Dr. José Szapocznik Briefs Congressional Staffers on HIV/AIDS Prevention
José Szapocznik, Ph.D., professor and Chair of the Miller School’s Department of Public Health Sciences and Director of the Miami Clinical and Translational Science Institute, briefed congressional staffers on the challenge of addressing opioid addiction, HIV and viral hepatitis during a lunch meeting at the Rayburn Building in Washington, D.C., on December 1, World AIDS Day. He was one of three people presenting on Capitol Hill.
Opioid addiction, HIV, and viral hepatitis (HCV) are related epidemics. Since the beginning of the HIV/AIDS challenge, addiction and drug abuse have been strongly linked with the epidemic, especially by increasing the risk of both contracting and transmitting HIV. Szapocznik focused his presentation on the work that the Department of Public Health Sciences has done to prevent the transmission of HIV.
“Miami has the highest rate of new HIV infections of any metropolitan area in the United States,” Szapocznik told the staffers. “We have been one of the three epicenters of the epidemic from the beginning, next to New York City and San Francisco. We are number one, and it’s a sad position to hold. So at the UM Department of Public Health Sciences we are naturally very interested in the prevention of HIV transmission and stopping the epidemic in its tracks.”
Szapocznik outlined two of the studies done at the Miller School. One of them, which looked at the number of syringes improperly discarded in Miami, was led by Hansel Tookes, M.D., M.P.H., who was at the time a Miller School student. The study, published in 2011, found eight times the number of publicly discarded needles on the streets of Miami as on the streets of San Francisco, a city with twice the estimated number of injection drug users. When intravenous drug users in Miami were interviewed, 95 percent of them said that they discarded their needles in the streets. In San Francisco that number is just 15 percent. It came as no surprise, therefore, that Miami has twice the rate of HIV infections among intravenous drug users, compared to the same population in San Francisco.
“The importance of a needle exchange program for Miami is phenomenal,” said Szapocznik. “San Francisco has one. We don’t. State law does not allow it. And our community is paying the consequences. It costs $380,000 to treat HIV over an individual’s lifetime. So every time you have one more infection, that is another $380,000.”
Another study led by Tookes, he told the staffers, showed that it cost Jackson Memorial Hospital $11.4 million per year to treat bacterial infections associated with intravenous drug use. A needle exchange program is needed, not just for the benefit of individuals, but also to lessen the financial and other costs borne by society, said Szapocznik, because getting everyone to use clean needles will dramatically reduce the spread of HIV among intravenous drug users.
Szapocznik also spoke to the Congressional staffers about research led by Lisa Metsch, Ph.D., voluntary professor, and Daniel J. Feaster, Ph.D., associate professor, both of the Department of Public Health Sciences, who have studied the dramatic effect of successfully moving HIV-positive individuals through the so-called “HIV treatment cascade.”
“We have to find those who may be infected, ensure they get tested, learn that they are positive, engage them in treatment, and ensure they remain and adhere to HIV treatment,” said Szapocznik. “If they do all this, they almost certainly become ‘virally suppressed,’ meaning the virus becomes undetectable in their blood. Once you have viral suppression, according to some studies, you reduce the likelihood of infectivity by 95 percent, even with unsafe sex. And if we use a combination of viral suppression and pre-exposure prophylaxis, we can definitely stop the epidemic in its tracks.
“For the Department of Public Health Sciences this research has a very high priority. Our community, Miami, leads the nation, sadly, in the rate of new HIV infections. We aspire to lead the nation in a different way, by being the number one innovator in stopping the HIV/AIDS epidemic. Legislation of many different kinds, on the state and federal level, will be key.”
The congressional lunch briefing was sponsored by the Friends of the National Institute on Drug Abuse, and organized by the American Public Health Association in cooperation with the Congressional Addiction, Treatment and Recovery Caucus. Szapocznik’s co-presenters were Wilson Compton, M.D., Deputy Director of the National Institute on Drug Abuse/NIH, and Scott Stokes, Director of Prevention Services at AIDS Resource Center of Wisconsin.