When HIV/AIDS emerged in the 1980s, it was primarily associated with unsafe sex between gay men—in 2020, however, that is no longer the case. With injection drug users accounting for 10% of new HIV diagnoses across the globe, the face of HIV is rapidly changing.
Shelby County currently leads the state of Tennessee in drug overdose deaths and that number is only increasing due to the recent COVID-19 quarantine requirements. But one Friends For Life (FFL) employee is making it his personal mission to change that reality.
“We’re slowly gaining the trust of the population,” said David Closs, an Outreach and Care Specialist for FFL. “I’ll have some people come tell me about someone they know who is high risk [for contracting HIV] and that they should get care and so I’ll give them my information.”
Closs comes to FFL from West Memphis, Arkansas and has been an employee since April 2020. He went from being a warehouse manager to studying public health and has a deep desire to combat the opioid epidemic.
While his time with the organization has been short, he has already seen the effects of his work by partnering with local needle exchanges to provide free HIV testing.
“This job was a great opportunity to try getting involved with [drug prevention education],” said Closs. “There’s a dire need out there in Memphis.”
While controversial, needle exchange programs are internationally recognized by health organizations such as the World Health Organization, Centers for Disease Control and the National Institute of Health. The WHO even recommends that each injection drug user be provided 200 sterile needles to reduce the spread of HIV.
“Around the country, [injection] drug users are high with HIV—a lot of them have it,” said Closs. “But in the Memphis community, for some reason, it’s low. And what you’re seeing is that most people aren’t getting tested.”
Memphis currently has two needle exchange programs: Safe Point and A Betor Way (ABW). These programs provide people with sterile needles and syringes to reduce the transmission of HIV and other bloodborne viruses. However, these programs have carried negative connotations that Closs has been battling since the beginning of his outreach.
“A lot of people have a bad taste in their mouth about needle exchanges,” said Closs. “They’re like, ‘oh, you’re just giving them stuff and enabling them.’ And it’s like, well not everybody’s in the same frame of mind, not everybody’s ready for treatment. But they’re taking the first step.”
In Closs’ experience, for many people who abuse injection drugs, needle exchanges are the start to seeking treatment. He says that, for many, needle exchanges are the only times drug users are treated with decency.
“I’ve seen a couple of people get into rehab through there,” said Closs. “This is the first time all week that they have had a conversation with a person that didn’t involve them getting told to ‘get away from me.’ They get that a lot.”
Stigma is something that has followed HIV since its introduction in the 1980s. Closs says that people still believe that they can tell if someone is HIV positive just by looking at them or that using chemical products can exterminate the virus. Nonetheless, he still advocates to injection drug users that PrEP is the best way to combat exposure.
“I’m hoping if I can get one or two on [PrEP], they can spread the word,” said Closs. “Then we can get the whole population on PrEP and reduce HIV in the area.”
Closs says the stigma of being HIV positive for injection drug users far exceeds anything he had previously been exposed to. He says most fear how HIV will affect their ability to use more than the actual virus itself.
“The population I’m dealing with—they're injecting, they’re already putting their life at risk,” said Closs. “They’re more worried about people finding out they have it and not wanting to be around them.”
Along with the fear of isolation, many simply do not have access to information about current HIV treatment options or what to do if they believe they were exposed.
“A lot of them didn’t know that HIV could be treated. They thought it was a death sentence,” said Closs. “When I sit them down to do a test and I ask them what they would do if they were positive, some say, ‘Oh, I would just kill myself. I’m not sober anyways.’ I have to tell them it’s not like that anymore, there’s treatment.”
While Closs knows there is a long road ahead of him, he is hopeful about what the future holds for his HIV prevention work. He reflected on one man he met through ABW.
“He was an [injection] drug user and was getting clean needles from [ABW] and he said he shared sometimes,” said Closs. “I gave him the information for The Corner and he called them freaking out. He had injected with somebody who was HIV positive, so we were able get him on PEP. And now I call and talk to him once a week.
“That's one person who I feel like if I hadn’t had the conversation with, he would probably be HIV positive right now," said Closs. "You know, you can’t change the world, but if you can change one person... that person may be able to.”