HomeMy WebLinkAboutMINUTES - 11142006 - C.154 FHS #61
TO: BOARD OF SUPERVISORS Contra
FROM: Family and Human Services Committee Costa
DATE: November 14 2006 County
ST`4 COUPI'C; ,!
SUBJECT: HIV PREVENTION C j
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
ACCEPT the attached report and recommendations presented by the Public Health Director on
needle exchange as part of a comprehensive HIV prevention program, as recommended by the
Family and Human Services Committee.
FISCAL IMPACT:
None.
BACKGROUND:
This issue was originally referred to the Family and Human Services Committee for monitoring in
2002. Since that time the Health Services Department has been reporting on the needle
exchange program, funding, health care needs and referral services. In 2006, state law
changed to allow local implementation of needle exchange services without a biweekly
declaration of emergency provided that an annual presentation is made and community is
allowed to provide public comment. This report constitutes the annual report to the Board of
Supervisors on the status of the clean needle and syringe exchange project.
CONTINUED ON ATTACHMENT: YES SIGN URE:
_ '.ECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S):
MARK DeSAULNIER,Chair FEDERAL GLOVER,Member
ACTION OF BOARD ON (L APPROVE AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
UNANIMOUS (ABSENT —I� ) AND CORRECT COPY OF AN ACTION TAKEN
AND ENTERED ON THE MINUTES OF THE BOARD
AYES: NOES: OF SUPERVISORS ON THE DATE SHOWN.
ABSENT: ABSTAIN:
ATTESTED //
JOHN CULLEN,CLERK OF THE BOARD OF
SUPERVISORS AND COUNTY ADMINISTRATOR
Contact Person:Dorothy Sansoe 5-1009
CC: CAO
HSD
BY- ,DEPUTY
Contra Costa Health Services
Needle Exchange Update Report to Family&Human Services Committee
October 16, 2006
RECOMMENDATIONS
1) Accept this report on needle exchange as part of a comprehensive HIV
Prevention Program.
2) Direct the Health Services Department to continue supporting and monitoring
needle exchange services and report annually as required by law.
SUMMARY
In 2006, state law changed to allow the local implementation of needle exchange
services without a biweekly declaration of emergency provided that an annual
presentation is made and community is allowed to provide public comment.
The spread of HIV and Hepatitis C through the sharing of needles has long been a
concern in Contra Costa. While there is a downward trend in the number of cumulative
AIDS cases attributed to injection drug use (IDU), the percentage of new AIDS
infections attributed to IDU is actually higher in the last five years than in previous
years. Contra Costa continues to have a higher percentage of AIDS cases attributed to
IDU than California as a whole.
Reported cases of Hepatitis C and the number of infants with antibodies to HIV present
at birth have dropped since the state of emergency was first formally declared in 1999.
While it cannot be stated that needle exchange is totally responsible for the
stabilization, the availability of needle exchange as part of a comprehensive continuum
of services for injection drug users may contribute to this positive trend. Needle
Exchange services remain a necessary Public Health measure to reduce transmission of
blood borne diseases and should remain available in Contra Costa County.
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Contra Costa Health Services
Needle Exchange Update Report to Family&Human Services Committee
October 16, 2006
BACKGROUND
In 1999 the Board of Supervisors unanimously endorsed needle exchange as one component of
a comprehensive HIV risk reduction strategy to reduce the transmission of HIV and other blood
borne diseases attributed to injection drug use. The Board then declared a state of emergency
pertaining to injection drug use and HIV and renewed it on a biweekly basis as required by law.
On October 7, 2005, the Governor signed legislation (AB 547 / Berg) allowing counties to
replace the declaration of a state of emergency with an annual presentation at an open meeting
in which the public and other stakeholders are allowed opportunity to comment. The legislation
took effect January 1, 2006. Contra Costa Health Services Department completed the
necessary paperwork and received State authorization to implement AB 547.
On January 10, 2006, the Contra Costa Board of Supervisors:
TERMINATED the local state of Emergency first declared on December 14, 1999 due to
the existence of a critical local public health crises based upon the increasing and
epidemic number of AIDS/HIV and Hepatitis C cases in Contra Costa County, especially
among injection drug users;
AUTHORIZED the Health Services Department to administer, in consultation with the
State Department of Health Services, a clean needle and syringe exchange project
pursuant to Health and Safety Code section 121349 et seq; and
DIRECTED the Health Services Director to annually report to the Board on the status of
the clean needle and syringe exchange project.
DATA REVIEW
All data unless otherwise cited is provided by Contra Costa Health Department". Through
March 31, 2006, a total of 2,631 cases of AIDS have been reported in Contra Costa, with
Injection Drug Use (IDU) accounting for somewhat more than 27% of all AIDS cases ever
diagnosed. This rate remains higher than the state-wide rate of 19% of all reported AIDS cases
attributed to IDU (including men who have sex with other men and also inject drugs)2.
The number of new cases of AIDS reported over time has decreased significantly in Contra
Costa to an average of about 82 new cases per year in the last 5 years. The dramatic drop in
cases is attributed to improved treatment, earlier identification of symptoms and complications,
and a wider range of treatment therapies which slow the progression of HIV to AIDS. Similar
analysis among individuals with HIV only (not AIDS) is not available, as HIV reporting is not
considered reliable at this time. HIV non-names code was initiated in California in July 2002,
and in April of this year an emergency law changed code-based HIV reporting to names-based
reporting. However, implementation processes for names-based reporting are not yet fully
' Contra Costa Health Department Epidemiology, Surveillance and Health Data Unit. Special data runs and
HIV/AIDS Epidemiology Report,July 2006. www.cchealth.org_/uoups/epidemiology/aids/aidslinks.php
2 CA.Department of Health Services,Office of AIDS,Case Registry Section. CA AISDS Surveillance Report
Cumulative AIDS Cases as of July 31, 2006 www.dhs.ca.gov/ps/ooa/Statistics/default.htrn
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Contra Costa Health Services
Needle Exchange Update Report to Family&Human Services Committee
October 16, 2006
developed and very few counties are currently reporting HIV infections. Any HIV data cited in
this report refers to individuals reported by the Health Department prior to April 2006.
3
r
ALL AIDS and ID,U AIDS BY 5 YEAR
r ,, INCREMENTS OF DIAGNOSIS = . . ' �:
1200
< -r=ALL AIDS' —IPU AXD5
r r �
1000
600
400 ;
1200
O <'19911991 1995 '1996-2000. 2001-2006
77,
y
While there is a downward trend in the number of cumulative AIDS cases attributed to IDU in
Contra Costa, the percentage of new AIDS infections attributed to IDU is actually higher in the
last five years than in previous years.
F
�IDIJsviiithaAIDSas a,- Percent of A11 AIDS
Dia.gnoses`over Time:
� 35 r 30.5% 26.9°/0 32°0
IN25
` 20 ,
15
x y r s k
O
<1991 1991 1995 1996 2000 2001-2006;:
lz
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Contra Costa Health Services
Needle Exchange Update Report to Family&Human Services Committee
October 16, 2006
Currently there are 1,002 people living with AIDS (PLWA) and 692 individuals reported with
HIV in Contra Costa.
• IDUs are approximately 24% of those living with AIDS and 21% of those with HIV.
Nearly a third of all IDUs living with AIDS and more than 35% with HIV are female.
• Nearly 82% of IDUs living with AIDS and 90% of IDUs with HIV identify as
heterosexual.
• African Americans are 60% of all IDUs ever diagnosed with AIDS and 65% of IDUs
diagnosed with AIDS recently (2001 — 2006).
• Of cities with 10 or more cases of PLWA or HIV who are also IDUs, 44% are in West
County and 23% are in East County.
Other Data
The number of cases of reported Hepatitis C carriers has decreased dramatically since the state
of emergency was first declared in 1999. This drop can't be attributed exclusively to needle
exchange as a host of other factors such as changes in reporting, delayed diagnosis, etc., may
influence the decline.
e
y
Hepatitis C Carriers Over. Time
160
1400
' 1000 .,
600
r= 400
200
O
rhe h
� s
3
cchealth org/groups/epldemfology/other/August 2006
y
The number of infants testing positive for HIV antibodies at birth has also decreased over time,
from a peak of 42 children born between 1996-2000 to 19 children born between 2001 and
2005. Most of these children are expected to revert to negative status by two years of age.
Currently, 14 Contra Costa children have a diagnosis of AIDS.
Reports of needlestick exposures to law enforcement were also reviewed. A State form used by
law enforcement to report potential exposures to the State Office of AIDS is not consistently
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Contra Costa Health Services
Needle Exchange Update Report to Family&Human Services Committee
October 16, 2006
filed. None-the-less, of the 32 reported exposures from July 2000 —June 12, 2006, 4 were
needlestick injuries. A cross-check of data (n=71 incidents in FY 0506) from all sources
requesting follow-up assistance from Public Health identified 5 instances in which assistance
was requested for follow-up of a needlestick injury in FY 0506 — 2 of these cases were among
law enforcement (the non-law enforcement incidents would not be reported to the State.)
The Health Services Department is working with law enforcement to better complete and
submit these forms. Public Health staff provided an exposure reporting update to the Police
Chiefs and requested a designated safety contact at their September meeting. The Sheriff's
Department now has a designated Safety Officer who works directly with Public Health on all
potential exposures.
Alcohol and Other Drug Services Data
A review of AODS admissions data shows that injection drug users are about 21% of all
enrollments in the most recent 5-year period 3. An individual may have more than one
admission in a year. IDU enrollment in residential detox programs has increased from 13% of
enrollments in FY 0102 to 17% in 0506. The percentage of women enrolled in AODS services
has also increased over time, from 32% of all enrollments in FY 0102 to 39% in FY 0506.
NEEDLE EXCHANGE
Neither State nor Federal dollars can be used to purchase needles for exchange operations.
The Health Department provides $60,000/year for needle exchange services through a contract
with Community Health Empowerment (CHE). CHE's scope of work requires exchange services
twice per month in both West and East County, to 500 contacts in each area. CHE actually
operates and reports activities from 4 exchanges (Richmond, North Richmond, Pittsburg, and
Bay Point) on a weekly basis.
The projected annual expenses are approximately $91,000 and the total current income is
$62,500. The budget supports the Director and baseline supplies, but no other staff. The
fiscal agent, Greater Richmond Interfaith Program (GRIP), manages CHE funds and charges a
10% fee. Pittsburg Preschool Community Council provides staff support to the exchange
operating at the Pittsburg site. The Health Department identified some additional resources to
purchase templates for grant applications this fiscal year.
Needle exchange programs in the Bay Area vary widely in their total annual budgets and
methods of operation. Some programs provide services through community based agencies
and others provide services through the Health Department. '
Jurisdiction Funds
Alameda About $640,000
Berkeley $52,000
Contra Costa $60,000
Marin Exchange uses no county funds
San Mateo About $180,000
Solano No exchange
3 Special Data run on AODS admissions provided by Victor Kogler,August 2006
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Contra Costa Health Services
Needle Exchange Update Report to Family&Human Services Committee
October 16, 2006
CHE Progress Report
Community Health Empowerment reports missing some exchanges during the fiscal year due to
cash flow impacting their ability to order supplies in a timely fashion. Even with these
interruptions, CHE met and exceeded contractual obligations. The provider reports that
exchange participants value the service and the health information provided. There is an
increase in awareness of the dangers of ignoring abscesses and other conditions requiring
medical attention. New health education materials on abscesses are now distributed routinely
with each exchange and condoms and other risk reduction materials and referrals are available.
The reporting period is FY 0506. "Contacts" refers to the number of individuals accessing the
sites — the figures are not an unduplicated count. Individuals exchange one used syringe for
one clean syringe and many bring in syringes to exchange for other individuals (Total N). West
County participants are predominantly African American (53%) and East County participants are
predominantly White (66%).
Location Contacts For Total N # Syringes Gender
East County 2 sites 1608 4042 171 795 64% M
West County 2 sites 1575 3251 151,990 74% M
Total 3183 7257 323 785
Several attempts have been made to introduce other providers to needle exchange sites in an
effort to increase referrals. These attempts have been largely unsuccessful due to a variety of
reasons, including the unpredictability of site participants (wariness and lack of trust of
individuals unknown to them), the hours of exchange operation, interpersonal tensions, etc.
HIV testing access has been established on a limited basis. The Health Department has
provided limited Health on Wheels (HOW van) services at the sites in Richmond and is trying to
expand similar services to the sites in East County.
In their final report for the fiscal year, CHE indicated that an increasing number of individuals
were reporting difficulties with local law enforcement at the exchange sites. In some instances,
participants indicated that police confiscated syringes as they exited the sites. In other cases,
participants report being told by law enforcement personnel that they could not carry syringes
with needles still attached. The issue was raised at the monthly Police Chief's meeting in
September 2006 and the Chiefs suggested a joint development of a resource guide for law
enforcement on needle exchange. The AIDS Program will work with the Chiefs to develop and
disseminate the guide this year.
Pharmacy Syringe Sale
Many individuals - citing fear of law enforcement, stigma or other barriers - do not access
needle exchange services. In December 2004, the Board of Supervisors authorized a local
Disease Prevention Demonstration Project (DPDP) in Contra Costa. This Project, as authorized
by California Senate Bill 1159, allows pharmacists registered with the Health Department to sell
or furnish up to 10 syringes to an individual 18 years of age or older without a prescription.
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1
Contra Costa Health Services
Needle Exchange Update Report to Family&Human Services Committee
October 16, 2006
At this time three major pharmacy chains (Walgreen's, Longs and Rite Aid) and on a Safeway
store are registered in the DPDP. About 83% of the registered pharmacies have had customers
and 18% of those with customers report serving 10 or more people per week. Referral
information is provided and, where syringe disposal containers (Sharps) are not offered for sale,
referral information to the Pittsburg and Richmond Household Waste management sites is
provided. Pharmacies have requested additional health education and referral materials and
training for new pharmacists. There have been no major incidents reported by pharmacies or by
the Sheriff's Department. The AIDS Program will follow up with pharmacists on their requests.
Other Prevention Activities For Injection Drug Use
One program cannot serve as a panacea to address the substance abuse problem, and needle
exchange services are provided as a component of a comprehensive prevention strategy to
reduce transmission of HIV and AIDS among injection drug users in Contra Costa. Other
strategies include: HIV prevention providers work with non-infected substance users to develop
plans to reduce risk for contracting HIV; an AIDS and Homeless collaborative has trained
homeless services providers in HIV risk recognition and reduction activities; all Ryan White
CARE Act contractors have been trained to provide risk reduction counseling services and
partner notification support to their HIV positive clients; a Prevention with Positives program
supports clients by building prevention skills and developing incremental behavior change plans;
and the Health Department assists medical providers with partner notification assistance. HIV
testing also supports the risk reduction process and the AIDS Program has expanded testing
services in Alcohol and Other Drugs Services programs. These programs all provide support for
positive behavior changes among individuals who inject drugs or who partner with IDUs.
CONCLUSIONS:
1. Needle Exchange and Pharmacy Syringe services remain a necessary Public
Health measure to reduce transmission of blood borne diseases. While needle
exchange and the availability of syringes without a prescription are not solely responsible for
the downward trends noted in children born with positive antibodies to HIV or the reported
rates of Hepatitis C or increasing enrollment of women in AODS services, the availability of
needle exchange and pharmacy syringe sales may in part contribute to this positive trend.
2. Generally speaking, local law enforcement exposure to potential blood borne
pathogens via needle stick injury does not appear to have increased since needle
exchange and pharmacy sales have been implemented. There is a need for better
documentation of injuries and Public Health and Law Enforcement staff have undertaken steps
to strengthen communication.
3. The contract for needle exchange services should remain in effect so long as the
service is provided.
4. The Health Department is attempting to expand some form of limited health care
services to exchange sites in East County. We anticipate the availability of this service will
assist with the earlier identification of individuals in need of emergency and other care, and
referrals for other health and support services. A report will be provided at the next update in
the coming year.
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