Needle by needle, a Charlotte program curbs drug overdoses, HIV infections
In Charlotte, where stubbornly-high HIV rates and a worsening opioid crisis collide, there’s a program at the center working to reduce negative outcomes.
The Center for Prevention Services runs the only syringe access program based in Mecklenburg County, the Queen City Needle Exchange.
The center, which has been in existence for five decades, added the needle exchange program in 2018 as a harm-reduction response to the opioid crisis.
Harm reduction refers to practices that attempt to minimize negative consequences of drug use. The needle exchange program protects people who use intravenous drugs against the spread of HIV — which is a relatively higher risk for people who share needles. And, unlike many other prevention programs, the local needle exchange doesn’t require sobriety to help.
Just last month, New York authorized the first two legal injection sites in the country, signaling a focus on harm reduction — rather than solely relying on prevention.
Executive director Angela Allen says Charlotte’s a long way from establishing legal injection sites, but needle exchange programs and other harm reduction measures are still making a big difference in Mecklenburg County.
The Center for Prevention Services program has grown, indicating a progression of the opioid epidemic in Charlotte, she said — and it’s helping curb HIV rates in a city once known for having one of the highest infection rates in the country.
Mecklenburg pledged in past years to eliminate all new HIV infections by 2020. Since failing to reach that goal, they’ve enacted a “Getting to Zero” community plan to eradicate new HIV cases.
The Charlotte Metropolitan area ranked among the worst 25% of metropolitan areas in the nation for new HIV infections, according to 2017 data from the Centers for Disease Control and Prevention. Since then, the county’s rate has decreased only slightly.
And Mecklenburg County saw almost 10% more emergency room visits this year compared to last year for opioid overdoses.
Filling the gap
The Center for Prevention Services’ name has changed several times, and its mission has evolved over the years, too.
The Center for Prevention Services was started as the Drug Education Center in 1971 by the Junior League. Originally, its mission was to provide substance use prevention education to youth in the schools.
“If you think about that time, we were just coming off of the 1960s when there were a lot of drugs out there and a lot of new drugs out there, and we were starting to see that impact in the schools in the 1970s,” Allen said. “And there really wasn’t anybody addressing it.
“That’s why we were started, and that is in part what we are still doing.”
Half a century later, that education is still happening in schools and afterschool programs, but one thing is new — thanks largely to one center employee.
“I had never considered starting up the syringe access program. It just wasn’t in my universe — I was straight prevention for years,” Allen said. “But I had hired an employee who had lived experience… who came to me and said, ‘We’re doing prevention, and that’s great. There’s treatment, and that’s great. But in between, there’s a real gap.
“‘What about those people?’”
Lauren Kestner joined the center staff in 2017. She had friends who were involved in harm reduction work for many years, and when syringe exchange programs became legal in 2016, Kestner wanted to provide that service to center clients.
Years ago, she was a drug user herself. Now, she uses those experiences to shape how she views recovery.
“Abstinence-based care was not working for me as a drug user,” she said. “Coming into harm reduction and recovery, I’ve had to take pieces out of my whole experience, and there are things that have stuck with me from each part.
“I’ve had to take it all in, and I’ve had to use what works and I’ve had to leave what hasn’t, and that’s over the course of almost 40 years.”
The center added harm reduction services in 2018 to Mecklenburg and five other surrounding counties, and Kestner leads the program. Since then, the need has “exploded.”
“I had no idea when we started what the scope was,” Allen said. “And then, the pandemic hit. I don’t know if it’s because of the pandemic…. Or if it just takes time in any new area to gain the trust of people who are using drugs, but the growth in Mecklenburg County has been exponential.”
During the pandemic, people have been increasingly isolated, which naturally leads to more usage and a higher chance of overdose when people use drugs alone. Without someone there with naloxone, no one can help during an overdose.
“That’s not always been happening during the pandemic because people are alone. And they’re lonely, and they’re using and there’s nobody there to save them,” Allen said. “It’s a really scary time right now.”
Naxolone, or known as its brand name Narcan, is used to reverse opioid overdoses.
Since 2019, drug overdose deaths have increased in Mecklenburg County — though numbers remain lower than the state average. State data show that while emergency room overdose visits spiked statewide and in Mecklenburg County in 2020, this year’s rates are much lower. Allen says that’s because harm reduction works.
Harm reduction services provided by the center include syringe distribution and safe-use supplies, such as Naxolone, wound care kits and fentanyl test strips. They also provide tents, sleeping bags and other supplies for unstably housed people, who are a large part of their demographic.
“We do work in the homeless camps, but that can be anyone. I think all of us kind of have a vision in our head of who is homeless, and I think that vision is very often incorrect,” Allen said. “We serve people from all walks of life… Substance use dependence really reaches across the spectrum.”
Kestner said drug use is still seen as a moral failure — that’s why harm reduction is so important.
“It’s about meeting people where they’re at first. If you’re not engaging in needs-based care, then you don’t really believe in saving lives,” she said. “Abstinence isn’t the only way, and harm reduction has never been against it. You are just always met with dignity, and you are never met with judgment.
“We will walk right next to you, and we just kind of want to sit beside you and offer you some refuge during the process.”
Since the start of the program, they’ve distributed more than half a million syringes in Mecklenburg County and distributed 5,370 doses of naloxone. They’ve reported 1,334 successful overdose reversals.
The majority of their members are between the ages of 25 and 40, and most are white. Many of their clients report a negative HIV status, but the second highest majority lists their status as “unknown.”
“Sometimes it starts with a prescription drug that they were given by their doctor legally, and they got hooked. That happens all the time, and it happens to everybody, no matter what you look like or what your income is.”
A long way to go
Southern states account for about 51% of new HIV cases annually, even though just 38% of the U.S. population lives in the region. In 2017, North Carolina had the 6th highest number of new HIV infections in the nation.
A Trump administration-era plan from 2019 targeted Mecklenburg County as one of the 48 counties with highest HIV rates in the country.
HIV infections reached a high in Mecklenburg County in 2014, before generally declining until 2018, according to county data. Numbers increased slightly in 2019.
As of December 31, 2020, nearly 34,963 people living with HIV reside in North Carolina — 6,862 of those in Mecklenburg County.
Mecklenburg’s “Getting to Zero” plan has a new goal of reducing new cases of HIV by 75% by the end of 2024 and the plan called for distributing PrEP, beginning in 2018, which reduces the chances of contracting HIV by 97%.
But Mecklenburg is still a long way off from that goal, said Deputy Health Director Raynard Washington.
Over the last year, the county saw a decline in new HIV cases, but Washington attributes that to reduced access to testing during the COVID-19 pandemic. He expects to see a slight uptick when testing resumes normal capacity.
“We are seeing more new infections this year than what we saw last year, which is expected. I wouldn’t consider that a real trend, but really just a sort of restabilization,” he said. “We saw that decline in 2020, and we are estimating that the 2021 numbers will be a little bit higher than 2020.”
Washington said a team continues to work on this issue on the county level, specifically on the prevention front — he cited testing sites and awareness campaigns in communities that are disproportionately affected, including Black residents and gay men.
But he largely attributes the low level of HIV transmission via intravenous drug use in Charlotte to harm reduction programs like Queen City Needle Exchange.
“The fact we have a needle exchange that distributes over 100,000 needles a year is a sign that public health is working,” he said. “In most communities, I would say we have consistently seen, with the introduction of harm reduction strategies like needle exchange, almost a complete elimination of HIV transmission via IV drug use.
“We’ve got to continue to provide that resource so that we don’t start to see that kind of transmission.”
Allen said HIV, Hepatitis C, endocarditis and several other illnesses are directly tied to substance use, so the needle exchange’s number one purpose is to cut down on that spread.
“And they’re very effective at doing that,” she said. “So their next purpose is that what the studies have shown is that people are about 15 times more likely to go into treatment, if they are involved in some sort of syringe access program.”
According to the Centers for Disease Control and Prevention, needle exchange programs do not increase drug consumption, and participants are also more likely to enter drug treatment programs. But stigma still holds many programs back.
“All of the benefits often get lost in the controversy over syringe access and the stigma around drug use in general,” Allen said.
But Allen said it’s time for the community to become equal partners in this work.
“The crisis has gotten worse. We are growing because the need is growing,” Allen said. “Drug use issues impact everyone in the community because they drive up Hep C and HIV rates, and that creates more problems in the community that we should all be concerned about.
“And it’s only invisible until it happens to your family.”
‘The work hasn’t stopped’
A minority of HIV infections come from intravenous drug use — Shannon Farrar, executive director of Carolinas CARE Partnership since 2015, says most of the transmissions they hear about are through unprotected sex.
But she says it’s likely IV drug use infections from shared needles are underreported.
“People are going to tell us the least stigmatizing thing they can,” she said.
The CCP educates people about HIV and AIDS, links them to medical services if they need and even helps connect them to wraparound services, such as housing to maintain their medical care.
She reiterated that people who are unstably housed have many more risks for HIV, too. Some of them rely on survival sex to have a place to stay, and while on the street, they might have crimes perpetrated against them, or have their medication stolen, making them more likely to transmit the disease to others.
“Our goal is to keep people housed so they can keep their medication safe, don’t have to engage in survival sex, and they’re able to control who’s in the home with them,” she said.
In a national hotspot for HIV transmission, they stay busy, Farrar said — and even more so during the pandemic.
The pandemic has exacerbated houselessness and made it harder for the CCP to serve their clients. They had to minimize their HIV testing capabilities, and people without transportation usually can’t make it to their testing site. She worries about disease progression while testing has been delayed.
But while COVID has made things harder, Farrar said it’s also made her staff more determined.
“Those of us who have been talking about HIV before the pandemic were still talking about it during the pandemic,” she said. “The work hasn’t stopped.”
This story was originally published December 16, 2021 at 1:33 PM.
