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. 2023 Dec 15;94(5):395-402.
doi: 10.1097/QAI.0000000000003293.

Weathering the Storm: Syringe Services Program Laws and Human Immunodeficiency Virus During the COVID-19 Pandemic

Hannah Jackson  1 , Christopher Dunphy  2 , Mary Blain Grist  2   3 , Xinyi Jiang  4 , Likang Xu  2 , Gery P Guy Jr  4 , Sheila Salvant-Valentine  1
Affiliations

Weathering the Storm: Syringe Services Program Laws and Human Immunodeficiency Virus During the COVID-19 Pandemic

Hannah Jackson et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Syringe services programs (SSPs) are community-based prevention programs that provide a range of harm reduction services to persons who inject drugs. Despite their benefits, SSP laws vary across the United States. Little is known regarding how legislation surrounding SSPs may have influenced HIV transmission over the COVID-19 pandemic, a period in which drug use increased. This study examined associations between state SSP laws and HIV transmission among the Medicaid population before and after the COVID-19 pandemic.

Methods: State-by-month counts of new HIV diagnoses among the Medicaid population were produced using administrative claims data from the Transformed Medicaid Statistical Information System from 2019 to 2020. Data on SSP laws were collected from the Prescription Drug Abuse Policy System. Associations between state SSP laws and HIV transmission before and after the start of the COVID-19 pandemic were evaluated using an event study design, controlling for the implementation of COVID-19 nonpharmaceutical interventions and state and time fixed effects.

Results: State laws allowing the operation of SSPs were associated with 0.54 (P = 0.044) to 1.18 (P = 0.001) fewer new monthly HIV diagnoses per 100,000 Medicaid enrollees relative to states without such laws in place during the 9 months after the start of the COVID-19 pandemic. The largest effects manifested for population subgroups disproportionately affected by HIV, such as male and non-Hispanic Black Medicaid enrollees.

Conclusion: Less restrictive laws on SSPs may have helped mitigate HIV transmission among the Medicaid population throughout the COVID-19 pandemic. Policymakers can consider implementing less restrictive SSP laws to mitigate HIV transmission resulting from future increases in injection drug use.

Disclaimer: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

PubMed Disclaimer

Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

Figures

Figure 1:
Figure 1:
Trends in newly diagnosed HIV rates among the Medicaid population by states’ allowance of syringe service programs laws: before and after the start of the COVID-19 pandemic. Notes: Data on newly diagnosed HIV rates were collected from the Transformed Medicaid Statistical Information System (T-MSIS). Data on state syringe service program laws were collected from the Prescription Drug Abuse Policy System. SSP allowance states are defined as states that allowed the operation of SSPs. SSP non-allowance states are states that had barriers in place for the operation of SSPs.
Figure 2:
Figure 2:
Association between state allowance of syringe service programs and new HIV diagnoses before and after the start of the COVID-19 pandemic: event study results Notes: Data on newly diagnosed HIV rates were collected from the Transformed Medicaid Statistical Information System (T-MSIS). Data on state syringe service program laws were collected from the Prescription Drug Abuse Policy System. Reported are the coefficient estimates and 95% confidence intervals from a weighted least squares regression model that included the event study policy variables, controls for COVID-19 gathering bans and stay-at-home orders, state fixed effects, and time fixed effects. The model was weighted based on state Medicaid enrollment and standard errors were clustered at the state-level.
Figure 3:
Figure 3:
Association between state allowance of syringe service programs and new HIV diagnoses before and after the start of the COVID-19 pandemic: one year “lookback period” to define new HIV diagnoses Notes: Data on newly diagnosed HIV rates were collected from the Transformed Medicaid Statistical Information System (T-MSIS). Data on state syringe service program laws were collected from the Prescription Drug Abuse Policy System. Reported are the coefficient estimates and 95% confidence intervals from a weighted least squares regression model that included the event study policy variables, controls for COVID-19 gathering bans and stay-at-home orders, state fixed effects, and time fixed effects. The model was weighted based on state Medicaid enrollment and standard errors were clustered at the state-level.
Figure 4:
Figure 4:
Association between state allowance of syringe service programs and HIV screenings before and after the start of the COVID-19 pandemic: robustness check Notes: Data on HIV screening rates were collected from the Transformed Medicaid Statistical Information System (T-MSIS). Data on state syringe service program laws were collected from the Prescription Drug Abuse Policy System. SSP states are defined as states that allowed the operation of SSPs. No SSP states are states that have barriers in place for the operation of SSPs. Reported are the coefficient estimates and 95% confidence intervals from a weighted least squares regression model that included the event study policy variables, controls for COVID-19 gathering bans and stay-at-home orders, state fixed effects, and time fixed effects. The model was weighted based on state Medicaid enrollment and standard errors were clustered at the state-level.
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References

    1. Glenshaw MT, Gaist P, Wilson A, Cregg RC, Holtz TH, & Goodenow MM. Role of NIH in the Ending the HIV Epidemic in the US Initiative: Research Improving Practice. JAIDS Journal of Acquired Immune Deficiency Syndromes, 2022;90(1):S9–S16. - PubMed
    1. Centers for Disease Control and Prevention. HIV: Basic Statistics [internet]. Updated 6-21-2022. Accessed on 8-1-2022. Accessed from https://www.cdc.gov/hiv/basics/statistics.html.
    1. Beyrer C, Adimora AA, Hodder SL, Hopkins E, Millett G, Mon SH, Sullivan PS, Walensky RP, Pozniak A, Warren M, Richman B. Call to action: how can the US Ending the HIV Epidemic initiative succeed? The Lancet. 2021. Mar 20;397(10279):1151–6. - PMC - PubMed
    1. Centers for Disease Control and Prevention. Diagnoses of HIV infection in the United States and dependent areas, 2020. HIV Surveillance Report, 2020; vol. 33. https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published May 2022. Accessed [8-1-2022].
    1. Hulsey J, Mellis A, Kelly B. COVID-19 pandemic impact on patients, families and individuals in recovery from substance use disorders. Addiction Policy Forum. https://www.researchgate.net/profile/Jessica-Hulsey/publication/36137138.... Published 6-9-2020. Accessed 8-16-2022.