ENCORE Deserves Applause: Needle-exchange programs effectively stop disease spread

Masssachusetts has seen a spike in HIV infection by drug injecting users in the past few years. RI has seen no such spike in the infection rate; if anything it’s plateaued or trended downward since its 10-year high of 121 in 2008. Part of that success has to be credited to the state’s only needle exchange program: ENCORE, operated by AIDS Care Ocean State (ACOS).

“Needle exchange is a proven, effective program,” says Raymand Joseph, prevention supervisor. Joseph has worked for ACOS since 2004. The ENCORE program (standing for education, needle exchange, counseling, referral), started in 1996. Their main public health concerns are HIV, syphilis and hepatitis C. Joseph continues, “When we talk about regional things [like the spike in MA] trends in bigger cities usually trickle down to little cities.”

Statistics of HIV infections and other diseases are tracked in real-time — as the Department of Health finds out about them they put them in the record. In 2019, RI is more or less on track with where it was last year for  new HIV infections. “We’ve seen a plateau,” says Joseph. “They haven’t gone dramatically down, but we have seen a shift in the population infection.” Demographics of new infections are skewing younger, ages 18 to 24, men who have sex with men. Last year, needle-injecting drug users made up only single percentage points in new infections, but people sharing dirty needles remains a constant health risk.

ENCORE not only provides clean needles to clients. It provides education, narcan and fentanyl test strips, and refers them to other services as needed. In 2012 they redid their pre-enrollment process and have serviced 526 unique clients since then.

That ratio of dirty needles taken to clean needles given was an evolution over time, says Joseph. It used to be a one-to-one-plus-one ratio. You bring one needle, you get one plus one (ie, two needles). The ENCORE program is on Broad St, but beyond just fixed sites they have mobile sites and home delivery. Five days a week they go to various streets in Providence, Newport and Woonsocket. In 2018 through their home delivery they distributed 16,000 needles and collected close to 17,000.

ACOS is limited in the services it provides, but not limited in the referrals it can give. They refer clients to other nonprofits and healthcare services as needed in a very personal fashion. Joseph explains, “It means, ‘Call my friend Meg, she’s expecting your call. I’ve told her about you,’” says Joseph.

The testing ACOS offers is for HIV, syphilis and hep C, and they get the results the same day. ACOS is one of three vendors that does testing onsite for HIV (and the only one that does it offsite). Any testing they can’t do they often do offsite: at bathhouses, methadone clinics, Amos House (all the Houses really).

Right now Joseph says there’s a focus on the opioid epidemic and the drug injecting users, but some things for ACOS are never not a focus, such as housing. “If we get someone into stable housing,” says Joseph, “the quality of life for that person increases dramatically.” Any client of ACOS is eligible for their housing programs if they are an HIV positive RI resident. They try to place clients onto other housing lists if ACOS has none available.

“Our program has been effective in keeping clients that we serve as a low risk for opioid overdose or death,” says Joseph. One of the things difficult to gauge is the effectiveness of the program against the number of injecting drug users. There is no way to keep an accurate count of everyone in the state who is using needles to inject drugs. Our HIV infection rates plateauing could offer a much better indication of its effectiveness.

Joseph would like to expand more into rural areas, but their small staff already covers an impressive region. ENCORE runs on a few full-time employees, one part-time and half a dozen per diem. Time will tell if Massachusetts’ spike in infection rates will hit RI, but the ENCORE program will provide our best defense.