Without A Syringe Exchange Program, New Hampshire Is At Risk Of An HIV Outbreak

Nov 28, 2016

On the week of World Aids Day, a look at HIV and AIDS in New Hampshire. New preventative methods and ever-improving treatments mean that more patients are living longer, healthier lives. But many challenges remain, including testing and insurance discrimination.


  • Dr. Tim Lahey - Associate Professor of Medicine at Dartmouth, and a clinical immunologist with a focus on HIV and tuberculosis. 
  • Laura Byrne - Executive Director of the HIV/HCV Resource Center in Lebanon, New Hampshire.
  • Wendy Leblanc - Vice President of the Southern New Hampshire AIDS Task Force.

This Thursday, December first, is World AIDS Day, which started in 1988 to raise awareness about HIV and the AIDS pandemic. Now, almost thirty years later, many Americans may associate AIDS more with Sub-Saharan African and deep urban poverty.  However, around forty new cases of HIV were diagnosed in New Hampshire in 2014, and it's estimated that 20 percent of all HIV-positive people do not know they have the virus. Meanwhile, new treatments and preventative measures are helping to combat the spread of HIV, but factors like stigma and low funding continue to hamper progress, including here in the Granite State.

New Hampshire is currently the only state in New England without a syringe exchange program, which allows drug users access to safe, clean needles and provides a place to dispense used needles. Dr. Timothy Lahey, an immunologist at Dartmouth Hitchcock Medical Center with a focus on HIV and tuberculosis, says that the opioid epidemic in the state, especially in rural areas, closely mirrors that in Indiana. 

The Centers for Disease Control and Prevention showed us that within the last couple of years, the number of opioid overdoses in New Hampshire rose by 73.5 percent. So we are in the middle of just a raging fire of heroin and other opiate abuse, and so far our HIV cases have not seen an uptick, but our expectation is that it is basically a matter of time that we have something like Indiana happen.

New Hampshire is high-risk for an HIV outbreak due to shared needles, because the state does not have a safe syringe exchange program. In Austin, Indiana, over several months, more than 190 cases of HIV were reported in a population of 8000. Like New Hampshire, Indiana is in the middle of an opioid crisis, and experts attribute the cause of the outbreak to injection drug use. 

Critics of a syringe exchange program worry that handing out clean needles will encourage injection drug use. Laura Byrne, Executive Director of the HIV/HCV Resource Center in Lebanon, who also operates the syringe exchange program in White River Junction, Vermont, disagrees with this claim. 

In areas where there are syringe exchange programs, there are a greater number of people actually getting into, and being retained, in drug treatment programs. There are fewer needles that are found on the street, more needles being returned to the exchange. Syringe exchange programs generally also offer HIV and Hepatitis C testing.

Dr. Lahey also says that increased use of preventative medications, like Pre-Exposure Prophylaxis (PrEP), can curb the spread of HIV infections in high risk communities. High risk individuals include partners of those with HIV or AIDS, and injection drug-users. PrEP, also known as Truvada, is available as a daily prescription pill, and is also used to slow the spread of HIV in infected individuals.  Listener Trevor, from Laconia, shared that he uses Truvada as a preventative measure, and that the Truvada manufacturer offers coupons to cover any additional costs outside of what his insurance provides. Wendy Leblanc, who is the Vice President of the Souther New Hampshire AIDS Task Force, says that the biggest challenge she faces when finding preventative medication for her clients is that many general practitioners do not have the training to prescribe Truvada. 

It's been several years that PrEP has been available, but it's really become more widely talked about in the last year or two.

 Both she and the other guests said that there are a variety of initiatives to train practitioners in prescribing preventative medication, and that any Planned Parenthood in the state has providers who can prescribe Truvada.   Early in development, preventative medications were frowned upon by both the HIV/AIDS community and physicians, because many feared PReP would lead to more high-risk behavior. Dr. Lahey says this is not a logical fear.  "A decision to have sex or not to have sex is in no way informed by the presence of a pull in a medicine cabinet, it's just not part of the equation," he says. "In fact, if you look at the big studies in which prep was proven to work, the users' incidents of sexually transmitted infections did not go up." Dr. Lahey says, because these patients were high risk to begin with. 

A way to think of [preventative medication] is we don't want people to speed on the highway, but if they are going to speed on the highway, I'm glad they wear a seatbelt.

You can find out more about PrEP and HIV-screening at NHHIV.org

Producer's Note:

 We had several emails and calls about the repercussions of poor HIV/AIDS management during the early years of discovery that we did not have a chance to address during the show. Below is an excerpt from an email we wanted to share from Kathy Seward MacKay, author of Dying in Vein: Blood, Deception...Justice.

Subject: Hemophiliacs: The Forgotten Victims

My husband, Dave, was a hemophiliac who died of HIV and hepatitis from an FDA-approved medication called Factor 8 concentrate. Seventy thousand [were] infected world wide. 3/4 of them [are] now dead. It wasn't just an accident. The tainted product was on the market for 20 years when it was known to be dangerous. The survivors spent most [of] their youth and young adult years fighting for their lives and were unable to prepare for their futures. They suffer financially and emotionally 30 years later. I have been photographing this population for the last 16 years and I've seen the suffering first hand.