Study says IV drug users in counties at high risk of hepatitis C or HIV

A preliminary report by the Centers for Disease Control and Prevention has identified 220 counties in the United States as most vulnerable to outbreaks of HIV and hepatitis C among those who inject drugs in those communities, according to the Kentucky Health News.

Fifty-four of those counties are in Kentucky and two of them are in the Buffalo Trace Area. Robertson County is ranked 175th and Lewis County, 178th.

At least two factors may contribute to Robertson County's ranking, said Allison Adams, Buffalo Trace Health District executive director. Those include a small population to measure any incidence against and the lack of availability of health care.

In Lewis County, Health Department Executive Director Anita Bertram said she wasn't surprised by the numbers, while acknowledging that her county isn't alone in seeing an increase in IV drug use.

"I don't think Lewis County has a monopoly on drug users," she said.

Statewide numbers would seem to bear Bertram out. Kentucky leads the nation in the rate of acute hepatitis C, with 4.1 cases for every 100,000 residents, more than six times the national average, according to the CDC.

Adams, too, said she has seen an increase in HIV and hepatitis C over the past few years, and expects data from the state she has requested to back that up.

"We're no different from the state -- the state as a whole has seen an increase over the past five years," Adams said. And those numbers are expected to "skyrocket," she said.

“Both HIV and hepatitis C can be transmitted when people who inject drugs share their needles," Doug Hogan, acting communications director for the Cabinet for Health and Family Services, told Kentucky Health News. "Many of Kentucky’s HCV cases are among rural youth, ages 12-29, who have been sharing needles."

"About 25 percent of our state’s population lives in these 54 counties," Hogan said.

The CDC began this study after an unprecedented outbreak of HIV infections occurred in Scott County, Ind.a, in 2014 among its intravenous drug users to see what other counties might be vulnerable to such an outbreak.

Researchers looked at all 3,143 U.S. counties and based their rankings on six variables, including: the number of overdose deaths, per-capita-income data, unemployment data, population studies, prescription opioid sales, and prescription sales for opioid treatments.

The report points out that this does not mean that HIV or hepatitis C outbreaks are inevitable in these counties, or that there is a current problem with intravenous drug users in these counties, but says that intravenous drug users in these counties are at a higher risk.

One way to slow down the spread of HIV and hepatitis C is through needle exchanges, where intravenous drug users trade dirty needles for clean ones. Needle exchanges were authorized in Kentucky under a 2015 anti-heroin law but also require local approval.

So far, only Louisville and Lexington and the counties of Boyd, Carter, Clark, Elliott, Franklin, Grant, Harrison, Jessamine, Kenton, Knox, Pendleton and Pike are either operating or have approved such programs. Of the 54 high-risk counties, only Boyd, Carter, Clark, Knox and Pike counties have operating needle exchanges.

There have been conversations among officials about a needle exchange program in Mason County, Adams said. Beginning  a program would require the cooperation and approval of both Mason County Fiscal Court and Maysville City Commission, she said.

"It is a work in progress," she said.

The rewards of such a program are two-fold, Adams said: It would reduce the incidence of blood-borne diseases like HIV and hepatitis C by helping to stop the spread of the diseases and thus reduce the long-term costs of health care. In addition it removes a public health risk by lessening the likelihood of used needles being discarded along roadways and in public parks or becoming a danger to law enforcement, she said.

Hogan said, "The Kentucky Department for Public Health is working closely with (the) CDC and at-risk communities to increase HIV and hepatitis C testing, and is assisting counties in their processes of establishing syringe exchange programs."

Lewis County has considered the option and elected not to offer a needle exchange, Bertram said.

"We want to concentrate on awareness and education," she said. 

Bertram said she and lead nurse Katie Branam are available to speak to organizations and would welcome the opportunity to address residents about the issue.

Currently both Buffalo Trace Area Health Department and the Lewis County Health Department offer a number of programs for those who may be infected or are at risk of HIV or hepatitis C, such as education and testing.

A complete list of Kentucky counties included in the risk can be found at 

Melissa Patrick of Kentucky Health News contributed to this story.