America’s Dangerous Syndemic

In 2015, a sudden HIV outbreak, triggered by the sharing of needles among opioid users in a seemingly improbable setting—rural Scott county Indiana, population 24,000—precipitated a public health emergency. To date, 227 people in Scott county have been diagnosed with HIV and several hundred infected with hepatitis C. Caught off-guard and ill-prepared, the county relied upon the costly emergency deployment of state health department and 40 Centers for Disease Control and Prevention (CDC) staff. Following intense debate, Indiana’s then-Governor Mike Pence suspended the state law barring needle-exchange programs, a critical step in arresting the dual outbreaks. Estimated lifetime costs for caring for those Scott county residents now living with HIV and hepatitis C are formidable: over $100 million.

While America’s escalating opioid epidemic has attracted high-level political attention and intensified media coverage, the knock-on outbreaks of HIV and hepatitis C it inspired in Scott receive relatively modest notice. Yet we ignore these sister epidemics—a complex “syndemic”—at our peril. Now is the time to focus keenly upon this phenomenon: at this critical moment when President Trump has declared the opioid epidemic a public health emergency, when the presidentially appointed independent Commission on Combating Drug Addiction and the Opioid Crisis, headed by New Jersey Governor Chris Christie, has completed its work, and when we face ongoing serious risk of new outbreaks.