Lewis and Clark County does not offer a needle exchange program, despite a spike in rates of HIV infection among injection drug users in Montana and the availability of funds to provide or support programs to distribute clean needles.
The Montana Department of Public Health and Human Services recently announced it investigated 11 new cases of HIV in the first six months of 2018. Almost half of the people infected in 2018 listed injection drug use as a risk factor, while only 22 percent of people infected last year reported injection drug use.
The risk of becoming infected with HIV is high if a person shares needles or injection equipment because sharing needles is a direct route of transmission. A recent effort by legislators and the state health department is working to discourage risky behavior, while also helping people who are engaged in risky behaviors minimize exposure to HIV.
A bill passed by the 2017 Montana Legislature allows certain organizations to provide a needle exchange program to prevent the spread of disease, including HIV and other transmittable diseases like hepatitis B and C. And while there are state dollars and federal dollars from the Centers for Disease Control and Prevention available for local organizations to fund or support needle exchange programs, the Lewis and Clark County Public Health Office said it doesn’t have the infrastructure to start one.
“It’s logistics as much as anything,” said Eric Merchant, administrator of disease control at the county’s public health office. “We would love to have that in place. It’s just not as simple as taking the money and doing it.”
Merchant said the program would require a lot of education and outreach, staff resources and finding a way to dispose of medical waste.
“Logistics aren’t something we’re on top of at this point,” Merchant said.
Officials at Lewis and Clark Public Health said they weren’t sure where injection drug users were getting needles. In Montana, there are few exchange programs listed on the DPHHS's website. For people in Lewis and Clark County, the closest exchange location is the Trinity Community Center in Butte.
Several providers said they operated underground needle exchange programs until state law was changed. The Bozeman Chronicle previously reported Connections, a nonprofit in Bozeman, helped drug users get clean needles before the law was changed, but now operates a program called Friends with a Point.
A spokesperson from the state health department said they knew some people traveled to exchange sites and others purchase needles at a drug store since a prescription is not required in Montana.
The main goal of needle exchange programs is to limit the transmission of disease by collecting dirty needles and providing clean ones, but providers are also trained to have a conversation with people about the risks and how to lower them, as well as options for treatment.
“In an ideal world I’d have the program to disrupt the transmission of disease,” Merchant said. “But a syringe exchange program is a small piece of the overall picture.”
While the county isn’t actively working on establishing a needle exchange program in Helena, it does operate an HIV prevention program administered by the state.
Shelly Maag, the public health nurse supervisor, said the program helps people get free testing, counseling and refers them to a host of other services. Maag said the county is responsible for reaching out to people who are high-risk individuals, meaning intravenous drug users, men who have sex with men, people who are incarcerated, sex workers and people who have sex with HIV positive partners.
If someone comes in for testing, they can be counseled on how to reduce the risk of infection. Maag said she also refers people to a variety of services such as preventive medicine, treatment and housing options.
While the HIV Prevention program only covers people who fit the high risk criteria, Lewis and Clark Public Health offers free testing to anyone who requests an HIV test.
“That’s just something we decided to do,” Maag said.
While services are always offered in the office, Maag said her staff make an effort to offer testing at events or will visit different locations in the Helena area.
Maag’s office also is working to address transmission of disease beyond HIV. She said the county sees more people testing positive for hepatitis C, which can lead to severe liver disease.
To limit exposure to HIV and hepatitis, the state health department recommends using only sterile needles, talking to partners about HIV and STDs and always using condoms. The department recommends discussing sexual history with a health care provider and asking about getting tested.
Maag said she mostly speaks to patients who are in recovery, so it’s a priority to ask if people were using cleaning needles.
“We do hand out ‘works’ kits, but it doesn’t include needles,” she said.
“Works,” or the materials needed to inject drugs, typically include spoons to cook drugs, cotton balls and a container for used needles.
According to DPHHS, part of the HIV prevention grant allows contractors to offer a syringe exchange service as long as it includes education and counseling, distribution of condoms, provision of naloxone and referral to medical services.
A spokesperson from the state said Lewis and Clark County did not request support for a needle exchange program, but could request those funds in the next grant cycle.
A full list of services available in Montana and information on HIV and STDs are available on the state health department website.