Falling Through the Cracks

Two columns on how Iran is treating its massive epidemic of injecting drug use by tackling it as a health problem, effectively lowering H.I.V. rates among drug users using an approach to drugs known as harm reduction.

Rwanda, a country with the same population of Ohio, has emerged as an example of how to slow the spread of coronavirus, with only 1,500 cases reported so far. Besides initiating a lockdown, implementing free testing, and recruiting community health care workers, police, and college students to be contact tracers, officials also used "the same structure, same people, same infrastructure and laboratory diagnostics" that had been working to contain the spread of HIV.

There are six countries that have reached "90–90–90" targets meaning, "90 percent of people with HIV in a country know their status, 90 percent of those diagnosed are on treatment, and 90 percent on treatment are virally suppressed." The solutions that have worked for these countries, like cross-sector partnerships and evidence-based prevention campaigns, are now models for regions still fighting to reduce rates.

In the past two years, Zika virus has arisen as one of the most pressing public health concerns. This piece charts the worldwide efforts by doctors using new technology to develop a vaccine for Zika.

Two of America’s largest cities, New York City and San Francisco, are working to reduce HIV rates by bringing better health care options closer to the communities and connecting individuals with resources such as insurance and payment methods. Although the two cities are using different approaches, both are seeing early success in fighting against the epidemic.

The San Francisco Bay Area has had fewer COVID-19 deaths than would be expected for such a densely populated area, largely by "drawing on resources and expertise that predated the coronavirus pandemic." Unlike other large cities, the Bay Area was able to quickly identify where hotspots may emerge, and initiate changes – such as allowing only one entrance to hospitals and not using traveling certified nursing assistants in multiple nursing homes. City health officials also increased outreach to at-risk minority neighborhoods, after seeing the virus disproportionately impacting these communities elsewhere.

To increase awareness and proactive medical treatment for women drug users in Ivory Coast, the NGO Doctors of the World launched a callout for volunteers to hold workshops that would help improve body care, well-being and self-esteem. One workshop that came out of this was a photographic project that offered the women "another vision of their body, their face and themselves," while also testing the participants for tuberculosis.

By prioritizing treatment over law enforcement, Switzerland dramatically reduced its drug problem. In 1994, the country adopted a progressive policy to treat heroin addiction as a public health crisis, focusing on harm reduction, treatment, and prevention in addition to traditional law enforcement. The policy, which embraces medicated-assisted treatment and universal access to services, helped greatly reduce issues such as the incidence of HIV, drug overdoses, and deaths over the long-term.

The Belle Reve House in Louisiana houses and treats low-income and homeless people living with AIDS. The house offers wraparound services and works to keep the virus at almost undetectable levels. Residents are less likely to spread the virus when living at Belle Reve, which is crucial in New Orleans, where the transmission rate is among the highest in the country.

Sharing stories about addiction brings stakeholders together. With the cost of prevention being much lower than the cost of treating outbreaks disease and overdoses, advocates for needle exchanges have sought to open more centers in Kentucky. Despite initial opposition from the Bourbon County community, groups like the Recovery Warriors have succeeded, by holding meetings and sharing experiences, to ultimately pass a motion to open the county’s first needle exchange.