Via The Guardian, a long, alarming report: Rural counties across the US becoming a powder keg for HIV outbreak. Excerpt:
A man was lying sedate after injecting drugs. His fellow users, to amuse themselves, threw needles at him like a human dartboard to see if they would stick, according to a recent police report in Wolfe County, Kentucky.
“Back in the day, all we had to worry about was people drinking or smoking weed,” said special deputy Gary Smith, who is entering his 25th year with the Wolfe County sheriff’s department.
But with a growing US opioid epidemic that has escalated the number of injection drug users, the bucolic county has become acutely at risk from another public health problem.
Wolfe County tops the list of places that are most vulnerable to an HIV outbreak.
A new alarm for the HIV epidemic sounded early last year when a small, rural town in Indiana was beset with a staggering 188 cases of the hard-to-control disease – and the sirens have been heard in similar towns across the country.
The threat of another outbreak such as the one in Austin, Indiana, so concerned the Centers for Disease Control and Prevention (CDC) that the federal agency drafted a report showcasing which places in the US are most vulnerable to a similar outbreak.
HIV rates among drug users have dropped substantially since they peaked in the 1980s and before Indiana’s outbreak, rural counties had been largely insulated from outbreaks of HIV. But the opioid addiction epidemic has put new communities at risk.
“If we don’t begin to think about how we could prevent this from happening again, it could really erode our success,” said John Brooks, a CDC epidemiologist and the senior author of the vulnerability assessment.
The CDC determined a county’s vulnerability with a sobering recipe: high rates of drug overdose deaths and prescription opioid sales, a high white population, astounding rates of hepatitis C and searing poverty.
“For many years this was an urban issue, an inner-city issue, but what we learned from southern Indiana is that rural parts of our country are now at significant risk,” said Ardis Hoven, an infectious disease specialist with Kentucky’s department for public health.
“If you look at these areas, the uniqueness is not only the poverty, not only the issue of unemployment and early teen births and educational issues, but the cultural issues embedded in many of those areas.”