Why all those discarded needles are signs of progress for HIV, Hep C in Southern Interior

THOMPSON-OKANAGAN - Nearly 400 new Hepatitis C cases and as many as 15 HIV cases were recorded by Interior Health last year, and most were caused by injection drug use.

The numbers may seem surprisingly high, but are average compared to recent years, according to senior medical health officer Dr. Trevor Corneil, who says they’ve actually been on an overall downward trend over the past 15 years with the advent of harm reduction strategies.

With the number of discarded needles skyrocketing across the Thompson-Okanagan, you might have expected that HIV and Hepatitis C rates would be on the rise, given most cases are caused by dirty needles. In Vernon, roughly 700 needles were picked up by social agencies in the first six months of 2016. In Kamloops, the average collection has spiked to an unprecedented 500 needles a month and the issue has been on Kelowna council’s radar as well.

But, all those needles showing up in parks and public spaces are actually keeping rates stagnant, probably even lowering them, and according to medical experts pose little to no health risk to the general public.

“What has worked is flooding the market with clean needles,” Corneil says. “So whenever (a user) goes to inject, they actually have a clean needle to use and are not looking around to share a needle.”

And with a significant number of people infected with Hepatitis C and HIV in Okanagan communities — many of them unaware of it — it’s important that drug users continue to have access to clean needles, Corneil says.

In 2015 in the Interior Health Authority, there were 387 new Hepatitis C cases identified. Roughly 80 to 90 per cent of those were considered to be chronic cases where the individual was infected for some time without showing any signs or symptoms. The other 10 to 20 per cent are people becoming newly infected with Hepatitis C, Corneil says.

Roughly 50 per cent of cases are people between the ages of 20 and 40 and about 40 per cent between the ages of 40 and 60. Individuals over 60 make up about ten per cent of cases.

The most likely source of infection for anyone who contracted the disease after 1970 is injection drug use, Corneil says.

“Those can be recreational users and they can also be chronic substance users,” Corneil says.

With HIV, there are between ten and 15 new cases recorded every year in the region, most of them men between the ages of 20 and 40. The most common sources of infection are injection drug use and intercourse between men.

While infection rates are down overall across B.C., Corneil says there’s been a slight increase in newly recorded cases lately, something that probably has to do with a campaign by Interior Health to expand HIV testing.

“In the last three years, we’ve quadrupled the number of HIV tests that we’ve done,” Corneil says. “We are finding cases that are hidden, persons who are not aware they’re positive.”

Treatment for HIV today is the best it’s ever been, Corneil says, noting most people can live a relatively normal life. For Hepatitis C, there is a new medication that can suppress, and in some cases clear a person of the virus — although most people with Hepatitis C won’t notice health impacts until their 70s or 80s.

While treatment is good, prevention is better, and that’s why health authorities have focussed on providing clean needles and drug paraphernalia to users. It’s known as harm reduction and is considered the most effective strategy for lowering transmission rates.

But in addition to preventing the transmission of HIV and Hepatitis C, flooding the market with needles has had another effect: It has quite literally flooded parks and public spaces with them. Fortunately, the risk of contracting HIV or Hepatitis C from a needle stick is virtually zero. Corneil says there have been no documented cases of someone getting HIV from a needle stick, and few, if any, when it comes to Hepatitis C.

“That’s helpful and important for people to know, but that doesn’t however take away any of the concern or the fear that a person has, or that I would have if my nephew was in a park with me and there was a needle on the ground,” Corneil says.

He says the health authority is committed to working with municipalities to find a solution for better needle disposal — but it’s complicated.

“An example is certain dumps won’t actually accept needles that are picked up from parks unless they’re bleached,” Corneil says. “There is not a single drug user I know based on the instability in their life who would think to bleach their needles before putting them in a box.”

Changing municipal waste management rules so that needles could be taken to the local dump — which already happens in places like Vancouver — would help relieve what Corneil describes as a ‘bottleneck’ in the collection of discarded needles.

Another step forward would be the creation of a safe injection site, something that has been discussed in Kelowna and Kamloops. With a growing overdose crisis province-wide, such sites would offer supervised injection with clean needles, and also provide a location where materials could be safely collected and disposed of.

Safe injection sites would also be a key point of contact for health providers to provide education and outreach to drug users.

“We would not see someone in a safe consumption service setting without having a discussion about many things, including of course treatment, and… the risks of HIV and Hepatitis C,” Corneil says.

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