases of HIV infection reported annually, CDC reported. By April 21, 2015, Indiana officials had diagnosed HIV in 135 people in a small community within Scott County.
Most of them reported injection drug use with oxymorphone as their drug of choice, said CDC’s May 2015 report, adding that some reported injecting heroin.
Since early 2015, at least 191 people had tested positive for HIV in Scott County, the Indiana State Department of Health said in April 2016.
"The outbreak in Scott County turned a floodlight on the intertwined nature of opioid use, HIV, and (hepatitis C virus) … It’s possible that the opioid epidemic could already be having a similar impact in other communities," said a June blog post by Richard Wolitski, director of the office of HIV/AIDS and Infectious Disease Policy at the U.S. Department of Health and Human Services.
A CDC analysis published November 2016 found that at least 220 counties in 26 states are "potentially vulnerable" to HIV and hepatitis C infections among persons who inject drugs "in the context of the national opioid epidemic."
Markey said, HIV and AIDS rates have spiked "due to increased heroin and fentanyl use."
There are risks for HIV transmission among people who share needles and syringes to inject opioids. An Indiana county recently had an HIV outbreak linked to the injection of opioids, including heroin. At least 220 U.S. counties may be at risk of similar outbreaks.
But the CDC said it does not have national data addressing Markey’s heroin and fentanyl claim, and estimates that HIV and AIDs diagnoses have declined in recent years among people who inject drugs.
Markey’s statement contains an element of truth but ignores critical facts that would give a different impression. We rate it Mostly False.
Sen. Edward J. Markey, Senator Markey on Trump Opioid Announcement: A Vision Without Funding Is An Hallucination, Oct. 26, 2017
PolitiFact, Donald Trump declares public health emergency over opioid crisis. Here’s what that means, Oct. 30, 2017
White House, President Donald J. Trump is Taking Action on Drug Addiction and the Opioid Crisis, Oct. 26, 2017
Centers for Disease Control and Prevention, Community Outbreak of HIV Infection Linked to Injection Drug Use of Oxymorphone — Indiana, 2015, May 1, 2015
Centers for Disease Control and Prevention, Provisional counts of drug overdose deaths, as of Aug. 6, 2017
Centers for Disease Control and Prevention, Hepatitis Surveillance Report, May 11, 2017
Email interview, Brandon Marshall, associate professor of epidemiology at the Brown University School of Public Health, Oct. 30, 2017
Email interview, Cora Lynn Bernard, PhD Candidate in Management Science & Engineering at Stanford University, Oct. 31, 2017
Indiana State Department of Health, HIV testing hours extended at Scott County One-Stop Shop, April 26, 2016
The New England Journal of Medicine, HIV Infection Linked to Injection Use of Oxymorphone in Indiana, 2014–2015, July 21, 2016
Centers for Disease Control and Prevention, HIV Surveillance Report, 2015; vol. 27. Published November 2016
Centers for Disease Control and Prevention, CDC Fact Sheet: HIV Incidence: Estimated Annual Infections in the U.S., 2008-2014 Overall and by Transmission Route, February 2017
Centers for Disease Control and Prevention, HIV and Injection Drug Use, Page last reviewed and updated March 16, 2017
Centers for Disease Control and Prevention, HIV and Injection Drug Use, Page last reviewed and updated Nov. 29, 2016
U.S. Department of Health and Human Services, Interconnected, Intertwined, and Colliding: Co-Occurring Epidemics of HIV, Viral Hepatitis, and Opioids, June 14, 2017
Journal of Acquired Immune Deficiency Syndrome, County-Level Vulnerability Assessment for Rapid Dissemination of HIV or HCV Infections Among Persons Who Inject Drugs, United States, Nov. 1, 2016
National Center for Biotechnology Information, County-Level Vulnerability Assessment for Rapid Dissemination of HIV or HCV Infections Among Persons Who Inject Drugs, United States, Nov. 1, 2016
National Center for Biotechnology Information, Increases in self-reported fentanyl use among a population entering drug treatment: The need for systematic surveillance of illicitly manufactured opioids, Aug. 1, 2017
CNN, Greatest rise in heroin use was among white people, study says, March 29, 2017
National Institute on Drug Abuse, Research on the Use and Misuse of Fentanyl and Other Synthetic Opioids, June 30, 2017
National Institute on Drug Abuse, Emerging Trends and Alerts
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