Here's a health question: What's the leading cause of hepatitis C and the second leading cause of HIV transmission in California?
Answer: Sharing of dirty needles among drug users.
Yolo County is among 18 California counties doing their part to try to reduce injection drug use and the spread of blood-borne diseases by exchanging dirty needles for clean needles. Equally important, the county's 1-year-old program offers HIV and hepatitis C testing and referral to services.
Yolo supervisors voted last week to extend the $100,000 program another year. Supervisors Helen Thompson, Mariko Yamada and Mike McGowan voted to approve; Matt Rexroad and Duane Chamberlain voted against. The money comes from the county's Pomona Fund (tobacco settlement bond proceeds that provide $1 million per year, in perpetuity, for programs at the discretion of the supervisors). So this program has no impact on the county's general fund.
Needle exchange programs have been in large urban areas for a long time; they are less common in rural counties, so the birth pangs of Yolo's program are worth watching.
The county has authorized two organizations to do needle exchanges: SANE (Safer Alternatives through Networking and Education) and Harm Reduction Services. In the first year, most of the exchanges are coming from individuals who collect used needles from their peers, exchange them for new ones and deliver them back to their peers. These folks (called "satellite syringe exchangers") are indispensable in reaching the hidden drug user population.
In the first year, two-thirds of the 1,874 contacts were men over 40 years of age.
The supervisors who voted against renewal were concerned that the program distributed 61,752 needles and recovered only 50,499 (leaving 11,253 unaccounted for). County Health Department Director Dr. Bette Hinton didn't seem concerned about this. She noted that at any given time, 5,000 to 10,000 needles remain in circulation, and some are confiscated by police. Still, other needle exchange programs have recovered more needles than they hand out. This should be the aim of the Yolo program, too.
Some residents claim that syringes they find in parks are coming from the county's needle exchange program. But that's hard to determine. As Supervisor Thompson said at the Wednesday hearing: "Before the program, there were needles in the park. If we end the program, there will still be needles in the park" from diabetics and drug users.
Anyway, the county health and waste departments have established a task force on safe syringe disposal. As part of this, they might consider the feasibility of labeling needles to better track where exchange program needles end up.
McGowan was focused on the right thing here: "The downsides for not dealing with diseases that come with needle use come out of our budget in a really ugly way."
One year is not enough to see the long-term impact on health. Staff indicated that hepatitis C cases were down in the last year, but that they needed three to five years of tracking to see a pattern.
In this first year, the program clearly is beginning to reach the hidden user population. The county should build on that. If it does, Yolo should see a drop in HIV and hepatitis C cases in coming years.
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