An HIV physician talks about heroin, harm reduction and political will in the heartland

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Two epidemics, fueled by stigma and allowed to flourish amidst political neglect, set the course of Dr. Judith Feinberg’s professional life. So when she was asked to join a TEDx talk themed “Leading with Hope in a Changing World,” she had to look well into the past, as well as far ahead to find the hope.

Beginning her medical career as the AIDS epidemic unfolded, she focused on providing effective care and on the research that led to treatments for a disease that finally, over decades, was changed from a death sentence to a manageable and survivable condition. Then, as she recounts in Heroin in the Heartland, during just two weeks of infectious disease consulting services at Cincinnati’s University hospital, she saw four patients with endocarditis, a heart valve infection. Seeing one patient with the condition during that time, in that place would have been a lot, she says now.

Her experience at Johns Hopkins in Baltimore, however, where she had seen the impacts of an urban epidemic of injected drug use, told her what was happening, and what had to be done.

Dr. Feinberg tells the story here, of a quest to launch a program to provide sterile syringes, and to persuade policy makers that tactics to reduce harm from drug use don’t enable drug use. People who inject drugs, she explains “don’t need a sterile syringe to inject, but they need a sterile syringe to avoid getting infected.”

It took nine years, while the epidemic of injecting drug use spread infections that included hepatitis C, as well as endocarditis and HIV across the tri-state area where Indiana, Kentucky and Ohio meet.

“My worst fears came to pass,” Dr. Feinberg told Science Speaks. “When I think of this I get quite angry.”

Ohio, she notes had the resources to respond to the unfolding crisis immediately. What leaders lacked was political will. “You know how many people died during those years?”

When it was over, in 2015, wanting “to do something worthwhile,” she took a position at the University of West Virginia, moving to a state that she notes has some of the most discouraging health indicators in the nation, a state she notes is “broke,” but a place where she was asked to tell her story as one of “hope.” Once focused on addressing the impacts of HIV, she now is focused on preventing new infections. She finds her work, and her institution, rewarding.

“My experience with the syringe program,” she said, “told me that political will is the most important thing.”

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